Working in the field of Endocrinology, I’m bombarded by patients quoting at me what they’ve read from the latest diet books. Whatever the program du jour, it’s guaranteed to stoke your metabolism, increase your energy, and result in more intense orgasms…got your attention there, didn’t I? Sensationalistic claims sell books, sure. But sadly, most of the books in this genre will either: (a) not help you at all, or (b) give you a temporary placebo effect, just from being more focused on your health, but then you’ll eventually regress to your baseline because the program isn’t sensible or sustainable.
Today, I’m pleased to write a review of a trend-bucking new book called Your Best Health Ever! The Cardiologist’s Surprisingly Simple Guide to What Really Works. It’s written by Dr. Bret Scher, who practices in San Diego. Disclosure: although I have no direct financial relationship with Dr. Scher, I will be paid an infinitesimally small amount of money if you purchase his book using the Amazon affiliate link below. Additional disclosure: I know Bret personally, and I can tell you he’s an excellent doctor and an all-around great guy. I promise you, if he was a quack with a lousy book, I wouldn’t lie to you, my reader (or readers, if I really want to be optimistic about the reach of this blog). Being a coward, though, because Bret’s my friend, I probably would have lied to him and said his book was “good” and left it at that.
To get a sense of what this book is, what isn’t this book?
This book is not a weight loss book or a diet book. It is not a sensationalist book built around extreme ideas or extreme programs. If you follow the tenets in this book, you will become healthier. You will reduce your risk of chronic diseases. Period.
So unsexy, right? I love the fact that Dr. Scher takes the honest, straightforward approach, as opposed to making outlandish claims he’ll never be able to support. You can tell he didn’t have a book agent advising him, though, because this brand of bland honesty is unlikely to sell as many copies.
Become healthier? Reduce my risk of chronic diseases? What about the six-pack this program’s going to give me? And the orgasms? I want my orgasms.
Listen, I’m going to editorialize for a moment here. One of the major reasons why people fail to get and maintain health is because they’re looking for two things that do not exist: a smoking gun and a magic bullet. For the sake of illustrating my argument, let’s focus just on weight management. There are so many things that factor into weight gain and inability to lose weight – resting metabolic rate; caloric intake; macronutrient composition of your diet; exercise type, frequency, duration, and intensity; sleep duration and quality; stress; mood; cravings; social circumstances; work circumstances; hormonal issues; sleep apnea; medications…the list goes on and on and on. With the myriad things that tend to affect weight, it is my clinical experience that there is almost never one smoking gun which, if discovered, will lead to a magical melting off of excess poundage. Nonetheless, my patients appear to be on a lifelong Quixotic quest for this mythical smoking gun. Why?
It would be easy – but intellectually lazy – to simply chalk this up to stereotypical American laziness (if I have any readers outside of the U.S., I’d love to hear from you in the Comments below, as to whether your countrymen and women also have the laziness gene). Anyway, I think it’s more complicated than just being lazy. I’ve seen how much time, energy, money, and emotional capital my patients spend searching for the smoking gun. That’s not laziness. In part, I think it’s about hope – hope that there’s an answer. We like answers, probably because we are rational beings. If there is a problem, there should be an identifiable cause of said problem, right? The idea that there is an answer out there that simply needs to be discovered gives us hope, and hope enables us to avoid confronting some hard realities. Confronting hard realities – like the fact that there is no smoking gun – is depressing. And people don’t want to be depressed (duh).
The second thing that doesn’t exist is the magic bullet. People who have been fruitlessly searching for the smoking gun still seem to hold out hope that there is a magic bullet – one that will help them lose weight regardless of the fact that none of their doctors has ever been able to identify a smoking gun. Do you see how desperately people hold on to hope, even when it makes no rational sense? If there was truly a magic bullet that could be purchased at GNC or Super Supplements (like Dr. Oz would have you believe), does it make sense that more than 1/3 of adults in the U.S. are obese? Of course not. But people want to believe, even though that isn’t rational.
When we stop being rational, our emotional nature takes over. And when it comes to losing weight and getting healthy, emotion is no good. Emotion leads us to make poor choices that give the brain’s pleasure center a quick hit, and emotion leads us to look for easy solutions. Easy solutions make us feel better faster, and that’s what we want. We are overweight now, and we want to lose the weight yesterday. When there’s a book that comes along and claims that if we just eat this and don’t eat that, everything will be fine, we want to give ourselves over to it and let the change cascade over our bodies like warm water in the shower…wake up, people! That ain’t going to happen. This type of change takes a lot of hard work. Not only that, but the work doesn’t stop once you’ve lost the weight. Now you have to maintain your new, healthier lifestyle, or you will regress to right back where you started – maybe worse. There is no finish line when it comes to health.
