So You Think Keto is Extreme? Hold My Beer!

Two weeks ago I went to my first appointment with a new primary care physician and she said that while my bloodwork looked pretty darn good, she thought my sugars were still a little higher than she’d like to see. For crying out loud, I’ve been eating like a champ and my other numbers are, frankly, enviable. Total cholesterol 108. LDLs 59. HDLs 41. Triglycerides 94.

But my glucose was at 106, a touch higher than the recommended 99. And then there’s my LP-IR Score of 56. Any doctors out there agree that glucose of 106 and LP-IR of 56 is a concern?

Then my new doctor said something that surprised me. “You should consider intermittent fasting,” she exclaimed.

Wait, what? Don’t eat? But…but…but.

She explained to me that there was a lot of research out there that intermittent fasting (IF) was the best way to lower insulin resistance and that many people found it easy to integrate into their diets. She suggested I try IF 4–5 days per week and after a while, we could recheck my insulin numbers. She also jotted down the name of a Canadian doctor who has written a few books about the subject, Dr. Jason Fung, and sent me on my way.

I’ll be honest, I’m a connoisseur of popular diets and eating styles but I’d never heard of IF. So I went home and searched the interwebs for details, and before long I was fully down the rabbit hole. Holy moly there is a whole subculture of people who don’t eat for long periods of time in the name of good health.

I watched a few interviews with Dr. Fung and I was really struck by the science. I downloaded one of his books, The Complete Guide to Fasting: Heal Your Body Through Intermittent, Alternate-Day, and Extended, and read it over the course of a few days. I went from thinking the idea was crazy, to deciding to try it out.

Fasting has been around for thousands of years, and for our ancestor’s fasting was simply a matter of the difficulty of sourcing food. Our paleo brethren often went long periods without eating and I suspect there weren’t too many cavemen with type 2 diabetes. Fasting has long been used in religious worship across multiple belief systems. Hell, when you think about it we all fast daily — we don’t eat while we sleep. Intermittent fasting is just increasing the time you already don’t eat. I decided to use the 16/8 method of fasting, where you don’t eat after dinner and then skip breakfast before breaking the fast at lunch. What that looks like for me is that I don’t eat from 7 p.m. to 11 a.m. (water, tea, and coffee are fine).

Without going into too much scientific detail, IF is about insulin. When you eat, your insulin increases. When you don’t eat, it doesn’t. If your insulin is always elevated because you eat all day, and/or eat too much sugar and carbs, your insulin remains elevated and your body reacts by pumping sugar into your bloodstream. When you are fasting your metabolism increases. The bottom line is your body burns off sugar to provide energy, and when it runs out of sugar it burns stored fat.

There’s a nice explanation of the benefits of IF at Healthline. There’s tons of information all over the web so if you want to learn more just Google it.

I’ve been doing IF for almost three weeks now. Truthfully, it’s not difficult. I just don’t eat after dinner and then skip breakfast. I start eating again around 11 a.m. and between lunch and dinner, I try not to snack too much. Of course, when I do eat I eat a low carb, low added sugar diet. I call it a modified Mediterranean Diet or Pegan (which I’ve written about before).

I won’t know if IF has lowered my insulin levels until I get them checked again in a few months, but I can tell you I have lost weight. Belly weight. My midsection is definitely tighter and my pants are looser. I mean, it’s not rocket science. I’ve been eating less. Is that a crazy idea? I don’t think it is.

So It’s the Kind of Protein in Red Meat, not the Saturated Fat that Kills us?

steakI have been thinking about reintroducing red meat into my diet after a decade or so of avoiding the stuff. In the ongoing saga that is my diet, I feel like I’ve finally settled into some themes about how to eat healthy — I call how I eat a modified Mediterranean diet but it has also been called Pegan. Basically, I’m all in on eliminating all processed carbs like bread as well as all added sugars while increasing my intake of healthy fats from sources like avocado and nuts/seeds. As for meat, I’ve been sticking with fish, chicken and turkey. We have the meats!

