Heart Disease Myths

Everybody knows how to prevent heart disease. Not really. Everybody just thinks they know. In truth, just about everybody is pretty much wrong. OK, admittedly the parts about exercising, shunning cigarettes and not getting too stressed are clear to us all. Those of you with sharp eyes have noticed that I did not mention diet or medication. Eating well is crucial but “eating well” is probably different from what you think it is. As far as medication, most everyone thinks that lowering your cholesterol with medication, probably a statin drug like LIPITOR, is effective and necessary for many of us, including those don’t like taking medications. Some TO-BE-DETERMINED statin drug was one element of the “polypill”, an almost magical drug mix formulated to prevent most of our major long-term health risks. Many in medicine advocated the polypill. Some were skeptical of such an aggressive medicinal approach to health care. We’ve seen this before. More should have been skeptical, and not just about the medications. Conventional dietary recommendations are almost as suspect. Lets back up and examine our assumptions about heart disease. Eating Well First, let’s look at that “eating well” piece of the puzzle. The official “healthy heart” diet is pretty straight forward? Limit your fats. They are bad for you, especially saturated fat. Fats make you fat and that’s not good. Margarine is better than butter because it doesn’t have all that saturated fat. Eat more breads, especially whole grains. I am not going to comment on the avoid salt and eggs recommendations right now, other than to say they are also wrong. Eating fatty food is supposed to be bad because it bumps up your cholesterol. “Cholesterol is bad if not downright evil. Your cholesterol is high, you are going to die of a heart attack or stroke. We have to get it down, right NOW.” This advice about diet, cholesterol, eating more grains and medicating away heart disease is wrong. Worse still is that this misguided advice led us astray for decades, wasting an awful lot of well-intentioned effort on the part of patients, and inevitably costing lives. How could this have come to pass? The core, the heart of our mistaken approach, is pretty simple to identify. Some authorities made bad assumptions and, as often happens, most of us trusted the experts and fell neatly into line behind them. Instead of marching off into a golden sunset, it was over the cliff. When we actually got round to asking the right questions carefully and conducting...

Calcium and D Don’t Build Done, Right

We are supposed to make mistakes so that we learn. Sometimes medical authorities, especially those who issue official guidelines, are remarkably intellectually dull. A current example is the US Preventive Services Task Force recommendation not to take vitamin D and calcium to prevent bone fractures. If they were correct, if this were based upon solid science, it would be the official acceptance of a revolutionary discovery in human physiology. It isn’t. It is instead kind of embarrassing. Expert panels are supposed to be collections of experts, individuals with particularly acute judgment about often controversial medical therapies. They are supposed to judiciously weigh all the evidence in their quest to develop useful guidelines for clinical practice. Unfortunately, panelists are almost invariably researchers with little, if any, clinical experience. There was a mini-flurry of controversy, which got far too little attention, when a study of these panels found that essentially all of the panelists had conflicts of interest because they were simultaneously receiving funding from pharmaceutical companies who would benefit from the recommendations. In this case, it is not the financial seducements fuzzying up their brains. It is unequivocally established that calcium and vitamin D are essential, even the most essential of the essential nutrients required by our bodies to make bone. We also know that most (calcium) to nearly all (vitamin D) Americans are deficient by all surveys. The chief foundation of their recommendation, according to one of the panelists, was the Women’s Health Initiative (WHI) study. That explanation makes sense, but further disturbs me. I have written about this aspect of the WHI study in the past. The problem was that the conclusion (no reduction in the rate of fractures from the 400 iu vitamin D and 1,000 mg calcium supplements) was unwarranted and based upon misinterpretation of their own data. First, probably all of you stumbled over that dose of vitamin D. 400 iu will raise the average person’s D level only 4 ng/ml. Most people run 10-20 ng/ml without supplementing, and we need over 50 ng/ml (maybe 70) for optimal bone formation. It is clear that concluding that vitamin D does not help, when taking only 400 iu, is like saying that water won’t help quench thirst when you are only allowed one swallow. Lacking clinical experience, they could miss that problem. The inexcusable error they made was overlooking the finding in the WHI that when they considered only the women who took the pills, the fracture rate was significantly lower. So, in other words,...

