Newest 2KetoDudes podcast with me and my buddy Tom Seest

(8 year Ketogenic Veteran) #1

Oh geeze. Here we go. Episode 88, just in time for Halloween.
“Scary Heart Stories”
with my good friend @TomSeest
We talk about how the ketogenic diet helps with our heart issues. He has his issues with the upper two chambers of the heart, me the lower two chambers. Together we make a perfect heart! :purple_heart:

(đ૯αท ʍ૯ઽƬѳท) #2

Another terrific episode!

(*Rusty* Instagram: @Rustyk61) #3

I downloaded it already and will listen to it today at work.

(Paula Green) #4

Fantastic episode! It got me out of the house this morning to go swimming - I only listen to podcasts in the car or when I’m walking. I was so desperate to listen that my reservations about whether to go swimming were quickly over ridden by the thought of half an in the car listening to you all :slight_smile:

My husband had a few heart issues last year (nothing as serious as Tom and Brenda) but I got to spend a quite a bit of time listening to his cardiologist and seeing his various tests. So this episode seemed familiar, but it was much nicer listening to Tom and Brenda explain everything in a way I could understand and in just an interesting manner.

So pleased that the keto diet is working well for you both to manage your conditions.

(*Rusty* Instagram: @Rustyk61) #5

So, @Brenda, I listened and am very excited about how the fasting has improved yours and Tom’s issues. When I was 28 years old (56 now) I had a MI and it left some scaring. I’ll be following your post much more closely now.

(Erin Macfarland ) #6

Great episode!

(Mel Soule) #7

Great episode and recipe BTW.

(Dawn Comber) #8

I listened to the podcast twice back-to-back. As always, the 2 Keto Dudes podcasts are full of great info and inspiration!

(Bret Scher) #9

I am getting caught up on past episodes of 2KetoDudes, and this on was an interesting episode. I love pretty much everything Carl and Richard do, but tis episode concerned me a little. As a cardiologist I want to weigh in and clarify a few things. I am concerned about the concept that Tom’s heart function improved due to the keto diet and fasting. I am a huge fan of ketogenic diets and IF, and there are many many benefits. but I don’t think correcting AF related heart dysfunction is a direct effect. I see this all the time. Someone has rapid AF and their heart function is reduced (its called a Tachycardia-mediated cardiomyopathy). As soon as we slow the rate down with medications (metoprolol or other beta blockers) their heart function recovers very rapidly. It sounds like Tom was put on a beta blocker and his rate improved. I would argue that was the most likely reason for his improved heart function. I think he should continue with his keto lifestyle and IF, but I caution giving others the idea that if this happens to them, they don’t need meds, they just need ketosis and IF. Also, regarding the diagnosis of “scar” in Tom’s heart. I would caution about taking what your doctor says with too much certainty. To truly diagnose a scar, you would need an MRI or specialized nuclear uptake scan. My guess was that the diagnosis of “scar” was incorrectly made from the beginning. Reduced heart function does not equal scar. Trust me, I think Tom is benefitting his heart with keto and IF, but I felt the need to correct what I see as errors of interpretation to hopefully help others who may be in a similar scenario. If anyone has any questions, please reach out to me at www.LowCarbCardiologist.com. Keep up the great work Carl and Richard!

(8 year Ketogenic Veteran) #10

Hello Bret, yes, there is an incredible amount of work that Tom has done, much much more than was on this podcast. Hopefully you could talk to Tom himself.
As an update, Tom’s AF has finally resolved. This is rather recent.
@TomSeest

(Tom Seest) #11

Glad to see you’ve joined us in the forums, Dr. Scher. I’ve been following your excellent podcast for about a half a year now, and only wish that I had come across you earlier in my unfortunate journey. People like you, Dr. Jack Wolfson, and the many joining you have tough work ahead of you, but it is both challenging and rewarding.

Unfortunately, as you know, a podcast is an excellent medium for getting the word out about a concept, but can be a difficult medium to actually get details out about specific challenges, etc. So, I’ll provide more detail here, as I have in many other online forums, that will help clarify some of my points.

First of all, I was fortunate to locate and find three cardiologist that would work with me as a cash patient, that did not have insurance, and that weren’t necessarily pro Keto, but most certainly didn’t fear fat. I assure you that this was not an easy task.