Depressing, right? Now you’re starting to get a sense of why people are resistant to substantive change. I know there’s some laziness there, given all this talk about hard work. But it’s also about letting go of totally irrational hope and embracing a rational course of lifestyle change, which could fail! The magic bullet never fails, because it’s magic. But once you take ownership of your life and implement change, you might fail, and that’s scary, because that’s all on you.
Back to the Book
All of my mumbo jumbo is meant to provide some context for the structure of Dr. Scher’s book, which is intended to help you achieve and maintain health. According to him, health is not merely the absence of disease. It’s about integrating the mind and body in a way that promotes happiness, energy, sleep, ease of movement, and the absence of chronic disease. If one of your goals is to lose weight, that will probably happen if you follow this program, but he actually encourages you to put away the scale, at least initially:
Health is about much more than weight. When we can transform our lives and prioritize our health, appropriate weight loss will follow.
That’s why I don’t recommend using a scale as your guide to your success. Many of my clients are uncomfortable when I tell them to put their scale away for the next four weeks. They ask: “How will I know if the program is working? How will I know how I’m doing?”
You’ll feel better, have more energy, and see the world in a brighter light.
Your pants will be a little looser.
You’ll notice your exercise routine is getting easier and more comfortable.
You’ll enjoy your meals, and you’ll enjoy being mindful and being present.
And after four weeks, you’ll also notice a positive impact on your blood work, your blood pressure, and other health markers.
Dr. Scher provides a “four-week plan,” but it’s not in the same league (or even the same universe) as the hcg-diet your chiropractor put you on last year. Like the good doctor says, this isn’t a “diet.” This is a way to approach your life and help you make lasting, sensible, sustainable change. Each week, you’ll be focusing on just a few tasks from each of the following main categories: Modify Your Mindset, Nourish Your Body, Move With Purpose, Manage Your Stress and Sleep, Build Your Support Community, and Re-examine Your Healthcare. Honestly, there weren’t too many surprises in this book, at least for me. You, also, may know a lot of what is in this book. But what you know is worthless until you put it into action, and that’s where this book excels. Dr. Scher gives you discrete chunks of eminently doable tasks each week, which should prevent you from becoming overwhelmed and giving up. Importantly, he also stresses that you must give yourself permission to fail:
Be Your Own Caddie
Don’t worry, this isn’t about golf. This is about being kind to yourself, encouraging yourself, and supporting yourself.
I’m not a very good golfer. Sometimes I’m downright awful, and I can get very frustrated. It’s all too easy to say to myself, “How could you do that!” “That was so stupid!” “Are you kidding me with that shot? What’s the matter with you?”
I’m not proud of that. No surprise, my next shot often just gets worse. How could I expect anything else with such a negative mindset?
Would a golfer’s caddie ever say “You are an idiot! You are a terrible golfer! How could you hit such an awful shot?”
Of course not! But that doesn’t stop us from saying that to ourselves.
The same is true when it comes to a healthy lifestyle. It’s all too easy to get down on ourselves. “How could I be such an idiot for eating that ice cream. I have no willpower, I’m too weak to resist!” “I’m such a lazy slug. I can’t even get 8,000 steps in a day. What in the world is wrong with me?”
Be Your Own Health Caddie
When these thoughts creep in, ask yourself if your caddie would say those things to you. If not, reframe your thoughts the way your health caddie would say them:
“Sure, you shouldn’t have had the whole carton of ice cream. What a great learning experience. Take note of how you feel at this moment and remember that next time you start to dig into the ice cream.” “You got 6,000 steps today. That’s certainly better than none. Let’s find ways to get you to 8,000 tomorrow.”
Doesn’t that sound better?
So what does the program actually look like? As a teaser, I’ve cut and pasted Week 1 from each of the main categories on which you’ll be focusing. Obviously, these bulleted points are fleshed out more comprehensively in the body of the book, but notice the simplicity of each task. Now, I’m concerned that people who read the book will be tempted to skip steps that seem overly simple, obvious, or new-agey – don’t skip steps! Don’t roll your eyes and discount the message when the doc uses words like “mindfulness.” Just recognize that he’s from southern California, and sometimes Californians say some stuff that sounds a little “hippy dippy” to the rest of us normal people. In order to succeed, you should buy in to the whole enchilada, so I’d urge you to read and do it all. Most of the steps in the program are simple because getting healthy is simple.
THE PLAN: MODIFY YOUR MINDSET
- Define your goals, write them down and sign the paper. Take time to visualize what it looks like to accomplish those goals. Remember to visualize the habits that coincide with achieving those goals, too. Start asking your positively framed “What if” questions.