The more I eat this way, the better I feel and the better my blood test results. My triglycerides are very low (under 100 at last check) and my LDL cholesterol is well below the 70 mark recommended for heart disease patients. The “experts” I’ve been following such as Dr. Mark HymanDr. Stephen Sinatra, and Gary Taubes to name a few all suggest sugar, not fat, is the demon that causes heart disease and frankly the data is compelling. The common theme among these low carb/high fat evangelists is that red meat (and the saturated fat that comes with it) is fine.

There are good scientific and health-minded reasons to eat high-quality, organic, grass-fed, sustainably raised meat as part of an overall healthy diet. — Dr. Mark Hyman

Yes, everyone agrees plants are better for you and that they should make up the largest part of your diet, but if saturated fat isn’t bad then grass-fed red meat should be back on the plate in modest portions.

Not so fast.

new study found that eating meat regularly is associated with a 60 percent increase in the risk of heart disease, while plant-based proteins have been found to benefit the organ.

But the study doesn’t point to saturated fat as the culprit, rather it suggests there’s something troubling about the protein in meat versus the protein in plants, nuts and seeds.

“Our results suggest that healthy choices can be advocated based on protein sources, specifically preferring diets low in meat intake and with a higher intake of plant proteins from nuts and seeds,” the authors said.

This research doesn’t vindicate the anti-meat people because the argument against meat has long been about saturated fat. If true, and protein is the issue, then they have been right all along but not for the reasons they believe.

The saturated fat debate is far from over. Both sides make compelling arguments based on real research. Personally, I’m not willing to risk it by introducing saturated fat to my diet when I haven’t been eating it for years. No butter, no red meat, no coconut oil.

But I was, as I mentioned above, considering adding back in a little grass-fed beef to mix things up. Hey, I haven’t had a good burger since the George W. Bush administration.

Thanks for nothing Loma Linda University School of Public Health, AgroParisTech, and the Institut National de la Recherche Agronomique!

If You Eat at McDonald’s, You’re Not Even Trying

ZoesQuinoaSaladYesterday at lunchtime I was sitting on the patio of my favorite fast casual Mediterranean restaurant enjoying a quinoa salad (no feta) with a little grilled chicken and a Greek-style dressing. It’s my go-to lunch and it’s delicious, filling, and healthy.

As it happens, the patio at this particular Zoe’s Kitchen is adjacent to a McDonald’s drive through. As I sat there soaking in this gorgeous Phoenix afternoon, I watched as car after car came through the drive through picking up their Big Macs, fries and sodas. The line never slowed during the 30 minutes or so I sat there eating my salad.

I know it’s not politically correct to fat shame people, but maybe it’s time we held some people accountable for their lifestyle choices when it comes to food. It wasn’t lost on me as I sat there that just a few days earlier the headlines across America announced that American adults are getting fatter. Here’s an excerpt:

New data shows that nearly 40 percent of them were obese in 2015 and 2016, a sharp increase from a decade earlier, federal health officials reported Friday. — New York Times

40 percent of American adults are now obese. Let that sink in for a second. More than one in three of us! How can this be the case given everything we now know about diet and health? What kind of person says to themselves it’s lunchtime, I think I’ll go to McDonald’s for a Quarter Pounder with Cheese and a shake?

There’s no logical reason for a grown adult to eat at McDonald’s. I realize there are some extenuating circumstances that have led us to become among the fattest people in the history of the world. Yes, food is addictive. Yes, some people have low metabolism and are susceptible to gaining weight. Yes, there are socioeconomic determinants of health.

But W-T-F America, stay the hell out of McDonald’s. There are so many better choices, several right there in the same shopping center. Time is not an excuse — you can get in and out of a fast casual restaurant like Zoe’s with a to-go order in 10 minutes.

I guess it bothered me so much because I’m trying so friggin’ hard to stay healthy. I have never had a weight problem, and I never smoked, yet I had a heart attack at 45. I try to limit the pity parties in my head, but when I see people eating at McDonald’s I get angry. The same thing happens to me when I see a morbidly obese person. I know it’s not right, but when I see huge people I think to myself how is it possible I had a heart attack and they haven’t?

I also get pissed when the local baseball team promotes their newest “food” item and they seem so proud of themselves for offering fans a Funnel Cake Chicken Sandwich or a Churro Dog, which is a cinnamon churro inside a chocolate-glazed doughnut, topped with frozen yogurt, caramel, and chocolate sauce. A few years back they offered a $25 18-inch cheese filled corn dog that came in at a whopping 3,000 calories. That’s 500 more calories than a healthy man is supposed to eat in a day. And I’d go to the games and see otherwise normal looking people eating this disgusting display.

