Dr. Bret Scher discusses obesity treatment with Dr. Westman. – Adapt Your Life® Academy

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Dr. Bret Scher

Dr. Bret Scher discusses obesity treatment with Dr. Westman.

Introduction to Dr. Bret Scher

Dr. Eric Westman: It’s my great pleasure to have Dr. Bret Scher with me today.

Dr. Bret Scher: I can’t believe this is the first time we’re sitting down to have this sort of conversation. We’ve been sort of working in tandem for so long in this field, so it’s great to be able to be here with you.

Career path of Dr. Bret Scher

Dr. Eric Westman: I was trying to think back to when we first met. It’s been a while. I got into this world of obesity treatment. Dr. Atkins was a cardiologist, but I wasn’t treating heart disease. Then all this other stuff changes, where triglycerides and HDL get prominent in the blood, but not all cardiologists think that way.

It was reassuring to meet you and to see that maybe I wasn’t as crazy as everyone said I was. This was what, 15 years ago? Could you start by explaining to someone who doesn’t know who you are? Where you trained and how you got into the ideas you have? There’s still a website, ‘Low Carb Cardiologist,’ and you wrote a book, Your Best Health Ever!, just for those who don’t know. How did we come to cross paths?”

Dr. Bret Scher: I started as a general cardiologist, but my focus was always prevention. When I did my fellowship here in San Diego at Scripps Green Hospital, Scripps Clinic, it was a combined General and Preventive Cardiology Fellowship.

Now, interestingly, the preventive clinic had an Ornish-style program. That’s where my fellowship training was.

Ornish-Style Program

Dr. Eric Westman: For those who haven’t heard that term, and refreshingly, there are some who don’t, that’s the ultra-low-fat version of prevention.

Dr. Bret Scher: It is a lifestyle program. It is stress management, exercise, quitting smoking, it’s community support. It is also a very low-fat, predominantly vegan diet. That was my preventive cardiology training.

Cardiology Job

Then, when I went out into the ‘real world’ and started my regular cardiology job, I really did want to focus on prevention. There, I was doing a mix of cath lab work, hospital rounds, ICU care, and outpatient clinics, getting a mix of all of it, and realizing something wasn’t right.

The way we were trying to help people, we were great at putting stents in. We were great at helping people who were having heart attacks. But it seemed like we were pretty bad at preventing them and really helping people get healthy. Why is that?

I started bouncing around, trying to figure out why that was. At the time, I just thought I needed to spend more time with patients. They needed someone who understood physical activity, nutrition, and behavioral decision-making.

So, I went and got training in all these areas. Then I opened up a wellness center with a friend of mine. Fortunately for me, though, he was well-versed in ketosis and ketogenic diets, just by chance.

On a couple of our patients whose blood sugar was out of control, they were overweight, and no matter what we were saying, it just wasn’t really resonating with them. My friend said, “How about we try a ketogenic diet?’

My first response was, “What? Crazy! I can’t do that. I’m a cardiologist!”

Dr. Eric Westman: What year was this, just for context?”

Dr. Bret Scher: Probably 2012, I want to say.

Science on low-carb diets for obesity

Dr. Eric Westman: The science on low-carb diets for obesity had been out for 10 years. But I don’t know how many people read that.

Dr. Bret Scher: Right. To his credit, when I responded, he said, “Have you read anything about it? Have you looked into it?” I said, ‘No, maybe I should.’

I remember finding a study or two by this guy named Dr. Westman, and I said, “Someone’s actually done research and published on this!”

I never learned this in cardiology. I never learned it in my fellowship or even in my internal medicine training. Suddenly, I thought, ‘Okay, well, that’s interesting. I never learned it; why don’t we try it?’

Metabolic Health

I tried it on myself, and on a couple of patients, and started reading more about the literature. Then I got really upset, like, “This works better than anything I’ve seen for weight loss and for managing metabolic health, which is connected to cardiac health. Why have I not heard anything about this?”

That set me off on a mission: people need to know about this. Not that everybody needs to be on a ketogenic diet, but this has to be a treatment option that every doctor knows about because of how well it can work and how much it can help people.

That started me on my journey, and from there, I became the medical director at Diet Doctor, where we focused on ketosis for medical conditions and improving metabolic health. Then, about two years ago, I transitioned over to Metabolic Mind. I’m now the medical director of the Baszucki Group and Metabolic Mind, where I run the podcast focusing on ketogenic therapy for treating mental illness and other brain-based disorders.