THE PLAN: NOURISH YOUR BODY
- Become more mindful with everything you eat. Ask yourself, what nutrition does it provide? Does it help you feel full and feel energized? Do you enjoy it? Does it help you or hurt you?
- Practice mindful techniques when you eat. Start each meal with three mindful breaths, and focus on your food as you eat. Use this to help you assess your fullness, so you stop eating when you’re no longer hungry.
THE PLAN: MOVE WITH PURPOSE
Here’s the core principle behind this plan: when you exercise with purpose and intensity three days each week, and use your activity tracker to make sure you’re moving more the rest of the week, you don’t need formal exercise every single day to achieve better health and lower your risk of chronic diseases.
- Increase your daily activity: park farther away, take the stairs, walk every 30 minutes at work, start a gardening project, etc.
- Get an activity tracker and determine your baseline activity level.
THE PLAN: BUILD YOUR SUPPORT COMMUNITY
- Talk about your goals with your friends and loved ones.
- Gauge their responses. Are they supportive, or dubious? Constructive, or critical?
- Use this feedback to help you decide who to include in your community, and enroll at least two people the first week.
THE PLAN: RE-EXAMINE YOUR HEALTHCARE
- Know your baseline blood tests. At a minimum, get a standard lipid panel, hs-CRP test, fasting glucose and insulin levels, and Vitamin D level.
- Even better, discuss with your doctor the option of getting advanced lipid testing.
- Measure your baseline weight, BMI, waist circumference, and body fat percentage.
- Carefully review your medications with your physician. Inform him or her that you intend to implement purposeful lifestyle changes to safely decrease your dependence on them.
So that’s Week 1. Easy, right? The subsequent 3 weeks then build on Week 1 with more specific tasks and goals. Dr. Scher acknowledges that it may take 8-12 weeks or longer to complete all the objectives, which is fine. The point is to incorporate all of this into your daily life so it transforms from a “program” into just “life.”
My Personal Takeaways from the Book
I’m fit and healthy. But like almost everyone, I could do better. I did find a few things in this book that caused me to reevaluate my own food choices, reconsider my medical practice, and revisit some controversies in the realm of nutrition that I hadn’t thought about for quite awhile. In no particular order:
Dr. Scher makes a good case for looking at the ratio of “anti-inflammatory” omega-3 fatty acids to “pro-inflammatory” omega-6’s in your diet. If you’re like me and you buy the cheap stuff when it comes to meat, fish, poultry, and eggs, you’re probably buying animal products that are higher in omega-6’s and lower in omega-3’s. If you convert to grass-fed beef, wild fish, and pasture-raised chickens, the feed for these animals is different, and may result in a more optimal intake of omega-3’s. I’m a bit torn here, because the theory makes intuitive sense, but there isn’t sufficient hard end-point data (like prospective studies showing reduction of heart attacks, strokes, diabetes, and cancer) to make the extra cost a no-brainer. Plus, there isn’t anything close to universal agreement that omega-6’s are pro-inflammatory.
Additionally, I don’t think we can say that wild, grass-fed, and free-range are always better. For example, farmed (Atlantic) salmon has a very high fat content, resulting in the total amount of omega-3 fatty acids in a serving being equal to or even greater than a similar serving of wild salmon. Incidentally, this probably explains why the only type of wild salmon I enjoy is king (ka-ching!), which has a higher fat content than other wild salmon.
As for grass-fed beef, did that beautiful slab of steak on your plate come from a cow that was slaughtered at the end of summer, after months of eating omega-3-rich grass? Or was it slaughtered in winter, after months of eating hay (technically still grass-fed, just drier), which is much lower in omega-3’s? Not only that, but was your meat cooked at a gentle temperature, thereby preserving much of the heat-sensitive omega-3’s, or was it thrown on a grill with the gas cranked up to 11, Spinal Tap-style, which could result in significant degradation of the healthy omega-3’s?
And eggs…don’t get me started on eggs. Although there’s no question that chickens permitted to forage naturally on grass and insects will lay eggs higher in omega-3’s, finding those eggs at your local grocery could be a thrash. Organic? Means nothing when it comes to omega-3 content. Cage-free? Just means your chicken was wandering around an overcrowded, poop-filled barn, instead of an overcrowded, poop-filled, tiny hen house. Free-range? Technically, your chicken could be mostly cooped up in a hen house with a small door to access the outdoors, presuming your chicken could fight through all the other chicken bodies to actually get outside. If you have the time, access, and cash, and you want to boost your omega-3 intake, buy your eggs locally from a farmer with pasture-raised chickens.
