Video

Transcript

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