Dr. Berg Interviews Low Carb Cardiologist Dr. Bret Scher
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hey guys welcome back I have another special guest today we have a pretty top-notch cardiologist dr. Brent share so welcome thanks for being on thank you Eric it’s a pleasure to be here so you’re you’re actually practicing San Diego I used to live in San Diego I used to practice there for about three years I was right next to this stadium there the I guess the stadium and your your your body where the Jets fly ball right right so we may hear some today you know I have a couple different offices ones in the Kearny Mesa area I do a lot of online health consulting now which from my home which is my home where I am now which does sometimes get in the way of the Miramar Jets it seems like but you know that’s the price of freedom the sound of freedom as they say that’s right yeah well I’m really glad that I had a chance to chat with you simply because I mean you’re you’re like a board-certified cardiologist and there’s been uh some concerns about cholesterol we’re going to talk about that today and you’re also going to be speaking at our summit which I’m excited about as well yeah so it’s it’s rare to find a cardiologist that is that keto friendly low carb tell me when you first got out of practice did you like 20 years ago I think right yeah I’ve been practicing as a cardiologist now for 15 years and of course it was about 14 years before that of college and med school residency and fellowship all that fun stuff t to become a cardiologist so it’s been a while now yeah that’s a lot of work so coming out did you have did you have the mindset of just low carb well you’ve just pretty much conventional you know we’re going to just do things according to the American Heart Association absolutely American Heart Association knows all that’s that’s how I came out and actually my fellowship was actually in a preventive cardiology fellowship it was a combined general and preventive fellowship and we were in Ornish style program I mean we’re a very low-fat high-carb kind of program and you know the things that we were teaching people for exercise and stress management and community involvement those are crucial and I’m so thankful for the lessons I learned there but lessons I learned from nutrition maybe not so much and you know in retrospect it’s it should have been a red flag seeing how many people are struggling to maintain that type of eating and how many people were having cravings and we’re just longing for the days where they could cheat do something different and you know it just it wasn’t a very sustainable method for the majority of people now what happens is some people will thrive and some people will do great and when you’re going from a standard American diet to that type of diet of course there’s going to be a subset that feel fantastic and most people are gonna have some improvements but the question then becomes what’s gonna happen for the next ten years what’s gonna happen for the next 20 years because I’ve been let’s be honest I don’t care what you do for the next couple weeks the next couple months I care what’s gonna happen for the rest of your life and that’s that was the impact that I saw I wasn’t having you know the impact on people that they can make some immediate changes but they were coming right back having quote failed lifestyle intervention and that’s a term I’ve grown to hate because it it implies that we’ve tried everything that we’ve tried every possible lifestyle we tried the only possible lifestyle and they failed that lifestyle and and that’s when I started to have this little bit of awakening to say you know what maybe we’re not doing the right thing maybe our message is wrong and it’s not actually millions of people as false maybe it’s actually our fault and that’s how hard a weakening to have you know as I’m sure you can imagine to say everything I’ve been taught everything I’ve been practicing is actually wrong that’s kind of a tough thing to come to grips with that’s the big pill to swallow yeah absolutely so you so you eventually use you just stumbled on low-carb and tell me a little bit about like you yeah I did just stumble on it so it was sort of this major transformation time in my life you know the other thing I realized was I didn’t spend 14 years learning to become a cardiologist so I could you know plug your information into some calculator and have it spit out whether to give you a medication like that that’s not the impact I wanted to have on and I was seeing that I wasn’t affecting people as I had hoped when I came out of my fellowship and I was bright-eyed and bushy-tailed and thought I was gonna save the world of heart disease you know the reality was far from that so I actually that’s when I started boundless health and that’s when I started up a health coaching program with a friend of mine and we were working out of the basement of this gym and he’s an amazing trainer and health coach and on some of our you know more challenging clients he’d say hey you should try a ketogenic diet on this guy and I looked at him I said I’m a cardiologist I don’t want to kill the guy I want to I want to help the guy like what are you crazy and he looked right back I mean he says so have you looked into it you know the data behind it and I had to be honest with him I said actually no I haven’t specifically looked into it and that started this journey I started to read one thing and another thing and another thing and then my eyes got a