I’m not suggesting you don’t binge once in while. Have a dog and a beer at the ballpark. But for fuck’s sake don’t eat a deep fried chicken sandwich with funnel cake in place of bread. Have some restraint.

The New York Times story about obesity immediately brought to mind the Pixar film Wall-e in which the human race has gotten so fat they can’t walk anymore so they ride around in movable chairs and the food comes to them. They drink cupcakes in a cup (coming soon to a Diamondbacks game near you no doubt). I thought this film was supposed to represent a dystopia, not a glimpse into the not-too-distant future.

Am I bitter? Yes. Yes, I am. Maybe you’re thinking to yourself Len, chillax, have a Double Double once in a while, it won’t kill you. Easy for you to say — you probably don’t have three stents holding open your left anterior descending artery.

But beyond bitterness, I’m flabbergasted. I honestly can’t understand what would make someone walk into a McDonald’s. And don’t give me the “McDonald’s has healthy options” diatribe. I call B.S. on that. The fruit and yogurt parfait has 22 grams of sugar. The Low-Fat Sesame Ginger Dressing has 9 grams of sugar and 400 mg of sodium. And seriously, who eats a salad at McDonald’s? Maybe as a side dish for your Sweet BBQ Bacon with Buttermilk Crispy Chicken sandwich (1,760 mg of sodium, 18 grams of sugar, and 79 grams of carbs). Don’t forget your large Dr. Pepper (73 grams of sugar).

Why are 40% of Americans obese, according to the New York Times article?

While the latest survey data doesn’t explain why Americans continue to get heavier, nutritionists and other experts cite lifestyle, genetics, and, most importantly, a poor diet as factors. Fast food sales in the United States rose 22.7 percent from 2012 to 2017, according to Euromonitor, while packaged food sales rose 8.8 percent.

To paraphrase political pundit James Carville — It’s the food, stupid!

My Love/Hate Relationship With Breakfast

Today is National Cereal Day, and it comes at a time when I have been having a crisis of confidence regarding my breakfast choices. I’m not talking about whether to eat Lucky Charms or Cheerios (you might as well be pouring your milk over a bowl of cookies), rather my Sophie’s Choice involves grain in general. Because the more I look into it, even oatmeal or whole grain toast spikes your blood sugar which leads to diabetes and heart disease. Sorry Wilford Brimley, but oatmeal is actually NOT the right thing to do.

For years I’ve been eating plain steel cut oats with some berries or a banana and some sliced almonds for breakfast thinking this was a smart choice. It turns out this has been a better choice than cereal, pancakes or waffles but still inflammatory and a bad way to start the day.

“The major problem with oatmeal is the same problem with every other grain: It spikes your blood sugar and makes you hungrier.” — Dr. Mark Hyman, author of Food: What the Heck Should I Eat?

So if cereal is bad, and oatmeal is bad, what the heck should I eat for breakfast? That, my friends, is the question of the day.

In America, breakfast has really just become an excuse to pour sugar down your gullet. Breakfast has always been my favorite meal of the day. But as I’ve gotten older, and after having a heart attack, I’ve been obsessed with food and nutrition. I’ve talked to my doctors, read all the studies and looked into all the diets (Mediterranean, paleo, Engine 2, juicing, etc.) All the “expert advice” on the Interwebs is enough to drive you to drink. The web is a cacophony of conflicting advice. Who are we supposed to trust?

I’ve written about this before, but the best person to trust is yourself. My blood work has improved tremendously as I’ve eliminated grains and added sugar. My weight is down as well, though I’ve always been relatively thin by American standards. Late last year, six years post heart attack, I had another coronary catheterization and my arteries are clear. Whatever I’m doing seems to be working. So why change anything?

The biggest improvement in my blood work came after I started reading the advice of Dr. Mark Hyman. Yes, I’m skeptical of any “celebrity” doctor and I certainly don’t agree with everything he says — but he always links to research and that research is peer-reviewed and published in legitimate journals. When I started incorporating his paleo-vegan or “pegan” style of eating into my life, that’s when my blood work went from good to great.