My first cardiologist reviewed my blood extensive blood tests that I ordered, and the blood tests that I had been doing with @DaveKeto (Dave Feldman) before, during, and after my pneumonia, and he agreed that the pneumonia was the direct cause for the creation of the atrial substrate. He referred to it as either scarring on my lungs, my pulmonary vein, or my heart. He may have done this because he was trying to simplify the message for me, but I don’t honestly know. After the first electro-cardioversion failed on February 26, 2017 after 40 hours, he wanted to refer me to an EP to get mapped, and have an ablation done. So, this was the path he was recommending to me. Being a cash patient, and being risk adverse (I had read lots of books, studies, etc by then, I decided at that point that I didn’t want to try anything invasive as I felt it would add unnecessary risk to a bad situation.

Keep in mind that while I was in this condition, with my heart in tachycardia non-stop, I was working full time to support my family.

So, after reading about atrial substrate, theories about rotors, various triggers, etc., I opted for continuing my Ketogenic diet and fasting, along with supplementation, rest, etc. But, I couldn’t get my heart rate low enough, and the tachycardia persisted. Keep in mind that I wore a heart rate strap 24x7, monitored my BP 3 or 4 times per day, took regular ECG’s with my Kardia Alivecor, etc., but I couldn’t take the final edge off the Tachycardia. I could get the heart rate down at night, while resting, but I was regular averaging 120’s, 110’s, etc. during the day.

So, at that point in time, I found my second cardiologist located in Mexico. I went there because the price of procedures, medications, etc were within my budget, and I wasn’t doing well. He diagnosed me with CHF and a LVEF of 27%, wanted me on Metoprolol, an Ace inhibitor and an ARB. He also wanted to implant an ICD, and advised that I get on a heart transplant list. I opted to only take the beta blocker (later switched to Bystolic), because it seemed to take the edge off the Tachycardia. At the time, I had difficulty walking or climbing stairs, but I could still function. But, I know for a fact that the Beta Blocker dropped my Heart rate initially about 20 points, and eventually back into the normal range. I have no doubt that it helped.

About 2 months later, I located an another excellent cardiologist in St. Louis (Dr. Anthony Pearson in St. Louis (https://theskepticalcardiologist.com) and he confirmed the CHF, but noted that it was improving. I continued with the med, and continued doing what I was doing with supplements, dieting, fasting, etc. In December, I went back and saw him after seeing marked improvements in my blood work with my BNP / NT-BNP Pro readings, and felt I was ready to get cardioverted again. He wanted to put me on Amiodarone in preparation for an electrocardioversion, but I declined. I instead opted for 10 weeks of Berberine as an Antiarrythmic, and went in for my 2nd and hopefully last cardioversion on 2/27/2018. Dr. Pearson was skeptical that the cardioversion would stick for any length of time (and he may still be correct), but I have now been in Normal Sinus Rhythm for over 70 days.

So, let me give you the science behind some of my statements to clarify why I said what I said in the podcast.

Regarding a ketogenic diet and fasting with heart failure, I read many studies / articles on the top of fuel preference in the failing heart. While I always felt better when I stayed purely ketogenic (many advised cycling the diet), I had no actual science to base my decision to stay purely ketogenic or stick with fasting other than instinct. However, in the latter part of journey, I came across this study, which made me feel that I made the appropriate decision: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4766035/ This study basically says that the failing heart needs ketones and FFA’s for fuel, and the the blood glucose pathway is hampered / hindered in the failing heart.

Regarding fasting, I have no direct evidence that I had scarring, because as you point out, I had none of the expensive scans, mapping, etc. done, and I certainly had nothing invasive done. However, when I did visit my 2nd and 3rd cardiologists later, they indicated that I HAD TO HAVE HAD hypertension (even though my history of BP readings prior to the A-Fib did not indicate hypertension), because there was no evident substrate. My 2nd & 3rd cardiologist both indicated that the tachycardia was maintaining the A-Fib, and the A-Fib was maintaining the Tachycardia. While mostly true, after I lost the tachycardia, I did not return to normal sinus rhythm on my own. I realize this happens, especially after being in constant A-Fib / Tachycardia for so long, but at some point; I should have hopefully returned to NSR.

