The Moment Bret Scher Moved Away from Plant-Based and Toward Low Keto

Summary

In this insightful conversation, a cardiologist reflects on his journey from advocating a vegan, low-fat diet for heart health to embracing low-carb and ketogenic approaches. Initially influenced by mainstream guidelines and mentors, he shares his struggles with the limitations of conventional treatments, the challenge of patient non-compliance with lifestyle recommendations, and the realization that traditional practices often fail to deliver the expected outcomes. Ultimately, the conversation highlights the importance of critical thinking in medicine and the need for more personalized, effective healthcare strategies.

Takeaways

• 😀 A cardiologist with a background in the Ornish style preventive program transitioned to advocating for low-carb and ketogenic diets, which sparked his journey into questioning conventional dietary practices.
• 😀 Dr. Dean Ornish is a prominent advocate for a plant-based, low-fat diet, particularly for heart health. His program emphasizes smoking cessation, exercise, stress management, and community support, with the vegan diet being portrayed as a key component of its success.
• 😀 The doctor initially believed the vegan diet was crucial for heart health, following the prevailing medical understanding of that time, which stressed the importance of lowering LDL cholesterol.
• 😀 The doctor reflects on his earlier perspective, admitting that he would have believed a plant-based diet was the only way to lower LDL cholesterol and improve heart health, due to limited critical thinking at that stage of his career.
• 😀 There is a recognition that, in medicine, guidelines are often followed rigidly, without enough focus on the individual needs of patients, and critical thinking is sometimes undervalued in favor of established practices.
• 😀 The doctor recounts a moment where he shut down an intern's critical thinking about aortic valve replacement, only to later realize that changes in guidelines and techniques were needed, highlighting the importance of evolving medical practices based on critical thinking.
• 😀 Guidelines in medicine can streamline care and save time for clinicians, but the danger is that they often lead to treating patients as statistics rather than individuals, which can overlook personal factors in care.
• 😀 The doctor emphasizes that changes in medical practice are slow, with the average time for a shift in practice to be incorporated into guidelines being around 17 years, making progress in medicine frustratingly slow.
• 😀 The doctor faced a realization that cardiology, while effective in extreme cases (e.g., heart attacks or heart valve replacements), was not as successful in preventing or reversing heart disease through lifestyle interventions alone.
• 😀 After seeing patients struggle to adhere to lifestyle changes such as diet and exercise, the doctor questioned whether the standard lifestyle recommendations were truly effective, leading to a search for alternative approaches to improve patient outcomes.

Q & A

What was the initial stance of the speaker on a vegan diet for heart health?

Initially, the speaker was fully on board with the low-fat, plant-based vegan diet for heart health. They believed it was crucial for lowering LDL and considered it to be the primary solution for cardiovascular disease, as taught during their fellowship.

How did the speaker describe the role of Dean Ornish in promoting a vegan diet for heart health?

Dean Ornish is depicted as a major advocate for the vegan diet, promoting it as the key solution for heart health. However, the speaker notes that Ornish's program also emphasizes other elements like smoking cessation, exercise, stress management, and community support, which contribute significantly to the success of the program.

What realization did the speaker come to after practicing cardiology?

After entering their own practice, the speaker realized that while cardiology can effectively address extreme cases, such as heart attacks and heart failure, it struggles with preventing these issues or helping patients improve their conditions without resorting to extreme measures. This led to a search for better approaches to heart health.

Why did the speaker begin questioning the effectiveness of the standard lifestyle recommendations?

The speaker became frustrated with the failure of standard lifestyle recommendations (low-fat, calorie reduction, and increased exercise) to yield significant results. They noted that most patients found it difficult to comply with these recommendations due to cravings, emotional struggles, and lack of proper support.

What critical shift in perspective did the speaker experience regarding guidelines in medicine?

The speaker recognized that while medical guidelines are meant to streamline care and make it easier for clinicians to practice medicine, they can often stifle critical thinking. The speaker reflected on how guidelines can be slow to change and how this sometimes prevents doctors from adopting better practices that would better serve individual patients.

How does the speaker feel about the pace at which medical practices and guidelines change?

The speaker expressed frustration with how slowly medical practices and guidelines evolve. They cited the statistic that it can take up to 17 years for a practice to change and emphasized the challenge for researchers to admit when their long-standing views may be incorrect.

What role did the concept of 'critical thinking' play in the speaker's journey?

Initially, the speaker admitted to being focused on absorbing information from established experts without questioning it. However, as their career progressed, they came to value critical thinking and realized that ignoring it can lead to outdated practices. The speaker noted that embracing critical thinking ultimately led to better patient outcomes and the reassessment of treatment guidelines.

What was the speaker’s perspective on the 'group think' mentality in medicine?

The speaker acknowledged the power of the 'group think' mentality and how it shapes medical practices. They pointed out that it’s hard to break away from the conventional dogma, but this can create problems, especially when it leads to adherence to outdated or ineffective practices that don’t prioritize individual patient needs.

How did the speaker describe the transition from fellowship to independent practice?

The speaker noted that the transition from fellowship to independent practice allowed them to see the limitations of their previous training. In fellowship, they were not responsible for long-term patient outcomes, but in their own practice, they began to understand the challenges patients face in adhering to prescribed lifestyle changes and the need for alternative approaches.

What specific aspect of cardiology did the speaker find lacking when treating patients long-term?

The speaker found that cardiology was effective in treating acute issues but lacked a strong approach for long-term prevention and improving patients’ overall quality of life without requiring drastic interventions like surgery or medications. This realization led the speaker to explore alternative approaches to heart health.