Shifting gears, Dr. Scher recommends that everyone take a vitamin K2 supplement to promote bone and (possibly) cardiovascular health. This one is interesting, as I recently saw a patient I treat for osteoporosis come in with a K2 supplement, claiming that it acts like a drug to reduce fracture risk (her claim based on her own “research”). I didn’t know much about K2 at the time but had intended to look into it. I promptly forgot about it until Dr. Scher’s book brought it to my attention again. After doing some digging, I would agree with Dr. Scher that this vitamin has some potential clinical applications. However, the research has not shown significant increases in bone mineral density with K2 supplementation, nor have any well-designed clinical trials shown significant fracture risk reduction.
There is some data out there suggesting benefit, but I don’t think it’s conclusive enough to recommend that everyone go out and buy vitamin K2. As more data emerges, I may change my tune. One last thought on this topic: I think Dr. Scher’s argument would have been more powerful if he cited studies from peer-reviewed journals, instead of citing talks given by his friend, Dr. John Neustadt, a naturopath who apparently has expertise in the arena of K2. I don’t know Dr. Neustadt and don’t mean to paint him with the same brush I often use for naturopaths around here, but my negative impression of his field colors my outlook on the recommendation in favor of supplementation. Consider that my disclosure of bias.
The final nugget I wanted to mention is Dr. Scher’s take on statin therapy. This section of his book forced me to look at the issue of when to start a statin from a different angle than my usual one. Because my typical patient population consists of many type 2 diabetics, the choice regarding statin therapy usually isn’t whether to do it or not, but whether the patient gets a moderate dose or a high dose, per American Heart Association guidelines.
Because Dr. Scher is a preventive cardiologist, he gets to see many people before they actually have a high-risk chronic disease like diabetes, so there is more nuance to the decision of whether the patient in front of him will benefit from a statin or not, with respect to reduction in the risk of heart attack and stroke:
The guidelines mention that in addition to the calculated risk, physicians may want to consider:
- the person’s family history of premature heart disease
- the high-sensitivity CRP (hs-CRP) inflammation blood test
- the ankle-brachial (ABI) test for peripheral vascular disease
- an elevated coronary calcium score that is above 300 or above the 75th percentile for age
Amazingly, the recommendation is to use these tests only for deciding in favor of statins. The guidelines don’t mention, for example, using a calcium score of zero to eliminate the need for statin therapy. They don’t mention using a normal ABI and a normal hs-CRP as evidence that your risk is lower, and you therefore don’t need statins.
Why not? Likely because the guideline authors have a bias towards initiating statin therapy—the “more is better” approach. Believing that more medicine is always better is a very common bias in medicine that comes from the desire to help.
Unfortunately, it’s not always best for your health.
I take the opposite approach. What if our bias is against starting a statin?
A trial published in the Journal of the American College of Cardiology looked at that exact question. They found that about 50% of the people aged 45-75 who met other criteria for starting a statin also had a calcium score of 0.
Factoring this calcium score into their risk analysis reclassifies them into a lower-risk category that no longer meets the threshold for statin therapy. That’s a lot of statin prescriptions that could be avoided, thus reducing the cost and risk to the patient.
I think Dr. Scher is right that, as a profession, doctors are often too quick to pull the trigger on a prescription. Elsewhere in the book, he talks about the concept of reduction of relative risk versus reduction of absolute risk, which is an important concept to grasp, especially when we’re talking about how much you will really benefit from taking a statin for the next 30-60 years! If your absolute risk reduction is very low because of great health and ideal biomarkers in the rest of your testing, maybe that 20-30% relative risk reduction should not be the driving force to add yet another pill to your daily routine. I will reiterate that my patient population is going to get the statin anyway because they are high-risk, but I do occasionally see lower-risk patients, so Dr. Scher’s framework provides a sensible approach.
OK, let’s wrap it up. Who is going to benefit from Your Best Health Ever!? Highly motivated people who approach their health with the mindset of taking personal responsibility and embracing hard work will get a lot out of this book. The book provides a comprehensive framework for approaching health and, as such, can be used as a reference to sustain the changes made during the program.
Who will not benefit from the book? Those who are still searching for smoking guns and magic bullets. Those who deposit themselves in their doctor’s office and demand to be fixed. Those who do not have the self-awareness to realize that their current choices are poor. So, pretty much 95-98% of the people I see in my office. And with that, you now understand the unfortunate title of this book review.
Want to prove me wrong? Take control of your health and buy the book!
What do you think? Are you a health care provider who counsels patients about lifestyle modifications? What have you found successful? Unsuccessful? Do you walk the walk, or just talk the talk? Are you a patient who has struggled with your health? What has worked best for you in the past? Comment below!
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