Regarding Fasting, I did many fasts, but actually recorded extensive data for one of them. Before I had A-fib, I did lots of fasting / data recording for Dave Feldman, but I didn’t have the energy to do it while I was in constant tachycardia / A-Fib. On November 30th, 2017, I did a six day fast to measure the impact of fasting on inflammatory markers that were important to me at the time, and I recorded the extensive data during the fast on this spreadsheet here: https://1drv.ms/x/s!AnnheiLCcfWxgcE0qf2dNsbEiD0ysQ
Keep in mind that at the time, I had done extensive reading on blood markers and other indicators that would be good indicators as to wether I could return to Normal Sinus Rhythm and stay there after recovery. So, I focused on BNP during this particular fast. My BNP went from 147 to 75 during the five days, which as you know, is in the normal range. I wish I had the money to do the lab testing that I wanted to do, but I couldn’t afford much at the time, as we were selling our house. But, fasting has a remarkable impact on calming the inflammation around the heart, and the enzymes that respond to it. Do I have evidence that fasting helped save my heart. No. I have data that indicates that it helped, but I don’t have any direct supporting evidence.

While I couldn’t find much supporting evidence for my decision to use Berberine as an antiarrythmic, I clung to hope with the results from this study: https://www.hindawi.com/journals/bmri/2017/3146791/. After reading it, and many other articles studying how berberine works, I made the decision to supplement it instead of taking Amiodarone. Was this a mistake? Possibly. I’ll probably never know. But, I saw plenty of downsides with taking a 6 month to year course of Amiodarone.

I ordered lab work on the day of my electro cardioversion and my BNP was 84.5, so I felt my odds of the cardioversion sticking were probably pretty high. On March 12th, I had my BNP and ProBNP measured and they were 24 and 88 respectively. At this point, Dr. Pearson truly believes that I’ll be in NSR for some time.

Is the scarring or substrate gone? I don’t know. Did it ever exists? I really don’t know. I do know that I didn’t have hypertension. I do know that I didn’t have A-Fib before the pneumonia. But, I do acknowledge that there is much that I don’t know.

I did the best I could, given my budget constraints, my schedule, etc. and I’ll stick by that.

If I had followed the advice of my first cardiologist, I would have seen an EP and had at least one ablation. If I had followed the advice of my 2nd doctor, I’d be in NSR now, but contending with an un-needed ICD. Would these paths been better? Possibly, but I’ll never know.

In any event, I agree that people have to be careful when considering their diet, and fasting during A-Fib and with heart failure. I will assure you that I was extremely cautious and risk adverse during all my fasting, and with my diet. I watched my heart rate data, my heart rate variability data, my bp, etc. religiously, and maintained a highly optimal intake of broad nutrients using organ meats, organic vegetables and supplementation. I’m not sure that I would advise others to try this. But, if they have no other choice, it is an option.

As I said before, I look forward to continuing to listen to your podcast, and I really look forward to the day when your work is taken for granted and your community of specialists don’t fear fat, etc any more. With your specialty in preventive cardiology, you’re saving lives you don’t even know about, and I appreciate your work.

If you want any of my data, lab reports, or want to delve into anything specifically, I’d love to chat with you here or in person some time. And, I thank you for your good work.

(Bret Scher) #12

Wow! Thanks for that thorough and thoughtful reply. First and foremost, I am so glad to hear you are doing better! I think there is no question that you made the right the right choice for you and it paid off since you are doing so much better and are maintaining sinus rhythm, I appreciate that you blazed your own path and that you were proactive enough to research it as you went. If you ever need another opinion or just someone to bounce ideas off, please don’t hesitate to contact me. Thanks! Bret

(Bret Scher) #13

And also, thanks for all your kind comments about my podcast! I really appreciate it :slight_smile:

(Tom Seest) #14

I hope I never need the 2nd opinion again. While it was an educational experience, it’s not one that I’d wish on anyone or care to repeat. I think the biggest lesson I learned from the entire experience, is how resilient the body is, and how it can heal given the proper environment. I’m hoping that this is my last encounter, with what many believe to be a progressive disease, but if not; I have better tools for the next encounter.