little bigger and a little bigger and the world opened up and all of a sudden I realized wow there there really is this whole other world out there that has been just demonized by the medical community and not talked about by the medical community and for no good reason and then once I learned about it and then one started started implementing it with a client’s along with the health coach Dustin I mean then all of a sudden it was there’s no turning back I mean once you see the way you can impact people and see improvements in their blood work see improvement in their body composition and how they feel and then how their training and exercising and just being able to really transform their lives with a tool that’s never been taught before really I used to read never you know in mainstream practice so yeah that was a major awakening for me I mean you’re right at the cusp of where most the damage occurs in the artery in the coronary artery we hate high insulin so right so here you are you’re you you do surgery still or yeah so I do the angiograms where we put the catheters in the arteries feed them up through the heart inject the dye so we can see the arteries and see where they’re blocked then if a stent is needed I’ll call one of my colleagues and to come put the stent in but you know the way I look at it every time I’m in the cath lab every time I put on the lead and put on the sterile gear and end up in the it’s because we failed somewhere really I mean that’s what it comes down to because all of this I guess not all of this but 85 to 90 percent of what I see is preventable so by the time I see people in the cath lab you know I needed to see them 10 or 15 years earlier and that’s why you know I’m I still have my traditional cardiology medical practice but where I really get the most joy and the most satisfaction to see people as an online health coach right I sort of say take off my doctor hat now I put on my health coaching hat let’s talk about your lifestyle let’s talk about your stress management let’s talk about your nutrition let’s spend an hour and a half talking about this rather than your 20-minute office visit you know going over your prescriptions let’s see how this fits into your whole health and lifestyle and your whole life really I mean and that’s what everybody should be getting but our medical system is not geared up to provide that you must be honest it’s now like when you’re like right now you have a chance when you’re duping someone or or evaluating someone do you have a chance to get with them to consult them on the diet or are they open to it or yeah that’s a great question I mean I can’t I can’t stop talking about it so the biggest questions is are they going to be open to it and and part of it is the situation right when you’re look if someone comes in with a heart attack and someone ends up with a stent and they’re gonna have five new medications and their life has just been turned upside down on the one hand that’s a great time to talk about it because they’ve got the sort of scare factor on the other hand it’s a terrible time to talk about it because so many things are transitioning and you know may not be the right time for the jump in do it so it’s really part of it is sort of reading the person to see when is the right time to discuss this but at some point they’re gonna hear it from me tonight and I can only hope that they’re gonna internalize it and I guess the flip side of that too is saying like finding the right approach for each person cuz there’s not one diet there’s not one exercise program there’s not one way to manage your stress right there there are multitude out there and some are going to work better than others for each individual but the key is to make them all an option what really bothers me is that we say there’s one diet for people there’s one exercise program for people and that’s sort of what contemporary medicine says and I think that’s so just limiting and so short-sighted and foolish of us and and that’s really why cardiovascular disease continues to be the number one cause of death and has continued to be that way for decades it’s not like this is a brand new thing it’s been that way for decades and we haven’t had the impact that we really need to have to prevent cardiovascular disease and to help people live longer happier better lives totally what would you’ve had probably people do Kido talk about what happens if their their cholesterol starts going higher they might be concerned oh my gosh is this the right thing I’m eating all this fat let’s talk about that yeah yeah that’s a great point so the first thing the first caveat is to say when you look at the literature and you look at the studies that have been done and in my clinical practice the majority of people who go on Kido Kido do not get in a markedly elevated LDL so that’s the first thing because because all you have to here is a couple case examples see a couple cases on the Internet to think oh my god everybody who goes keto is gonna have an LDL particle number of 3,000 no it doesn’t work that way and all you have to do is look at the majority of the studies have been done that show either no change in April lipoprotein B or a small change in LDL C but the majority don’t see this dramatic rise so basically just because people are gonna listen and go what does that mean a pony brains talking about these little boats that are carrying the cholesterol through the body they’re transport units and they’re dumping off different cargo at different places