The Shocking Truth About Low-Fat Diets and Heart Health – Jaime Seeman - #CoSci

Dr. Jamie Seaman is a holistic obstetrician and gynecologist with a focus on fitness, nutrition, and ketogenic therapy. Known for her medical expertise and media appearances, please welcome Dr. Jamie Seaman. Thank you, Dave. You guys, one round of applause for Dave because I found out he's resistance training. I'm so proud of you. Next year, he's going to be totally jacked. I know. Well, thanks for having me. It's really good to be here. For those of you that don't know me, Dr. Jamie Seaman, if you want to follow me on Instagram, at DrFitnessFabulous. I'm a gynecologist. I didn't know we could tell jokes up here. Dave didn't tell me that. So I guess there's a little icebreaker since we're back from break. Do you guys know what a deaf gynecologist does? They read lips. I only get to say that because I'm a gynecologist. So don't use that one in the bar, okay? All right. Okay. All right. That's going backwards. Okay. A little bit about me. If you don't know my background, long before I became an OBGYN, I grew up in Nebraska and, you know, standard American diet. I was an athlete, so I got away with eating the standard American diet for a really long time. But I went to medical school where I met my wonderful husband. He's here in the crowd somewhere today. Hey, babe. And we went to medical school. We got married. We had three children. But when I made this transition from college to medical school, it was the first time in my life where I went from being extremely active to suddenly being very sedentary. Now, I got my degree in nutrition and exercise science, and then I went to medical school. And so here I am the first time in my life struggling with my weight, struggling with my health. I'm having these pregnancies. I'm failing my glucose testing. And fast forward to the end of my training and having three small children, I was diagnosed with prediabetes, and I was hypothyroid. I was on medication for that. And this picture here on the left was actually only, gosh, I don't know, five, six, seven years ago maybe now. And maybe you can't see it, but I mean, I was very inflamed. I was tired. I just didn't feel like an awesome human. And I thought that's just what life is like when you're a doctor and your husband is a police officer and he's working nights and you have three small children. So I kind of went on this personal mission back in 2015, 2016 to figure out my own health because I felt like as a health practitioner with a medical degree and a nutrition degree and an exercise science training that I would know the perfect diet and the perfect way to train and exercise to prevent disease. And I didn't. So I went on a path to figure it out. And I can tell you now that I'm the best health I've ever been in my entire life. My hemoglobin A1C is 5.0. I no longer take thyroid medication. I'm back in the gym training and lifting weights. We're going to get Dave like dead lifting here soon. So today's story is lessons from a gynecologist because never in my life did I think as an OBGYN that I would be standing here on the stage talking about metabolic health. So I'm going to tell you a story. Dave wanted me to tell you a story today. Okay. I can't figure out the up or down button. So you whoever who was up here earlier who can figure it out. Okay. Patient story time. This patient is 70 years old. She was born in 1954 and she went to college and then she went to nursing school. She was a nurse. That was her career. A little bit about her family history. Her mother was a smoker and had pretty significant cardiovascular disease. Other than that, there really wasn't a lot of health issues in her family. Her father died at age 52 of leukemia. She smoked in college, you know, in the 70s. That was kind of a popular thing. And then when she went to nursing school, she was telling me this story about how the nurses used to sit at the ICU desk and smoke cigarettes and they would wait for the attending physician to come round on the patients. And the way that they knew that the attending physician was coming to rounds is they could see his pipe smoke coming down the hallway. I mean, this just blows my mind because, you know, I didn't practice back then, but she's telling me this story and I was quite fascinated by, you know, what we know now. But she only smoked for a certain couple years until she decided to have children and so she stopped cold turkey when she got pregnant. So in midlife, she was actually quite healthy. She did, what did they call it, like jazzercise for a little while and she was just kind of eating a normal diet. But when she would go to her annual exams, they would tell her she had elevated LDL cholesterol. So in the early 1990s, when statins became a really hot thing, she was started on statin therapy. That was really the only medication on her med list at the time. And she was told to eat a low fat diet that fat caused heart disease. So when I talked to her about what her diet was like back then, she used to order like bean burritos at Taco Bell or she would eat pretzels or hot tamales because those are low fat. And she would eat mostly chicken, but, you know, occasional beef, maybe some fish. So she really struggled with her weight most of her life. She really struggled with obesity. I'm not sure what her highest weight was or her BMI or her body fat, but she was, you know, she described to me that she was generally overweight most of her life after she had children. Now she had had some success with the Atkins diet when the Atkins diet became very popular. And at one point, she really committed to the Atkins diet. She went on a very calorically restricted Atkins diet, was doing some treadmill walking, and she was