It’s just one more area where every clinician needs to know that this is a very, very powerful medical intervention, not just eating bacon, which US News & World Report says we shouldn’t do. It’s completely different.

Dr. Eric Westman: Although eating bacon is fine.

Dr. Bret Scher: Yes, eating bacon is fine. But if people say, “No, ketosis is just that diet where you eat a bunch of bacon,” a doctor is going to think that, and that is very common. It’s opposed to the reality that ketosis is a medical intervention that dramatically improves your metabolic health, changes brain chemistry, can treat seizures, can treat cognitive decline, can treat mental illness, and can put type 2 diabetes into remission.

That’s a term I never heard of when I was training or in the early stages of my career. We didn’t talk about the remission of type 2 diabetes. But here’s a dietary intervention that can do it.

Dr. Eric Westman: The fact that we need to be getting this information out there reminds me of a book from some years ago, The Tipping Point by Malcolm Gladwell. He’s back writing a new book or has one out, but the crux of his argument in The Tipping Point is that for something to tip, you need different types of people.

You need someone like Steve Phinney, who, to me, is the guru and nutritional genius. He can’t spread the word. So enter people like you, Dr. Bret Scher, who has developed this knack and great skill of interviewing with podcasts.

It’s something we’re not taught in medical school. You’re positioned in a unique place, and you’ve been able to interview so many different people in so many different areas.

Do you have a clinic now? Like, when you sit down with a patient, or if you’re talking to my patients, what have you learned? Where do you start with patient care now?

Clinical practice and seeing patients

Dr. Bret Scher: So for patient care, I still have an online preventive cardiology practice, telemedicine. I’m licensed in seven different states, so I can still see patients. I focus on the connection between metabolic health and cardiac health and how they are really, really intimately related.

You really have to address metabolic health first to address cardiovascular health. A big percentage of my patients are people who are following keto diets or low-carb diets and have high cholesterol or heart disease. They want someone who’s going to do something different than just guideline-based care and see them as individuals.

That’s where my clinical practice is. Then, I’m also the medical director of Baszucki Group and Metabolic Mind, so I wear two different hats.

You’re absolutely right. We have luminaries like Dr. Steve Phinney, Dr. Volek, and you, people who have really paved the way. But we need thousands of people out there with megaphones, letting everybody know what’s going on.

You mentioned the podcast. I’ve had different iterations of my podcast, and I remember thinking when I started, “I don’t care if anybody’s listening. These are just such fun conversations to have and learn from everybody.” But now I do care if people are listening because it’s so important for individuals and clinicians to learn this, especially if it’s not being taught.

We know how mainstream media reacts to headlines and clickbait, and how it misrepresents the results of studies, or at least the reach of studies. We need people talking about the underlying nature of what it really means and what we should truly be taking away from it. That’s a hard message to get out there.

Dr. Eric Westman: Let’s sit for a moment in your primary specialty of cardiology. I trained at the University of Wisconsin, the University of Kentucky, and Duke. Duke is kind of cardiology central. They’re the ones who got the initial money for drug trials, and they have the big building downtown. If there’s a big building in Durham, it’s the Duke Clinical Research Institute. They’ve been funded by Pharma and driven in the cardiology world.

It was only recently, in Chicago, when I gave a talk at the Illinois Obesity Association. They have a pretty mature state-level obesity meeting. One of the young doctors came up to me and just kind of shook his head about cardiologists today. He said, “My field, I’m internal medicine,” and he’s a former Chief. He said, “Cardiologists, all they want to do is lower LDL down to zero, and they don’t know anything about food.”

He actually does a low-carb-friendly or keto-friendly practice. What is it about cardiologists and cardiology? Can we accomplish, perhaps, just a different way of going about things? As diplomatically as possible.

Cardiology and a different way of doing things

Dr. Bret Scher: I think we have to. We have to accomplish a different way of going about things, and that means seeing heart health as a broader picture, not just a lab value of LDL. That’s not heart health.

Also, metabolic health is not the presence or absence of type 2 diabetes either. We’ve seen these data, these tables, whether it’s from the Women’s Health Initiative or from the recent study in the New England Journal of Medicine, that sort of put into perspective the contributory risk to heart disease of type 2 diabetes, metabolic syndrome, and lipoprotein insulin resistance scores versus LDL or ApoB.

They’re all on the list. They all contribute. But type 2 diabetes has a ratio of 10, metabolic syndrome a ratio of 6, and ApoB a ratio of 1.8. That helps put it into perspective. The New England Journal article found something almost identical to that.