After a year or so of eating a mostly pegan diet (I admit I didn’t always follow the rules, morning oatmeal being a perfect example. A little too much beer being another.) I was feeling pretty good about myself.

So recently when my wife picked up his new book Food: What the Heck Should I Eat?, I opened it first and started to read. And it reinforced what I’d been doing. And then starting on Sunday I doubled down on eating pegan. But then I woke up on Monday morning and with oatmeal off the table as it were I had no idea what to eat for breakfast! So I scrambled a couple of eggs with onions, avocado, and tomatoes using avocado oil in the pan and ate it with a serving of fresh blueberries. Then on Tuesday morning I fried a couple of eggs and ate them over a bed of sauteed spinach. And then this morning I woke up and couldn’t imagine eating eggs once again so I turned to the web to see what Dr. Hyman has for breakfast and basically it boils down to some kind of eggs with veggies or a smoothie.

So I poured some almond milk into the blender, added a half cup of frozen berries and a half cup of frozen mango, a tablespoon of ground flax seeds, two tablespoons of almond butter, half an avocado, and a tablespoon of coconut oil. And it was tasty. And it filled me up (in fact, as I write this it has been four hours since I drank my smoothie and I have not been hungry at all).

Still, there has to be more than eggs and smoothies, so I’ll continue to research. But it isn’t lost on me that what I’ve been eating for breakfast the past few days flies in the face of conventional wisdom about breakfast in America.

After all the controversy last year about saturated fat and in particular coconut oil, I’ve done more research. I think the medical establishment is wrong on fat and Dr. Hyman has helped to convince me. But I’m not just taking his word for it, I’m looking at the studies and ultimately my own body.

I’ll be getting some new blood work done soon so I’ll report out the results. In the meantime, just say no to National Cereal Day today and every day.

The Best Post Heart Attack Diet and How it Can Also Prevent a First Heart Attack

I can say with no uncertainty that the fastest way to get into an argument with a bunch of heart attack survivors is to discuss diet. Seriously, you’re better off discussing politics or religion. I think the reason for this is quite simple — nobody really knows the best way to eat to prevent heart disease, the number one cause of death in the world.

Well, that’s not entirely true. I don’t think anyone would argue that a truly healthy diet is mostly focused on fruits (providing you are not diabetic) and vegetables. And while we can argue about the merits of measuring glycemic load vs glycemic index, or whether juicing fruit removes too many of its healthy properties, fruit is healthy for most people and it is part of a balanced diet.

But that’s where the agreement ends and zealotry begins. For every diet “expert” on the Internet that claims fat will kill you there are an equal number who tell you fat is our friend. Should we eat meat? Just white meat? Just fish? And what about carbs? Simple or complex? Gluten or gluten-free? And just what the hell is a FODMAP?

For each style of eating there’s a diet out there that helps you meet these typically strict requirements. U.S. News and World Report recently published its 2018 ranking of diets, and they looked at no less than 40 popular diets. Some you’ve likely heard about, like the Mediterranean Diet, Weight Watchers, and the Zone Diet. Others sound flat out made up, such as the Nutritarian Diet, the Volumetrics Diet, and the Flexitarian Diet. And of course there are the “hot new trend” diets like the Whole30 Diet, the Engine 2 Diet, and the suddenly everywhere Keto Diet.

But back to my fellow heart attack survivors. I run a support group for heart attack survivors on Facebook and whenever diet comes up the same thing happens — everyone chimes in that their diet is best and if you don’t eat this way you’ll die. And they usually point to legitimate studies to support their view. And that’s the real problem. Many of these diets will improve your overall health, but in some cases the diets themselves contradict each other.

For example, one popular diet among the heart attack crowd is the Esselstyn Diet, which purports to prevent and reverse heart disease. Holy crap, shouldn’t we all be on this diet? Dr. Esselstyn argues that a plant-based, oil-free diet can not only prevent and stop the progression of heart disease, but also reverse its effects. On his diet, you’ll also need to eliminate nuts/nut butters and saturated fat, but you can increase whole grains. Hot dog buns yes, hot dogs no? And beware of the vegan police!