able to lose a hundred pounds. So that was the most success she had ever seen in her life when it came to her health. And she really only does cardio when she's trying to lose weight. Other than that, she's not a regular exerciser. In her 40s, she ended up having a hysterectomy for problems with her pap smears, which is completely unrelated to her cardiovascular health. But I'm a gynecologist, so I just put that in there for you. Because of her hysterectomy, though, she's not sure when she went through menopause. She really didn't have a lot of symptoms, and at that time, her doctors never offered her hormone replacement therapy or medical hormone replacement is what we're calling it now. But she continued on high-dose statin therapy, and she did have some side effects from it. She described at certain points her doctor would trial different statins because she was having some myalgias, or she would have some elevation in her muscle markers on her lab work. So she was on and off lots of different statins. Then in her late 60s, she was diagnosed with prediabetes. She was also diagnosed with Hashimoto's, which is an autoimmune thyroid condition, but she never had to go on thyroid replacement. And then in her 60s, she started getting on social media, and she would see Instagram and all these things talking about how evil statins were. So she really started to question if she should be on a statin for her LDL cholesterol. And so at one point, she talked to her primary care doctor about stopping her statin therapy, and her doctor was very opposed to this idea. But she said, okay, well, why don't we take you off of it, and then I'll have you come back in like six to eight weeks, and we'll recheck your lipid panel. Well, for those of you that don't know, her doctor was quite evil, because what will happen when you suddenly stop statin therapy is you'll get this rebound effect in cholesterol, and her cholesterol is going to be through the roof when she goes to get this blood draw, which is exactly what happened. So she panicked, and her doctor restarted her on the statin therapy. So then at age 68, she starts seeing things on the social media about this coronary artery calcium scan. And so I actually recommended to her that maybe she should go get a coronary artery calcium scan, because this is an excellent way for patients with elevated LDL cholesterol to risk stratify, essentially, the possibility that they may have a cardiovascular event. So she goes to get the CAC scan, and I want to take a public survey of what her score was. Is there anybody that thinks her score was zero? Any takers? Any takers? A few. Okay. How about 250? Anybody at 250? Anybody at 500? Okay, a few. 1,000? 1,500? 2,000? Anybody at 2,000? Okay, we have a great bell curve in the room. We have a great bell curve. Her score was just under 1,900. So she had a really, really high calcium score. So she panicked, absolutely panicked, and she went to see a cardiologist to decide what to do next about this incredibly high coronary calcium score that she got. So they did something called a CT angiogram. So she goes in, and they put dye into her IV, and they put it through her heart, and they scan her in the CT scanner, and it confirmed that she had very significant atherosclerotic disease. There wasn't any narrowing that they could see, but she did have complete occlusion of her right coronary artery, but there was what they call significant collateral circulation. So this had happened over a really long period of time, and her body was able to make these small little blood vessels around that blocked right coronary artery. So it appeared from the CT angiogram that her heart would still be perfusing. Cardiology adjusted her statin, actually increased her dose, I believe, and when she asked them about a ketogenic diet, because she had been hearing about that on social media, they told her that that would kill her, that saturated fat was a horrible idea, and that she should consider a plant-based Mediterranean diet. So now she's even more confused. She did seek the advice of an integrative cardiologist who was quite supportive of her ketogenic diet, adjusted some supplements that she was taking, and also talked to her about other, you know, holistic and integrative modalities. And for those of you that don't know, after my OBGYN residency, I completed a fellowship in integrative medicine. So for these patients, I'm very supportive of these alternative therapies, but I do practice Western medicine, and for most of my patients, it's kind of finding the balance of what's going to really give them, you know, the best quality of life. So I was really supportive of this. During COVID, she developed pretty severe atrial fibrillation and just started to get very paranoid because she would get symptoms from the AFib, and she wasn't sure if she was having a heart attack. So she was constantly trying to decide when to call her cardiologist and when to go to the ER, or maybe if she should just stay home and count her blessings. So at one point, they said, well, you know, let's get a stress test. Let's put you on a treadmill, and we'll, you know, increase the speed, and we'll put it on an incline, and we'll really see how well your heart is perfusing when you exercise, because knowing that she had this horrible disease, she was actually afraid to get back on the treadmill and start walking. Well, she passed the treadmill stress test. With flying colors, they were actually quite surprised how long she could go in the stress test with how bad her CT angiogram looked. But they did an echo right after the stress test, and it did show some wall motion abnormalities. So they were a little bit concerned that maybe there was some hypoperfusion happening, and they really