and there are the EPO is that because a little kind of like the the driver of that it’s the tells it what to do instructs it it’s like the cheek you know the ship so you’ve got your LDL lipoprotein and that’s your carrier molecule that has the LDL cholesterol inside on the surface of that lipoprotein is called an April lipoprotein B and that’s sort of by definition every LDL boat every LDL lipoprotein has one of those people B’s so people tend to use an interchange the LDL particle number or Abel B you can sort of use interchangeably to talk about the number of these boats floating around and then the LDL cholesterol is the amount of cholesterol inside all of those boats okay and traditionally we use LDL cholesterol as the end-all-be-all measure but really it is a far inferior measure to able B or o the lipoprotein particle number so the words get big it gets a little confusing but the number of particles are more important than the amount total amount of cholesterol okay so and for the most part most people don’t get a dramatic rise so that’s the first understanding with a low-carb akido diet now those that do the question becomes what does it mean and that is a very muddy waters indeed because there’s this teaching from that have been passed down for decades that any elevated LDL is dangerous regardless of the circumstance but the problem is any of those studies that have been done to date not a single one is focused on people who are following a low carb lifestyle who are burning fat for fuel and who are improving all these other markers of insulin resistance and diabetes and inflammation and metabolic health and all those improving while you’re using fat for fuel none of those people have been included in any of those studies okay and oh by the way those studies show a Moose’s you know sort of a weakest Association it’s definitely an association but is not that everybody with a high LDL is automatically getting a heart attack right there they’re people live to point out how many paradoxes there are there are tons of paradoxes tons of examples of populations with high LDL s and yet thrive and do well so there are plenty of reasons to say there are subsets of people who do just fine with elevated LDL so could the low-carb enthusiast the keto diet follower could that person be one of them we don’t have the evidence to say that for sure but gosh their shares a lot of reason to say it might be the case so it’s a really confusing situation because most people are going to go to their doctor and if they have a high LDL either outcomes of statin prescription or the doctor says you’re killing yourself with this diet you have to stop ignoring the fact that they feel better than they’ve lost the weight they have more energy and they’ve reversed their metabolic disease and all that right you’re with one markers off so you’re killing yourself so instead you really have to take a step back and see things from a much broader perspective and say okay why are you doing this what improvements are you seeing when is the what negatives I guess you could you could say or have you seen which is using just the LDL and then what does that mean for your overall picture and that’s when you have to dig deeper whether it’s calcium scores whether it’s carotid intima-media thickness testing whether it’s looking at the size and density of the LDL and the LDL pattern and your inflammatory markers if there’s god there has to be a deeper evaluation I think personally than just the reflex you have to get off your diet or you have to take a statin because this is a very special subset population and and again that’s why I really enjoy working with people as a health coach online because you can take the time to go through all this right you can yeah I’m just gonna say that I want to chime in because I think it’s not a simple answer it’s there’s some muddiness that you have to understand some basic physiology to really get the truth on it because you can’t even take one little indicator LDL and you have to look at other things as well and if you’re dying you’re stay on the far side than the size of the particle so that’s that’s so true and and I know there’s people watching right now and I’m just going to tell people I’m gonna put a link down below to your website so I’m sure there’s gonna be a lot of people that want to consult with you so they can get more information with the link down below because they’re gonna probably want to you know pick your brain so I’m dirty so I want to just shift gears to calcium in the Artemis coronary artery calcium there’s a test let’s tell us a little bit about what that is and how that would compare to maybe other indicators for risk for heart disease yeah it’s a great question so coronary artery calcium score is a very simple CT scan a cat scan takes about 10 seconds no contrast no ID a low radiation dose generally people say it’s about the same as a mammogram you know very low radiation dose in terms of CT scans because there are plenty of other higher radiation doses a relatively low radiation dose and it can tell you if you have calcium in the walls of your artery so it does not tell you if you have plaque or build up in the middle of your arteries if you look at my hand here if the middle is where the blood is flowing and the fingers the outside of the fingers here is the wall of the artery that’s where the calcium can get deposited and what it tells you though is that there has been vascular injury there’s been some type of a scalar injury and a body’s