It’s seeing cardiovascular health in a broader picture, which we really have to do. But the problem is we don’t have great drugs for insulin resistance. There’s metformin, and that’s about it.

Now, people would say the GLP-1s, right? Of course, now we have a drug that’s good for everything. There was an article that came out, like, “Oh, GLP-1s are good for arthritis; they reduce knee pain.” Okay, well, I don’t think they’re helping you build more cartilage in your meniscus. You just lose weight, and things happen. You improve your metabolic health, and things happen.

But there are better ways to do it than expensive injection medications. That’s what we’re not good at teaching, talking about, and working with as a field, as a field of medicine, not just cardiology, but medicine in general.

You’ve probably seen it from the Obesity Medicine Society. You’ve been so involved in that. They’re just all about GLP-1s and GIPs and the next generation.

Dr. Eric Westman: I’m a past president of the Obesity Medicine Association. It’s like King Midas came through, and everything’s gold now because of Pharma. The meeting is bigger and better, with free meals at the evening dinner sessions. You know how that works.

We’re in the infancy compared to the cardiology meetings that have so much Pharma influence. It seems like the one fulcrum point or tension is fascinating, and that’s that pesky LDL.

I kept pushing the slide from the Virta data: everything gets better except the LDL. Then I woke up one morning thinking, maybe it’s better for LDL to go up, at least in this context.

Then I’m talking to a pilot patient. We had some time to talk, and I said, “If you look out the window and your altimeter says 5,000 feet, but you’re on the ground, you’re in Denver. Geographically, you’re on a mountain. If you only look at a number and don’t look out the window, at sea level the altimeter would say zero. We’re looking at one number totally out of context.

Is it an underappreciation of the metabolic change that diet can make? Or is it an over-appreciation and over-treatment with drugs for one little thing, perhaps?”

Looking at numbers out of context

Dr. Bret Scher: It’s both. It’s because we’ve become so focused on LDL. In the Pharma-sponsored research, there’s so much research around statin-lowering LDL and reducing a very slight reduction in the risk of heart attacks because that’s where all the money is, and that’s where all the studies are.

Where I get in trouble in low-carb circles sometimes is that I prescribe statins all the time for my patients who’ve had heart attacks, had stents, had bypass surgery, or have evidence of soft plaque on their CT angiogram. I use statins in those situations, but by no means is that the one “be-all” treatment. That is a small part of the broader treatment plan, which has to involve lifestyle and nutrition and improving metabolic health because that is as important, if not more important.

Why have we become so focused on it? I mean, there are lots of reasons, but I think that’s why, because that’s where the majority of the research is. The majority of the research funding goes there because people aren’t funding the nutrition studies that we need to show the benefits they’re going to have.

Studies

Dr. Eric Westman: To that point, we have to be honest and self-critical. I’m not aware of any study where lifestyle has addressed metabolic syndrome in a randomized, prospective type of study to show that it’s better than the typical treatment. Are you aware of any kind of study?

Dr. Bret Scher: It’s a great question.

Dr. Eric Westman: I’m not, or even the treatment of metabolic syndrome with a drug compared to no treatment. I’m not aware of any. It’s not even on the radar of the scientists that I’m aware of. To say that metabolic syndrome is so important and that diabetes (inaudible) the risk, well, we’re still talking about cohort studies.

Where I train, all my patients are trained to say, “Oh, correlation, not causation” or “Nutritional epidemiology.”

Dr. Bret Scher: We use studies with surrogate markers as you mentioned, the Virta studies that they’ve published. In their one-year trial, they showed about a 10% increase in LDL with no change in ApoB, but a 12% reduction in calculated cardiovascular risk.

That’s not a proven reduction in heart attacks or longer lives, it’s a calculated cardiovascular risk. But it should wake us up to say, “Oh, okay, look at that. LDL goes up, but there’s more to it than just LDL.”

This calculator that we’re all taught to use and that is supposed to be so important actually shows a decreased cardiac risk. Where do we put that in the scheme of things? A five-year Pharma study that shows half a percent fewer heart attacks versus a surrogate marker that’s a calculation of reduced risk?

We have to balance that. That’s what we, as clinicians, have to do.

Dr. Eric Westman: On the other side of things, for those who are naysayers about low-carb or keto research and who say we’re killing people, I say: prove it. I’ll go to a meeting and say, “No, show me a study where someone on a well-formulated keto diet had more risk and more death.” It’s like we’re dealing with prejudice, not only in the popular press but also among doctors.