didn't know what to tell her at that point. And so they said, what will break the tie in this situation is to perform a heart cath. So now they're going to take her to the cath lab, not emergently, but in the near future, and they would actually, it's a more invasive test than a CT angiogram, but they would be able to actually look at these arteries in her heart and figure out if there really was some narrowing that maybe required a stent, or maybe required open heart bypass grafting. So the patient is actually my mother, and this is my mom. She's not here, but maybe she'll watch this on YouTube. So when I went to medical school, my mom said, I don't care what you do, but please don't be an OBGYN. That's all she said. And she was in nursing, and then later in her life, she got into healthcare administration. She actually was in charge of the Department of Surgery. So at a young age, she exposed me to medicine, and she's the real reason that I went into medicine. She had had a hysterectomy, so she said I was no good to her anymore, because she was like, why couldn't you do plastic surgery or something? Well, who would have known years later, I was helping my own mother navigate our healthcare system, and she had significant metabolic disease and significant heart disease. And I was just amazed sometimes sitting in these meetings, or these clinic visits with her, and listening to what these doctors had to say. So my mother has taught me so much, and so I'd love to just dedicate this whole talk to her, because I am her daughter. And my father's side, so my family history, so my mother obviously has very bad cardiovascular disease. My father comes from a long line of normal BMI diabetics. So it's no surprise that when I abused carbohydrates and stopped working out, that I developed prediabetes. So thank God for my parents for teaching me so many lessons that hopefully I can pass down to my own three daughters. So let's talk about my mom's case. What can we really learn from this? So she was on statins for 30 plus years, and we'll call it a low-fat diet, but it wasn't healthy. It was like a standard American low-fat diet. But her question to these cardiologists was, I've been on statins for a really long time that are supposed to prevent heart disease, and I have horrible heart disease. Now what the statins probably did is they probably hardened the calcium plaque. So you can imagine her coronary arteries are like these just concrete pipes, which is good because unstable plaques are more likely to rupture and create a heart attack. And they actually think she may have had like a silent myocardial infarction at some point as that right coronary artery was was closing down. But she developed cardiovascular disease despite statin therapy. She developed prediabetes, probably a combination of lifestyle and actually statin therapy, and mitochondrial dysfunction. She also developed sarcopenia. Now she didn't do resistance training, and she developed osteopenia. So her first DEXA scans showed that her bones were softening once she was postmenopausal. So I want to talk to you about the role of menopause and the role of estrogen. I'm not a cardiologist. I'm not a lipidologist, but estrogen actually plays a very important role in our cardiovascular health and in our metabolic health. So I want to define for you in really simple terms what estrogen does in the body. Now most people think of estrogen as a female hormone, but men have estrogen too. And estrogen is very important to men. And in both men and women, we make our estrogen actually from an androgen called testosterone. So for men who have low testosterone, they don't get as much estrogen and they don't get as much protection to the cardiovascular system. So in the pancreas, when we have estrogen, it actually improves our fasting insulin levels. It's quite amazing actually where estrogen receptors are found in the body. They're even in the inner ear. I mean, that's how, you know, disseminated estrogen receptors are in our bodies. But they improve glucose-stimulated insulin secretion. So each one of these points, I'm going to tell you what happens when you don't have estrogen. So as women lose estrogen when they go through menopause or they're in perimenopause, we start to see an elevation in fasting insulin and glucose levels and an increased risk of diabetes. In the liver, kind of the same thing, it works in tandem with the pancreas. It helps modulate gluconeogenesis and improves our hepatic insulin response and reduces hepatic insulin degradation. So in, you know, working with the pancreas once again, more insulin resistance, higher glucose levels, and that of course has downstream effects, more visceral fat and lots of metabolic disease. In the adipose tissue, estrogen also improves insulin sensitivity. In the talk earlier, somebody was talking about lipoprotein lipase. So it actually affects lipid metabolism within the fat cells, but it also reduces oxidative stress. In our skeletal muscle, estrogen improves insulin-stimulated glucose absorption, and it actually is anti-catabolic. So it's not an anabolic hormone as much as testosterone is, but estrogen is what I call anti-catabolic and is good at protecting the lean body mass. So for somebody like my mom, when she goes through menopause and she loses that estrogen production, her rate of sarcopenia starts to, the risk of sarcopenia really starts to increase if she's not strategic in dietary protein and resistance training to help maintain that lean body mass. Because the reason I'm such a fan of resistance training, Dave, is that if you're like me and you're a former pre-diabetic who likes eating some carbs, you know, maybe I want to be on a low-carb diet instead of a completely ketogenic diet, muscle is one of