response to it which is laid down the calcium you can get a score from zero up to you know thousands I’ve seen but they generally break it down as zeros obviously great it means you’ve had none of that vascular injury in the calcium deposition zero to 100 as being sort of a mild 100 to 400 is being moderate are greater than 400 be severe those are very loose definitions and age plays a big role in that because there’s obviously there’s also an age percentile score that you get because the score of 20 and a 40 year old is very different than the score of 20 in a 75 year old because it means completely different about the the speed and the likelihood that you can develop injury okay so what studies have shown is that the higher the degree of calcium the higher the risk of having a cardiovascular event and it tends to track them better than LDL cholesterol as a solitary marker it tends to charge better for a one time test than the carotid intima-media thickness test is it it’s a very good test to get it’s so good in fact that the latest cholesterol guidelines by the ACC and the ETA finally recognized it as a test that should be done in the majority of intermediate risk patients to help better identify whether they are a candidate for a drug is basically how the guidelines think about it I would think about a little bit differently but it’s the first time they’ve come out and said look with the calcium score of zero you’re probably not going to benefit drug so statin prescription would not be in to get in that case which is for you know an aaj ACC type of guideline that cardiology Association guidelines to say that is is revolutionary really so that shows how powerful this test can be but it’s so huge yeah I I recommend it to patients is because I said it’s a it’s a quick test it’s not expensive and it can give you a lot of data because if your score is like over a thousand you better change it’s time to change your diet right because it’s time to change something it’s probably time to change a lot of things right one of the hard things is though there’s no time stamp on it right so you can have somebody who’s been leading a standard American diet insulin resistant for 20 years and then they decide to go low-carb and improve their lifestyle and start exercising and six months later they get a high calcium score there’s no time stamp on that calcium score it doesn’t tell you when it came up so it could have been that it had been you know a lot of people would say oh it’s because you’re low carb now if you have this I calcium but actually it was probably that 20 years of standard American living that caused it so that’s why some people recommend if you’re going to go low-carb before going to drastically change your lifestyle get a calcium score so you timestamp it you have a time zero and no moving forward you can retest it again in three or five years or something like that to see if there’s a change because otherwise there’s no time stamp yeah so basically you can’t really evaluate something unless you have two numbers you have to go is it getting better or is it getting worse so that’ll tell you trends you know um great point do you happen to like like your cardiologist friends and things your associate associate doctors that you you know work with or do they are they open to it is it because it changing what’s happening in that area yeah I wish I could say it was changing and they’re open to it the vast majority are not no question about it because you know we’ve been taught that is bad we’ve been taught ldlc is everything and when you’ve been taught something for 10 15 20 30 40 years and you’ve told thousands of patients that it is hard to have that rehearsal so a lot of people are not open to it and you know in fairness some people would say look when you show me when you show me people living this way for 20 years are doing great not having heart attacks okay I’ll jump on board at that point but you know that data is hard to come by and the data we have to this point when you actually analyze the quality of the data for low fat diets when you analyze the quality of data for cardiovascular outcomes it’s really poor but if it’s all you have and you want to be you know and you want to practice according to the data then that’s all you have but I think it’s so much more important to say what is the quality and does it actually backup the recommendations and that’s where these recommendations are to really break down Wow interesting as far as like arrhythmia it’s atrial fib things like that do you work with those clients as well absolutely all the time do you ever have you ever done any type of your own research in doing more electrolytes more minerals for these since the minerals are associated with the pacemaker and the nerve conduction of the vagus nerve all that’s a touch on that a little bit yeah so so one thing I see very frequently is just palpitations or the general sensation of palpitations people getting PVCs premature ventricular contractions come in from the bottom part of the heart or PA sees premature atrial contractions coming from the top part of the heart and those can be brought on by caffeine and alcohol and stress and like asleep and other stimulants but they can also be brought on by some electrode abnormalities and frequently we are not good at testing for electrolyte abnormalities because we can just the potassium and magnesium in your and the calcium in your blood but we can’t test it the cells as well so that’s where you could have a deficiency and