Jeff Volek and I collaborated on one paper in the late ’90s, and we looked back to see if there was any data to say low-carb diets were good or bad. Actually, there were a few that said it was good. Now, 20 years later, I asked Jeff Volek at a recent meeting, “Is there any evidence that low-carb keto diets are bad?” He said, “No, there’s no evidence.”

I thought, why have I been defensive for 25 years when there’s really no evidence that it’s bad?

Oh, right, the epidemiology studies where they take 30% carbs or less as a “low-carb diet” and then take potshots. They take an anecdote of, whatever. Anyway, there’s no study that says it’s bad either.

Dr. Bret Scher: It just shows a complete misunderstanding. You can see it in the lay press, but also in the medical community. They’ll look at a study that uses 37% carbohydrates, which could be 200 grams of carbs per day, and say, “That was the low-carb group. Low carb did worse; therefore, low carb is bad. Keto must be bad.”

That is actually what many clinicians believe because that’s what the journals say, and that’s what they’ve been taught. If they sat down to actually think about it, they probably would understand. But busy clinicians don’t always have the time to do that.

That has nothing to do with a ketogenic diet or ketogenic intervention. You mentioned Jeff Volek, he just did this fantastic study at Iowa State using ketogenic interventions to treat depression in college-aged kids. It’s to be published soon.

If you can treat your depression and you can change your life and the way you see things, are you going to worry about a 10% increase in your LDL, especially if you’re improving your metabolic health? The same goes for what we do in Metabolic Mind. We just see story after story after story, along with studies showing people putting their bipolar disorder into remission, their schizophrenia into remission, again, things we never heard about.

Like type 2 diabetes into remission, we didn’t talk about these things before, but it’s possible. Yet they’re hung up on the LDL, just like you said. They’re so focused on the LDL, it’s the classic “not seeing the forest through the trees” analogy.

Different lab values, different meanings under different circumstances

Dr. Eric Westman: I’ve been thinking, I can write editorials now, which means the bar to get them published is a lot lower. There’s still a minor review process, but I think one of my next ones will explore how different lab values have different meanings under different circumstances.

It’s like the altimeter analogy: if your altimeter says zero and you’re in Denver, you’re subterranean, right? So, the idea is that LDL doesn’t mean the same thing, perhaps, under different circumstances. I guess the old story is that Galileo wasn’t killed because he said it was his hypothesis that the Earth wasn’t at the center of the universe.

I’ll say it’s my hypothesis that maybe LDL is different under different circumstances. Then there’s the ketone level, the ferritin level, the A1C, and glucose, maybe they’re a little elevated. It’s fascinating to see the knee-jerk reaction to this as if it’s necessarily bad.

Because it’s not a clear-cut “normal” blood work panel, how do you put that all together? I’m sure you’re following Dave Feldman’s Cholesterol Code study from the Citizen Science Foundation.

Dr. Bret Scher: Absolutely, yes. There’s a lot there, but talking about having to interpret tests differently, the fasting blood sugar is the perfect example. It’s a worthless test, in my mind. A worthless test, but yet that is the test we’re using to diagnose prediabetes and type 2 diabetes.

How many completely metabolically healthy people eating low-carb and doing intermittent fasting have a fasting blood sugar of 108? That’s considered prediabetes, but it’s their highest sugar level for the whole day. The rest of the day, they’re in the 80s and 90s.

There’s no way they have prediabetes, but because of the way we’ve defined that one test, their doctor is going to tell them they have prediabetes. That just shows the fallacy in the way we interpret so many tests. You’re absolutely right, that proves your point that we need to interpret these tests differently.

LDL

What about LDL?

It is fascinating what Dave Feldman has done, as an engineer, an outsider, to team up with researchers, scientists, and clinicians to say, “Let’s study this.” He’s not saying he knows what’s true, but he’s saying, “I really want to find out, so why don’t we design a way to do it?”

It’s amazing to me that he has got pushback and flack for the way he’s handled this because all he’s done is ask, “Why don’t we investigate it?” Which is brilliant, exactly what we should be doing.

The MAT study that came out showed really no difference in the amount of plaque between people with LDLs averaging 270 for almost five years versus 100-120 for basically their whole lives, but for different reasons, the keto group versus the non-keto group. Zero difference in plaque. It’s not a definitive end-all, be-all study, but if that doesn’t at least get your antenna up a little, saying, “Maybe there’s something here we should look into,” then I don’t understand. How can people not be curious about that and just dismiss it out of hand? You’ve got to be curious about it, it’s fascinating.