the greatest disposal agents of glucose. So if we can keep healthy muscle tissue, it helps us avoid metabolic disease. Now within the endothelium, which is the lining of the inside of our blood vessels, estrogen improves nitric oxide production, which is a vasodilator. So it helps those blood vessels dilate and keep them from constricting, which we know if they constrict too much, it can increase our blood pressure. So it's not uncommon after menopause, I literally just had a patient this week that was in my clinic and she suddenly had hypertension after she went through menopause. And so her doctor started her on a blood pressure medication and she came to talk to me about whether medical hormone therapy was a good idea for her because she really was doing a lot of lifestyle things well and developed this hypertension out of nowhere. The brain. The brain loves estrogen. It's very neuroprotective to our brain, especially an aging brain. It is an important part of our development as a young girl, primary sexual development, cognition, our memory, maintaining our body temperature, and of course that drives our feeding and sexual behavior as humans. So with the loss of estrogen as women enter menopause and beyond, there tends to be hypometabolism of glucose. So there's about, from what I've seen in the studies, about a 30% reduction in brain energy. So with the loss of estrogen, there's a brain energy deficit and patients will develop mild cognitive impairment, increased risk of things like Alzheimer's. We see a lot of mental health disorders that can happen due to the loss of estrogen in the brain. And then I mentioned when it comes to bone that my mother developed osteopenia. It does inhibit bone resorption and remodeling. So estrogen and testosterone, hormones in general, are very protective to our bones. So as women make this transition, the bones will increase their bone resorption. They'll start softening. And we typically actually, unless patients have risk factors, aren't screening with DEXAs until women are in their sixth decade of life. So once you're 10 or 15 years past menopause, a lot of damage has been done to the bones in that regard. So I'm a huge fan of getting these scans done a lot earlier so that patients can see where their bone health is. We reach our peak bone mass actually very early in life, like in our 20s. So we have to be really cognizant of this because as we get old and we become sarcopenic and we become really frail and we increase our risk of tripping or falling, if you break your hip after the age of 60, your risk of being dead in one year is like extremely high. So there's a lot of things that we're going to get taken out by in this world and falling and breaking a hip should not be one of them. So we have to pay attention to our bone health. So I want to go back to this idea that the loss of estrogen causes mitochondrial dysfunction. So pretty recent studies, this one was from 2008, show that estrogen regulates the structure and function of our mitochondria. So they actually increase the expression of respiratory complexes within the mitochondria. They change antioxidants within the mitochondria and they have anti-apoptotic factors that impact the structure and function. So essentially they help keep our mitochondria around and functioning how they're supposed to. And they do this by changing gene transcription that happens when the alpha estrogen receptor gets stimulated. And there's a cute picture of a mitochondria at the bottom. Okay, so hormone replacement therapy. There are so many metabolic disturbances that happen with the loss of estrogen. And one thing that happens, like I said earlier, is insulin resistance. And there is a significant risk of metabolic syndrome when patients go through menopause. We know that estrogen is essentially anti-inflammatory. So there is a relationship between the insulin resistance that develops and kind of a low-grade inflammatory state. So I am a huge fan of estrogen replacement. Now, in the current guidelines put out by the North American Menopause Society and the American College of OBGYNs, estrogen therapy is not an FDA-approved therapy for prevention of cardiovascular disease and prevention of diabetes. But in the studies, the patients that take estrogen have less cardiovascular disease, less diabetes, less osteoporosis, less colorectal cancer. And in the estrogen-only arms actually had less breast cancer, which is the most common cancer that gets brought up when we talk about hormone replacement therapy. So estrogen has an extremely important role. Now, for many, many, many years, my mother, when she was becoming menopausal, there were some large trials that came out that scared a lot of practitioners and a lot of patients away from use of hormone therapy. And we're really starting to see the pendulum swing now in the other direction. Menopause is kind of getting its limelight right now. Women in this room will live more than 40% of their life post-menopausally. That's like darn near half. So, you know, what used to happen is the lifespan wasn't very long and we didn't live a lot past menopause, so nobody wanted to talk about like longevity and aging. But because cardiovascular disease is the number one killer of women, we have to understand the role that estrogen plays in our metabolic health. And I'm a huge fan of hormone replacement therapy, and it's hard for me to know if my mom maybe would have been offered that if her CAC score wouldn't have been 1,900. It's hard to know. Okay. I'll probably have like five minutes for questions if you guys are coming up with those in your brain. But this is my next case report. So my husband is here. He's down here. Hi. Dave already knows this story. It'll be a whole presentation hopefully