(Tom Seest) #15

The new name definitely helps the visibility of the podcast. I probably would have found it earlier, under the new name, although I appreciated the optimism and positive message in the name of the old podcast.

(Tom Seest) #16

I do understand your skepticism regarding the potential scarring of the heart or the area around the heart and pneumonia, and my Atrial Fibrillation. And, as you correctly pointed out, we did not have any scans done with the exception of the TEE immediately before the cardioversion. But, I think it is only fair that I point out the reasoning behind that theory, and the supporting evidence to the claim.

First, my CRP tested at 0.43 on 12/05/2016, before the onset of my pneumonia on 12/23/2016. On 12/30/2016, while the pneumonia was still active, my CRP tested at 42.93. My tachycardia did not preset until 1/4/2017, according to my Apple Watch, which was the only mechanism I used for passive monitoring at the time. I did not detect the tachycardia personally until 1/14/2017 while on this virtual bicycle ride on my trainer: https://www.strava.com/activities/832272532 On 1/27/2017, I had my CRP retested along with many other things, and it had returned down to 0.60. To rule out most of the other common causes or triggers for Atrial Fibrillation (I had never had it or tachycardia before in my life, to my knowledge), I tested the following markers during January and February 2017, and all were found to be in normal ranges: serum electrolytes, RBC markers for potassium and magnesium, Vitamin D, thyroid, and parathyroid function. While the cardiologist didn’t see these as necessary, I wanted to be sure that I didn’t have any deficiencies that could point to some other cause, or common cause for the A-Fib and subsequent tachycardia. I can and will happily provide links to all of these blood tests if you have any desire to look at them yourself. Given the proximal nature of the CRP reading to the pneumonia, and then subsequent tachycardia and atrial fibrillation, and without confirmation from scans as you suggested, I really don’t know what else could have caused the A-Fib. I had no history of hypertension, even with my one time weight in the 500’s, as I had regular BP readings of 120’s over 80’s. While I recognize that the ranges could be off for individuals, I don’t see how a lower range hypertension over a period of years could cause this Atrial Fibrillation, which is why I thought the two subsequent cardiologists were incorrect with their speculations. The original cardiologist had me on Metoprolol as of 2/15/2017, for three weeks, and it made no impact on my BP readings or my tachycardia. So, I’m not sure he’s correct, and I’m not sure that he is incorrect. I am sure that we’ll never know.

I also thing there is plenty of supporting evidence to support his claim that the pneumonia probably caused the damage, even without specific evidence from scans etc. The science supports the possibility, found in articles and studies like these:



https://www.mdlinx.com/pulmonology/article/1131

While there is no direct evidence that the pneumonia caused my atrial fibrillation, or the mechanism that may have presented itself, it is possible that it happened via the fibrosis or scarring, and it is also possible that the tachycardia presented itself first, triggered by the pneumonia, and that the tachycardia induced cardiac remodeling, that led to the atrial fibrillation. It is interesting that edema didn’t present itself until June or July, but it is possible. Suffice it to say, I agree that we will never know.

I will say that the ketogenic diet and fasting, and yes the beta blocker, did an excellent job in reverse remodeling a misshapen heart. Fortunately, in this case, I have a series of TTE’s with estimates and measures that point out the original leaky valves, wall stiffening, thickening, etc. Whether the diet was the direct contributor, I’ll never know. I never tried any method in isolation, given the urgent nature of the challenge, so I’ll never know for sure. I will say that the heart had successfully reverse remodeled most of the way, and that cardiac efficiency was close to normal, before I got cardioverted a little over 70 days ago. So, like you point out, the diet may or may not have helped, and the same with fasting.

Unfortunately, I don’t see the day when we’ll ever had the evidence we need regarding the diet, the fasting, or alternative therapies, because there is little incentive to study them. I have noticed that the trend in the industry is to develop therapies and medications that simulate the benefits of fasting, without the pain. Stem cell therapies are popular in discussions and studies, and of course medications that control the rate of autophagy and apoptosis.

Either way, I’ll continue to enjoy your podcast more than the weekly dump from Dr. Mandrola because your’s gives me hope that most of the metabolic causes for heart disease can be eliminated or avoided through diet.

Keep up the excellent work.