Dr. Eric Westman: There are other vested interests, right? But even Feldman’s study so far, or the LMHR Budoff study, very technically, makes sense. Back when I was trained, and perhaps during your training too, HDL was a good thing.

In this dataset, the HDL average is 90 (mg/dL) for these people, which is really high. Even on a carb-normal range, it’s high. HDL used to be seen as a protective thing for heart disease. I’ve been interested to see that kind of erode over time.

When we were in training, HDL was kind of the “Let’s respect that” marker. Is it because there’s no drug for HDL, perhaps? I’ve even seen some people saying super high HDL can be a harmful thing. Do you know more about that?

HDL

Dr. Bret Scher: I think there are two reasons for that. One is because the drugs that raised HDL did not improve health or reduce cardiac risk, right? That’s a big one, whether it’s the CTEP or even something like niacin. These raise HDL, but they don’t improve cardiac health.

The second point is there are genetic anomalies. For reasons related to your genetics and the way your HDL is made, you might have HDL levels of 120 or 130 (mg/dL), but it’s not well-functioning HDL. It’s the equivalent of having HDL levels of 20 or 30 from a functional standpoint. I’m just making up those numbers, but to use an example, it’s not wild-type HDL.

It goes to the same point you made earlier about interpreting tests differently for each individual. The question is, why is your HDL what it is? Is it because we’ve tried to manipulate your system with drugs? Is it due to a genetic mutation? Or is it because you’ve improved your metabolic health so much that your HDL has gone up? These are totally different scenarios and need to be interpreted differently, rather than making a blanket statement like, “HDL doesn’t matter anymore.” In those settings where you’re using a drug to falsely elevate HDL or where there’s a genetic mutation, it means something entirely different than if you’ve elevated it through lifestyle changes and improving metabolic health.

Dr. Eric Westman: I’d have to admit that it’s not all been worked out. I sometimes passively allow or don’t take away certain things. I don’t think I’m in a position where I have to prescribe statins, though just about everyone else does. Around here, they still think statins should be in the water supply because cardiology rules.

That said, there are a growing number of editorials acknowledging the role of coronary artery calcium scores and CT angiograms. Now, we can actually know whether someone has the disease or not. The editorial language is interesting because it’s like there’s a tiny crack in the fortress wall of control.

The mindset has been, if your blood levels are up, we’ll give you pharma. But now, there are loopholes where, if people don’t have angiographic evidence, even on a CT angiogram, there’s really no evidence that giving a drug will be beneficial. It might even cause harm without any possible benefit because they don’t have the disease.

This occurred to me recently when a cousin went to a family reunion and got an executive physical. They put him in for a false positive treadmill test. He had normal coronaries. At the end of the hospitalization, they said, “Here’s your low-fat diet to prevent the disease you don’t have.”

A cancer doctor wouldn’t give chemotherapy and radiation just because someone might get cancer one day. Everyone doesn’t get it. You need tissue evidence.

What if a cardiologist had to have a tissue biopsy of atherosclerosis? Which artery would they take it from? I know it’s a crazy thought.

Dr. Bret Scher: No, but those are all great points. There was even that study out of Walter Reed a number of years ago. It showed that, if your calcium score was zero, those treated with a statin and those not treated with a statin had the exact same 10-year risk of heart disease. Statin or no statin, the risk was identical when their calcium score was zero.

Now, if the calcium score was above 100, those treated with a statin did have a lower risk of heart events. Again, it’s not that statins do nothing; they could be part of the solution. They are widely overprescribed, especially when there’s no evidence of vascular disease.

Drug/Pharma companies

Dr. Eric Westman: Have you seen the new movie, First Do No Pharm? Fiona Godlee, the former editor of the BMJ, is interviewed, and she is so spot-on about so many things. For example, she mentions how they’ve tried to get drug companies to open up their data sets for transparency. There’s concern that side effects have been covered up or not accurately ascertained.

She also made another great point, it could have been so easy to add a dietary arm to all of these studies. The express purpose of these trials was to show the drug was better than no drug. It wasn’t about what was best for human health at all.

That’s chilling, coming from a former BMJ editor. She even admitted that when the journal publishes a paper for a drug company, they commonly buy a million dollars worth of reprints to give to their army, to hand out and teach doctors. It’s in the financial benefit of even journals, which we think of as being this imperturbable bastion of science.