one day. But five, six years ago, my husband and I, this was actually before my mom got her coronary calcium, we decided to go get coronary calcium scans. We were in our late 30s. And of course, I thought that they would both come back with a score of zero. We were young. We were pretty healthy. My score was zero and his was not zero. It was like 186. Is that right? So we both kind of panicked, to be honest, because we thought it would be zero and it wasn't. Now his grandfather dropped dead of a heart attack when he was in his 50s. So there certainly could be a risk, you know, a familial risk there. And he didn't eat the greatest diet growing up. But at this point in our life, we were exercising, we were working out, and his lipid panel was beautiful. His labs, I mean, everything, he's beautiful, but his labs look great too. So of course, what was recommended to us is that he start a statin, that he start aspirin therapy, and that he eat a low-fat diet. So like Corinne did earlier, I mean, we kind of doubled down and we just said, we're going to stick to our ketogenic diet. At the time, it was actually very meat-based, lots of butter, lots of saturated fat, everything they told us not to do. And from talking to experts in the space, they said, well, the rate of progression is what's important. So repeat the scan in five years. So we anxiously waited five years and he went to get the scan repeated. And we were both really nervous when he went to get the second scan. He actually went to a different hospital to get the second scan. So this complicates the story, but his CACs came back at zero. So then we're like, well, this is interesting. Like, did you reverse your coronary calcium or was the first scan wrong? Like, we're really confused. So then we sent him back to the hospital to get a CT angiogram, because if we did reverse his calcium score to zero, the question would be is how much soft plaque is there? Maybe we just pulled the calcium out and there's a bunch of soft atheromas in his vessels. So he went and did the CT angio and his arteries were crystal clear, which was very reassuring to us. So we're currently having people look at his original scan to see if it's real, because if it's real, then it'll be the next case report here at the Citizen Science Foundation meeting. The only thing he added besides the ketogenic diet was vitamin D3 and K2. That was the only supplement that he added. But we did start to do probably more magnesium in our diet. He did some sauna therapy and all the weird things us biohacker people do. So time will tell, but hopefully that'll be the next story I tell you guys. So okay, we have three minutes and 20 seconds for questions, if anybody has questions. The question is, is hormone therapy contraindicated with a family history of breast cancer? And that is correct. It is not contraindicated. Personal history of breast cancer, we wouldn't use it. But if you have a family history, it does not mean that you're not a candidate for it. There is no basic science research that shows that estrogen or progesterone causes a breast cell to turn into a cancer cell. That mutation happens likely through some other mechanism. But a breast cell, when it first turns into a cancer cell, it maintains its receptors. So it maintains its estrogen and progesterone receptors until it mutates further. So if you have a breast cancer cell in your breast right now that we can't see with mammogram or MRI, I can't feel it, you can't feel it because it's not big enough, and I give you hormone therapy, it could make it grow. And that's what happens a lot of times is somebody will start therapy, get diagnosed, and they're like, whoopsie, took estrogen, got breast cancer. So that's what we thought for a really long time. But no, you would still be a candidate. Should every postmenopausal patient be on hormone therapy? The vast majority of patients who are within 10 years of menopause, the pros likely outweigh the cons. It's an individual discussion. I mean, like I said, the pendulum is really swinging. And from my standpoint, the patient really has to want to do it. I mean, I have patients that are convinced it's going to do and in that case, then we just don't do it. But for the vast majority of patients within 10 years of menopause, it's a good idea to consider it. After 10 years, the benefits aren't as robust. It does not mean that if you're 10 years past menopause, you can't do it. But it's much better in mitigating risk than reversing existing metabolic disease. Is my mom taking hormone replacement? So of course, she was very late to the game because of her osteopenia. We actually did put her on a short stint of estrogen and testosterone replacement. And we actually saw a significant improvement in her bones. So she did it for a short while to help her muscles and her bones. But there was a lot of question with her cardiovascular disease, if it was a good idea or not. And the unfortunate part is we don't have that literature. So my poor mother was sitting in a Las Vegas casino deciding to put money on red or black legitimately because we don't have randomized control trials where we take people with significant heart disease and put half of them on estrogen and half of them not and find out what happens. And I think most cardiologists would be scared to do that. But we know what estrogen does. I mean, I just told you it's a vasodilator. It stabilizes the endothelium. But with oral estrogen replacement, there is an increased risk of thrombosis because it increases clotting factors. But we don't see that with transdermal, so like through the skin. So my question, you know, in a study is, would transdermal estrogen therapy be helpful to these patients? But I cannot tell you that answer. Thank you, Jamie.