Then there’s the Keto diet, which argues you can have all the meat you want, plenty of high fat dairy, nuts and other fats but stay away from grains, fruits and sugar. Lamb chops yes, apples no?

Which diet is right? Can they both be right? Well, that’s a tough question. Both diets will undoubtedly lead to weight loss, but I’m interested in heart disease prevention. Which is it, bread or no bread? Fat or no fat? Apples or no apples? Trying to figure this out is enough to cause a heart attack!

For what it’s worth, U.S. News and World Report ranked the Keto Diet 35th out of 40 for best heart-healthy diet and dead last in overall diets, for the most part because it’s hard to follow and the data is not in yet on this relatively new diet (although it sounds an awful lot like the old Atkins Diet to me).

U.S. News selected the DASH Diet tops overall and for heart health. This diet focuses on lowering blood pressure, emphasizes fruits, veggies, whole grains, lean protein and low-fat dairy, and suggests you avoid foods high in saturated fat such as fatty meats, full-fat dairy foods and tropical oils, and sugar-sweetened beverages and sweets. Hmmm. This sounds familiar — eat your fruits and veggies and lay off the fat and sugar. A little lean protein and dairy is okay.

Here’s my take — as long as the jury is still out scientifically on “fad” diets like Keto or ultra-specific diets like Essylstyn and its little brother the Engine 2 Diet, I’m going to stick to the basics. I try to eat a Mediterranean Diet, which has been proven to lower the risk for heart disease. It’s also easy to stick to and gives you flexibility. And it aligns nicely with the mantra espoused by writer and journalist Michael Pollan, who famously wrote about his seven word diet: eat food, not too much, mostly plants.

Am I eating in the best way possible for my heart? I don’t know and I don’t think the medical community knows. But my post heart attack health speaks for itself. I had a recent angiogram that showed very little plaque buildup in my arteries and my blood work would make a healthy person jealous. Cholesterol is under 100. Triglycerides at 85.

I eat a diet rich in fruits and veggies, lean poultry, fish, healthy fats (think avocado and olive oil) and small amounts of whole grains. I avoid added sugar as much as possible. Wonder Bread no, Ezekiel Bread yes. It seems to be working for me. Is this a Mediterranean Diet, or the DASH Diet, or the Michael Pollan Diet, or the “Pegan” Diet?

Yes.

You Are What You Eat

fatsickandnearlydeadLong before I suffered a heart attack I had been thinking a lot about food and its relationship to health. I had good reason to learn more about food as my cholesterol, triglycerides and blood sugar were elevated due to a combination of genetics, inconsistent activity levels and an undying love of pizza. So I started doing research on how to naturally lower these signs of impending crisis and each time the path led back to the same place — food.

Flash forward to last night and here I am again watching a documentary about food and health, this time at a special screening of Fat, Sick and Nearly Dead at a local restaurant called Pomegranate Cafe. And just like all the others, the premise involves eating fruits and veggies. Hmm. Maybe it’s true that 50 million Elvis fans can’t be wrong.

Here are just some of the films I’ve seen and books I’ve read over the past few years that preach the gospel of healthy eating:

I’m sure you can find tons more, but these are some of the popular ones. The thing is, so much research (both scientific and anecdotal) points to the plain fact that food can make us sick and conversely food can heal. You don’t have to believe it, or even care, but that doesn’t make it not true. What would it take for you to change the way you eat?

What of you had a heart attack? Would you change the way you eat, or would you continue the unhealthy lifestyle that made you susceptible to heart disease in the first place? It’s not an easy answer. In the months since my heart attack I have run into all types of survivors — those who don’t change because they either don’t care about living or they think it’s too hard to those, like me, who are willing to make a radical change in hopes of not only living longer but being healthy enough to enjoy that longevity. For me it’s a no brainer, but I understand the other side.

Changing my diet was really hard at first, and not just because I missed regularly having a couple of slices at NYPD Pizza. The hardest part has been eating at restaurants. I’ll tell you what’s not hard — eliminating most animal products. I have been mostly vegetarian for years (I continue to enjoy seafood) and truthfully I don’t miss the meat. Yes, every once in a while I dream about a Double Double, but it passes and those cravings happen less and less. I’m even thinking being vegan or raw wouldn’t be too hard since I’m almost there already. Limiting fat and cholesterol is simple, especially if you eat mostly vegetarian anyway.