There have been other editors who have claimed, or whistleblown, that the system is being bought. This particular area of statin drugs has hit a chord. It seems like, post-COVID, the anti-vax, anti-lockdown, and anti-statin movements have all kind of jumbled together, hasn’t it?

Dr. Bret Scher: I think at its core, it’s an anti-single-message sentiment, this idea of “Believe us; we know what’s right.” For good reason, people are starting to doubt that now. Like anything, it can go too far, but I think at its core, people have valid reasons to start doubting and questioning.

We mentioned Dave Feldman, who’s been such a proponent of saying all data should be open-access. That just makes so much common sense. We need third parties to verify this data. If not, what are they hiding? Why can’t we see it?

There are statistics showing that if it’s a Pharma-sponsored study, it favors the drug 98% of the time. When it’s not Pharma-funded, it doesn’t favor the drug about 70% of the time or something like that. The disparity is staggering. Science is supposed to be the truth, but it seems to depend on who funds it and who designs it. This just shows you can design a study to show whatever you want.

Kevin Hall is a classic example of that with his two-week dietary studies comparing ketogenic interventions. Of course, that’s designed to fail because of the adaptation period needed for keto. If you want to design a study to make keto look bad, you create a two-week study – perfect! You can design it however you want.

When Pharma has a hand in trial design, it’s a disaster.

Dr. Eric Westman: I lost confidence in Dr. Kevin Hall’s work when he rewrote one of the studies on basic metabolism and energy balance. The abstract didn’t really reflect the internal methods or results. Anyway, that’s another sidebar.

What are you up to now? Speaking of funding, maybe we don’t need governmental funding to seek the truth.

Funding

Dr. Bret Scher: That’s a great point. One of the things that’s been so refreshing in the work I’m doing now as the Medical Director of the Baszucki Group and Metabolic Mind is seeing the power of a very generous and philanthropic family. They are changing the way psychiatric research is done and the way psychiatry is practiced.

We’ve helped fund, I think maybe 10 trials at this point, I’m losing count because there are so many trials. These are studies that otherwise probably wouldn’t have been funded or done. Now, we have trials funded to look at ketogenic interventions for treating mental illness.

It’s not Pharma-funded. There’s no big company with a vested interest in this. Because of philanthropists, these studies are getting done. It’s an example that I hope reverberates throughout every field of medicine. I hope people say, “I have the resources and passion to find out about this, and I see I can make a difference. Let’s do it.”

I think that’s what Dave and Jan Baszuki have really done. They’ve set an example to show this can be done well.

Dr. Eric Westman: Can you explain how they got involved in this to someone who doesn’t know yet?

The Baszucki Group/Metabolic Mind

Dr. Bret Scher: Dave Baszucki is the founder and CEO of Roblox. He and his wife, Jan, have the Baszucki Group and now Metabolic Mind, where Jan is the president.

It all started because their son, Matt, has bipolar disorder. I encourage everyone to visit our Metabolic Mind YouTube page to hear Jan tell their story. It’s incredibly powerful.

Matt was in and out of treatment facilities, homeless, and living behind a dumpster. This was a family with means, a loving and caring family. It’s the kind of story that often, unfortunately, ends tragically.

Fortunately for them, it didn’t end tragically. They were able to get him safe and treated, but he was never truly well. He was safe, and he was treated, but he was never well.

Jan tirelessly searched through every potential treatment and was lucky enough to come across Chris Palmer, Denise Potter, and others who suggested trying a ketogenic diet. That’s what changed his life. Now, he is well with no stigmata of bipolar disorder or any mental illness.

As he likes to say, he jokes that he’s more sane than any of his friends now. He’s on almost no medications, playing competitive chess again, and working a full-time job, things Dave and Jan thought they would never see from their son again. They never thought they’d have their son back, but he is back 100%.

You never want something like this to happen to anyone, but thank goodness it happened to their family because now they are so passionate and motivated. They are devoting the majority of their philanthropic efforts to researching this treatment, making it known, and educating clinicians and individuals about its potential.

Dr. Eric Westman: The personal experience with a disease is often a motivating factor. For example, doctors who lose weight using a low-carb or ketogenic diet often become advocates, or someone whose family member’s life is transformed learns and shares the treatment. As for philanthropy, were they philanthropic before?

Philanthropy

Dr. Bret Scher: They were already philanthropic. They are also very involved in regenerative agriculture and democracy initiatives, like advocating for final-five voting instead of the current political system. You can say a lot about our political system, but most of it isn’t good!