it couldn’t it may not show up and the way our food is you know farmed we our vegetables get to us and our soil it’s we just all are probably walking around a little bit magnesium deficient so that’s one of the first steps I always have is a magnesium replacement whether it’s a pill or whether it’s an Epsom salt bath or some way to get more magnesium into your system and a lot of people find benefit with that phrase palpitations other arrhythmias like a fib atrial fibrillation or SVT super ventricular tachycardias those a little more serious because those aren’t just a nuisance of a feeling but those actually have other health concerns and repercussions down the road so even more so I will reply make sure their electrolytes are replenished for those situations and also interestingly how lifestyle plays into this I mean the risk factors for afib or being overweight having high blood pressure not exercising and having a high sugar high carb diet can play into all that and so that’s why when people ask me does a low carb diet treat atrial fibrillation well I I can’t say that it specifically treats the the electricity imbalance I guess for the electricity short-circuit but what it does do is it treats every single one of the risk factors for an e-fit and therefore it can certainly make it less likely to happen I mean I may need to think about it magnesium where do you get magnesium well leafy greens and I mean it’s part of a you need some you need some vegetables and people don’t consume a lot of those but on top of that you have insulin resistance which which just for the Faculty of insulin resistance the majority population you’re not going to be able to absorb the amount of magnesium or potassium you once did so I think just my own viewpoint this is my guess I think it’s partly not consuming the right foods but partly the insulin resistance even if you do consume and it’s not going in like it should so you have to do more next up yeah interesting point yeah what about dumb he have you ever run into a situation where you assess someone with angina and their arteries are clear sure yeah yeah so there’s this condition called syndrome X or micro vascular disease it’s got a number of different names where sometimes then the main arteries look clear but the very distal arteries that you can’t see very well could have a plaque buildup or even the arteries could be spasming and that those can both cause angina so you know the treatment cardiologists tend to lose interest then because the treatment is no longer stents is no longer these cool procedures we have to open up arteries but treatment then is focusing on lifestyle maybe some medications maybe stress management maybe electrolyte replacement you know it’s now it’s getting a little more detailed in actually more challenging than just going in and putting it in the stent so so there’s a lot more involved from that standpoint but it’s something that happens quite frequently yeah Wow and then from your experience your you have a chance to you know try different diets and you’re obviously right now you’re you just basically stumbled or research and found low-carb is really effective for your clients what from a cardiovascular standpoint are you just finding like they’re responding way better than the other diets I mean I just want to kind of just get you touched on it but I just wanted to know what type of effects are you finding when you’re coaching these people that had I’m sure that you probably do most people you’re coaching if cardiovascular issues I’m guessing and then you coach them you change their diet and then you see changes yeah so there’s actually a mix of people I’m coaching a number are prevention they say I just don’t want to develop cardiovascular disease or I have but I have high blood pressure or high cholesterol or something and I don’t want to develop the cardiovascular disease or I just want to be healthier so I have that’s upset and then I definitely have the subset of people with cardiovascular disease already and you know it’s interesting and this is one of the challenges when you say how are they improving how how is our cardiovascular disease improving well that’s a tough metric and that’s something really hard to measure because you’re not going to do angiograms on these people on a regular basis because it’s got risks invasive you could do CT scans but if you’re not gonna really see progression of plaque to a substantial amount even these studies in the past that say you know vegan diets have shown your regression effect it’s an inconsequential change and in the plaque volume that really by today’s standards would not be something of real interest so it’s gotta be hard to show regression and that’s where I like this test the carotid into Media things see int it’s a specialized ultrasound of your carotid artery that measures the thickness of the wall essentially of that artery it’s been knocked down a little bit as a test because when you compare it head-to-head with a calcium score the calcium score has much better predictive value but where I think the CI MT has its value is following it over time whatever your initial value is okay you don’t have to react too strongly at that value but what happens over the next six months to two years is it thickening or is it actually thinning and regressing and you can see these dynamic changes much more clearly so that’s one marker you can use and I have seen some impressive results in a number of patients when they go Lokar I’ve not seen severe progression