Unfortunately for me, my heart was damaged by my heart attack and if I want to take care of it — permanently — I need to severely limit sodium. This has been the hardest thing for me, and not because I crave the taste. It’s hard because sodium is everywhere and often in places you least expect it. I won’t go into detail on why sodium is so bad for heart patients, but suffice it to say sodium makes you retain water and retaining water makes your heart pump harder. When your heart pumps harder, it will naturally enlarge and that would exacerbate my damage and inevitably lead to heart failure. How much sodium are we supposed to eat? The recommended daily allowance for a healthy person is 2500 mg. For someone like me, I need to stay under 1500 mg. I am currently eating between 1000-1500 mg per day. To give you an idea of what that means, a single teaspoon of table salt? There is around 2500 mg in a teaspoon of salt. A typical slice of pizza? 700 mg. How about a “healthy” meal at a “healthy” restaurant? A small Greek salad at Pita Jungle has 940 mg of sodium.

So you can see eating at restaurants is a challenge for me. But it’s worth the hassle given my condition. If you don’t have a heart condition, changing your diet is a breeze. But even keeping to the RDA is tough for a healthy person. A single portion of lasagna classico at Olive Garden contains 2830 mg of sodium. Holy salt lick Batman!

Why wouldn’t you change your diet? It’s so easy and the evidence is so clear. I know, you love a good steak. Enjoy, but why not consider making small steps in the right direction? Michael Pollen says it best. When asked how to dig through all the hype and misinformation he says, simply:

Eat food. Not too much. Mostly plants. 

In case you’re confused, by suggesting we “eat food” he’s basically saying to eliminate anything processed, chemical, manufactured, toxic, etc. Broccoli is food.  Methylchloroisothiazolinone is not.

Take this With a Grain of Salt

cutting-back-on-salt-01-afI promised I wouldn’t be preachy about heart disease awareness, so take this post for what it is — a cautionary tale. I have been on a very strict diet since October as I try to ensure my heart has the best chance it can to remodel itself following the damage of my heart attack. As you can probably guess, I’m seriously watching my cholesterol and fat intake. You may also know that there is a pretty clear link between salt (sodium) and heart disease, but I bet you didn’t know how clear.

Excess sodium can increase blood pressure which increases the risk of both heart disease and stroke. My cardiologist and the American Heart Association recommend heart patients limit daily sodium intake to less than 1,500 mg per day. One teaspoon of salt equals 2,300 milligrams of sodium. One Original Rubios fish taco has 450 mg of salt. A Big Mac has 1,040 mg of salt. A six-inch Subway Spicy Italian sandwich has 1,520. Get the idea?

Yesterday I made what I thought was a pretty healthy decision at lunch. I had mahi mahi tacos with nothing on them from my company cafeteria. A few hours later I went to cardiac rehab and my resting heart rate was elevated — with medications these days it’s usually around 60 bpm and it was close to 80. What caused the jump? The friggin tortillas! Two small flour tortillas together probably had about 700 mg of sodium and there was probably some seasoning on the fish I wasn’t aware of. I’ve been doing a really great job of sticking to around 1,000 mg per day so my lunch was way out of line — and it instantly affected my heart. That salt is some scary shit.

Ironically, yesterday was also the day that the CDC came out with a new report that most Americans were getting far too much salt in their diets. You can read the article online, but here’s a fact:

Americans eat on average about 3,300 mg of sodium a day. The U.S. Dietary Guidelines recommend limiting sodium to less than 2,300 mg a day, and about 6 out of 10 adults should further limit sodium to 1,500 mg a day.

I can tell you from experience that limiting salt is a pain in the ass. Eating out is nearly impossible and so many food items you bring home from the grocery store are also overloaded with it (ever looked at the nutritional values on a typical “healthy” frozen lunch?) This has become the hardest part of my post heart attack lifestyle. Salad bars are even dangerous. Leslie has done an amazing job of cooking for me and is even baking sodium-free bread from scratch. It’s still tough to stay on target.

It’s not that I miss the salt or the taste…it’s just so hard to find true low-sodium foods.