This particular cause hit so close to home for them, and they saw the impact they could have on this field. While it’s not 100% of their philanthropy, it’s probably the majority. They still continue their work in regenerative agriculture, democracy, and other areas as well.

Dr. Eric Westman: For those who don’t know what Roblox is, you can find simulated versions on YouTube to see what it’s about. It’s a massively popular interactive video game platform, mainly for teenagers.

Dr. Bret Scher: It is really for anyone, right down to kids.

Even though Dave and Jan are running the nonprofit, I don’t work with Roblox or have anything to do with it, so I can’t speak much about it. What we’re doing with the Baszucki Group and Metabolic Mind is really changing medical practice and how people view ketogenic therapy.

Dr. Eric Westman: Let me plant a seed here, there needs to be a crossover. Roblox could incorporate nutritional education into its platform, and maybe give players points for avoiding unhealthy food items like bananas in the game. We can’t wait until people are in medical clinics. We need to go upstream, educate people about food early on in schools, and stop the misinformation about nutrition.

Getting back to the Baszucki Group, what’s the strategy or plan that’s unfolding as a result of the work you’re doing?

Strategy and plan

Dr. Bret Scher: We’re working on multiple fronts to make an impact. One major focus is research. Dr. Shebani Sethi has already published her study. Dr. Iain Campbell is about to publish his study, and we’ve got randomized controlled trials at Emory University, the University of Pittsburgh, and one in Australia. Jeff Volek has wrapped up his study at Ohio State.

There are probably a dozen other trials happening right now, exploring different conditions. For example, Dr. Guido Frank at UCSD here in San Diego is studying ketogenic therapy for anorexia. The research is exploding, and it’s very exciting to see.

Another focus is giving people a platform to share their voices. For instance, Hannah Warren, who has been with us for about a year, has bipolar disorder. She’s managed her condition, now in remission, using a ketogenic diet. Her experience, passion, and ability to communicate are invaluable.

She’s really using her ability to communicate with others to help give voice to everybody else who’s gone through this, helping them talk about it so the world can know. It’s one thing to hear from a doctor, but it’s another thing to hear from somebody where it resonates with you. You might think, “That sounds like me. Wait, actually, that sounds like me. Maybe this will work for me.” That’s a great place to start.

The third part of our approach is teaching doctors, dieticians, nurse practitioners, health coaches, and anybody who’s going to help take care of individuals. We need to get them to learn about this. Actually, we now have some free CME (continuing medical education) available on MyCME, where clinicians can start learning about this. We want to expand on that. I’ve already spoken at a couple of Grand Rounds, and we hope to do more and more of that. We have to reach clinicians to let them know this is an option.

Again, maybe it’s not the option for everybody, but they need to know it’s an option, something that can treat not only the underlying symptoms of psychiatric disorders but also the metabolic consequences that come from having a psychiatric disorder or taking psychoactive medications.

People with severe depression, bipolar disorder, and schizophrenia are dying young, not just from accidents or suicide but also from metabolic dysfunction, and diseases like heart disease. It’s all interrelated. We have to treat those metabolic consequences. Lo and behold, there’s a nutritional strategy that can treat both the metabolic consequences and the underlying psychiatric disorder. That’s a pretty powerful treatment that more people need to know about.

Dr. Eric Westman: I’ll never forget a patient who came back to me while I was treating her for weight loss. She said, “My voices are gone.” Dr. Palmer and I have talked about this through the years. I looked at her chart – we were using paper charts at the time – and I said, “Wait a sec, what?” She had a schizoaffective disorder with active hallucinations up until eight days after starting treatment.

I talked to other people who said, “It was just coincidental. It just burned out,” and so on. However we published a case study, and other case studies have shown similar outcomes.

One of the challenges will be helping people sustain simple versions of ketogenic metabolism. I’ve worked hard with my company to make this more accessible for people. It’s important not to be overly concerned about perfection, like avoiding seed oils entirely or insisting people can’t eat at McDonald’s or Burger King. I’ve learned how to help people navigate those areas and still maintain ketosis, which is possible.

I hope the emphasis isn’t just on showing what can happen but also on helping people stay on it long-term.

Level of support

Dr. Bret Scher: That’s such an important point, the level of support needed and the sustainability for long-term use. When it comes to brain-based disorders, it’s sort of its own accountability partner for many people. A number of them know their symptoms will come back if they slip, and they don’t want that to happen. That’s their accountability partner.