in almost anybody most people probably stay the same but then you look at all the other risk factors in the market what’s their blood pressure what’s their waist circumference what’s their metabolic health from an insulin and glucose standpoint whether they’re inflammatory markers doing in granted these do not guarantee that their cardiovascular disease and their vessels are improving but these are the best markers and predictors we have to say what kind of impact are you having on your overall health and as I’m sure you know is a low carb diet the majority of those improve oh yeah absolutely you know Dave Feldman right of course he’s great so Dave Dave talks about he’s like a human guinea pig and he he went off the keto plan okay for six weeks I think it was and he showed before and after his art is I think I guess his arteries and his the coronary another core the carotid thickened did you ever hear that story yes see IMT went up significantly when he went on his sort of hook high carb standard American style diet not scary it was scary to see yeah no quick I mean like this is what happens right someone does keto and run around Thanksgiving they go off keto until New Year’s right so they’re just going to go off a bit and you don’t realize what’s happening you’re just clogging your arteries or these thickening your arteries and obstructing blood flow to your brain right right so important to differentiate that does not mean a plaque right clogged in the artery but that is an early sign of vascular disease vascular damage and the natural progression is down the road to develop another especially since you’re setting yourself up for inflammation internally in that from an information you have all this healing this patching effect of all the other things that can then create the the plaque right right exactly and that’s you know and that’s why the people who I work with I I counsel them saying look we don’t have 20-year data to say this diet is going to reverse your arterial disease but what we have for all these tests that we can measure to show that they are improving or if someone comes to me with an LDL of 250 and says my doctor says this is killing me and I say look there is another perspective here the other perspective is we measure all these other tests and follow them to see if we have any sign of progression or worsening of vascular disease if we do okay then we better react to that pretty seriously if we don’t then we continue to have this conversation of well what kind of evidence we have that this is helping what kind of evidence we have that is hurting because it’s the overall health and life of people that were concerned about not a specific number exactly well I’m really excited to have you come out and share some more in-depth information at our summit last last year we had a 500 we’re gonna have a thousand people Wow you’re gonna be actually shocked just to the quality of these people’s like it’s so there’s such an incredible group of wonderful people that are actually the watching right now and so we’re gonna make it mandatory that everyone watching has to come out well I can meet you in person and have a great time but I think what you bring to the table is like you have experience you’re in the trenches you basically you’re dealing with the number one thing that’s you know people die up so I think it’s going to be very valuable so how do you share your data so I appreciate you know you spending time in your busy schedule now just just it did this interview but it will definitely do some more as well great I appreciate the opportunity I really look forward to that conference later this year thank you if you wouldn’t mind to give me a thumbs up and like this video I’d really appreciate it
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Dr. Berg interviews a special guest, Dr. Bret Scher, he is a cardiologist practicing in San Diego.
Dr. Eric Berg DC Bio:
Dr. Berg, 53 years of age is a chiropractor who specializes in Healthy Ketosis & Intermittent Fasting. He is the author of The New Body Type Guide and other books published by KB Publishing. He has taught students nutrition as an adjunct professor at Howard University. He no longer practices, but focuses on health education through social media.
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Dr. Eric Berg received his Doctor of Chiropractic degree from Palmer College of Chiropractic in 1988. His use of “doctor” or “Dr.” in relation to himself solely refers to that degree. Dr. Berg is a licensed chiropractor in Virginia, California, and Louisiana, but he no longer practices chiropractic in any state and does not see patients so he can focus on educating people as a full time activity, yet he maintains an active license. This video is for general informational purposes only. It should not be used to self-diagnose and it is not a substitute for a medical exam, cure, treatment, diagnosis, and prescription or recommendation. It does not create a doctor-patient relationship between Dr. Berg and you. You should not make any change in your health regimen or diet before first consulting a physician and obtaining a medical exam, diagnosis, and recommendation. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition. The Health & Wellness, Dr. Berg Nutritionals and Dr. Eric Berg, D.C. are not liable or responsible for any advice, course of treatment, diagnosis or any other information, services or product you obtain through this video or site.
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