The Wisdom Of Effective Annual Health Screening

A recent article in the NY Times caught my eye. I couldn’t have agreed more, and also less. Titled “Let’s (Not) Get Physicals”, it was a reflection on the problems with conventional routine physical exams. http://www.nytimes.com/2012/06/03/sunday-review/lets-not-get-physicals.html?pagewanted=all The time-honored tradition has been for a thoughtful patient to see her/his doctor for an annual exam. The article discussed several of the screening tests that have been the foundation of the annual exam routine. Many of these have been shown to be ineffective. Ineffective screening tests are worse than just a waste of time and money, as they lead to other needless tests and procedures. The procedures, the next steps looking to identify or treat the “disease” that is not there or does not need to be treated, usually create their own problems. The end result is that the patient has been harmed by this well-intentioned effort. Bear in mind that dumping procedural screenings is nothing new. Annual chest Xrays, anyone? We used to do that not so terribly long ago. That was the agreeing part. My disagreement is based on the definition of what is done. From my experience it is certain that an appropriately directed annual health assessment is wise. That is true, even excluding the simple technology of a couple of blood tests. I see people every day who are so vitamin deficient that it shows up in simple blood tests from a conventional lab. But forgetting that, dumping all the post 19th century technology, there is ample, easily accessed and useful evidence of what needs to be changed to better a person’s health. Taking to patients about how they feel, what they eat, their exercise patterns, how they are managing the stress of their lives, etc., tells me a lot. With that information, I can help them improve the quality of their day to day lives and avoid developing the most common diseases in our society (e.g., heart disease and diabetes). The risks of talking to a patient, looking over a three day diet record, reviewing his/her use of supplements/medications and conducting a simple physical exam are close to nothing. Another shadow, looming over this discussion, is that doctors know that patients don’t change their habits. You can never get them (you) to change their diet or exercise. They won’t work to learn how to manage stress better. Docs know that. As you know very well, docs are wrong. A child can learn to read and write without any help. but...

The Foods You Chose Can Help You Lose, Or Not

The Foods You Choose Can Help You Lose, Or Not Many people think that Americans are obsessed with celebrity, politics or some sport. Yes, we are, but our chief obsession is not on that list. Americans are truly obsessed with weight, especially losing it. One reason exercise is so important for those losing weight and improving their body composition is that our body’s response, after losing weight by cutting dietary calories, is to slow down its metabolism. Faced with starvation, your body slows everything down. In that state, which some studies show persists for years, you will burn fewer calories than another person who weighs less than you, but never starved themselves. Exercise helps keep that from happening by forcing the body to keep running at a higher metabolic rate. The really, really bad consequence of the metabolic slowdown is that many people who lose weight not only regain every pound they dropped, but they also end up with a higher percentage of body fat than they started out with. They bounce back up to the same weight, but now they are fatter at that weight. That outcome is cruelly disappointing. A small but very interesting study shows that what you eat, specifically the balance of fat, protein and type of carbohydrates, might change the rules in this losing game. Researchers helped a group of overweight men and women lose 10-15% of their body weight, and then rigorously tested their individual responses to three different diets. One diet was the traditional low fat/high carb diet with 60% of calories from carbohydrates and 20% each from fat and protein sources. At the other end of the spectrum was a diet with 10% carbohydrates, 60% fat and 30% protein. The third diet had a middle range of carbohydrates (40%), with 40% of the calories coming from fat and 20% from protein. The carbohydrates in this diet were specifically selected to control blood sugar (low glycemic index and moderate glycemic load). Consistent with other studies, those in the low fat/high carb group dramatically lowered their metabolic rate, burning 300 calories a day less than those in the Atkins-like low carb group. In other words, those in the low carb/high fat group burned more calories. That caloric difference is like running 3 miles every day, without getting up off the couch. Piled up over a year, those additional 300 calories a day become 30 lbs of fat. The “old wives tale” about potatoes making you fat proves the wisdom...