You have to admit, the stakes for 5, 10, or 15 pounds of weight loss are very different from the stakes for mania, psychosis, or severe depression. The consequences are much, much greater. That, in itself, helps some people stay on track.

But that doesn’t mean it’s going to be easy for everybody to stick with it long-term. Like any diet, a ketogenic diet is no different from any other diet in that regard, especially in our ultra-processed food society. Processed foods are so ubiquitous and have become such an accepted part of society that it makes sticking with any dietary intervention challenging.

Dr. Eric Westman: I’d flip that around a bit. The reason people can’t follow a diet is because they’re hooked on sugar and ultra-processed foods, which aren’t part of any diet. They’re a perturbation of nutrition, designed by companies to make you eat things you can’t stop eating.

A diet, for health, has more in common between extremes like vegan, vegetarian, and carnivore than differences when compared to all the junk food. Lucia Aronica’s substudy from the Stanford study looked at these extremes and found both led to improvements in insulin resistance.

On the internet, there’s this false dichotomy, you have to be “meat-only” or “vegetable-only.” In reality, the focus should be on what’s happening inside the body.

It seems to me that keeping glucose and insulin as low as is practicable aligns with the cohort studies of diabetes and cardiovascular risk, as well as pre-diabetes and cardiovascular risk. To me, it’s not so important how you achieve that. How do you put together what someone should eat?

Putting together what someone should eat

Dr. Bret Scher: The timing of this, I’m not sure when this is coming out, but the U.S. Dietary Guideline Committee just made the recommendation that we should all eat less meat. It drives me nuts when I see something like that.

I did a video that basically says, “Why are we even talking about that?” We should be talking about everybody needing to be healthy. We need to worry more about health than about individual foods.

If someone is using meat as part of their diet and they’ve improved their metabolic health, their A1C has come down, their insulin has come down, their visceral fat has decreased, they have more energy, and they feel better, why in the world would we want to tell that person to eat less meat? That’s where the focus needs to be, not on individual foods.

The science is so bad at supporting the so-called “dangers” of meat anyway, but our focus is just off. It’s unfortunate, I think, because of preconceived biases and external inputs from companies, lobbyists, and others. This has really derailed us from focusing on health. Instead, it’s become about industry-sponsored policies and lobbying, as opposed to health.

I don’t care what you eat. For my patients, I don’t care if they’re vegan, carnivore, or anywhere in between. We’re tracking their health markers, and we’re going to find what makes them feel good, what they enjoy, and what improves their health. We’ll do different experiments to find the right mix, and whatever that mix is, I’m okay with it as long as we’re making progress.

Dr. Eric Westman: May I just remind the viewer that you are a board-certified cardiologist, U.S.-trained, and you’re not crazy.

Dr. Bret Scher: Thank you for that reminder!

Progress through the years

Dr. Eric Westman: I’m moving away from the traditional internal medicine approach. In our area, doctors don’t ask people what they eat. Can you imagine? Veterinarians, though, the first thing they’ll ask is, “What are you feeding your dog or your cat?”

I think there’s hope. Of course, I’m an optimist. You, too. Have you seen some progress through the years?

Dr. Bret Scher: Oh yes, definitely progress. It’s never fast enough for where I think it should be, but there’s progress. When you started 20-something years ago, and when I started my clinic in 2012, there wasn’t nearly as much information or acceptance as there is now.

Now, we have all these conferences popping up, the community rally in D.C., and so much more than we ever had before. We’re definitely moving in the right direction. I think as long as we can keep the focus on health, on making people healthier, we’ll continue to improve.

What we’re doing now isn’t working. You can’t keep banging your head against the wall and trying the same thing when it’s not working. Look, here’s an alternative. Anecdotal reports, clinical experience, and emerging data all show that it works. It’s got to be an option, and we’re starting to see that tide change.

Dr. Eric Westman: Again, just as a kind of retrospective, knowing who you are and how evidence-based you are, the mere fact that you’ve been in this space for these years is very reassuring to me. You didn’t bail out like, “What are we doing?” The fact that it just keeps getting better the more we study it is so encouraging.

Science is supposed to eventually find the truth, you know if it’s fully funded to study everything.

Thank you so much for what you’ve done before and what you’re doing now. I look forward to more great things from you, Bret.

Dr. Bret Scher: Well, thank you very much. I appreciate it. And thank you for all of your work and for being a trailblazer in this area. Thanks for having me on today.

You can watch the full video here.

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