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Open letter to President of American Heart Association as he recovers from a recent heart attack
Replies
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There is a word for people who become smug when someone they disagree with dies in an "ironic" manner (ie health professional dying of heart attack). They are called A**holes.24
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There's a story about Jim Fixx, a running guru, who died at age 52 of a heart attack (1984).
Nathan Pritkin, diet and fitness guru, died of leukemia (1985). He died with excellent cardiovascular health however.
I admit to casting these messages in doubt because of the cause of death.
Had Jim Fixx followed doctor’s recommendations and had a 12-lead ECG graded exercise test, they would have discovered in about 2 minutes that he had significant coronary artery disease. He didn’t because, as a “running guru” he was afraid that finding out he had heart disease would ruin his career as a running guru. (Turns out that dying of a heart attack messes up your career even worse).
One could say that instead of interpreting his death as “oh look, the running guy still had a heart attack”, the interpretation should be “wow, all that running kept a guy who might have died at 40 from having a heart attack for 12 years”.
Given the state of knowledge about risk factors, development of coronary disease, etc, and given that a lot of runners were younger, there was a certain amount of hubris about the protective effects of running back in those days.
Fixx’s death significantly changed the discussion and people began to discover and acknowledge the limits of exercise in mitigating risk factors. Exercise is a powerful, powerful, preventive tool, but it doesn’t confer immunity.
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lemurcat12 wrote: »https://www.heart.org/idc/groups/heart-public/@wcm/@adv/documents/downloadable/ucm_437479.pdf
AHA explanation of the position that they are taking.
https://www.health.harvard.edu/heart-health/high-tech-heart-tests-and-procedures-you-may-not-need-and-why
Discussion of why it does not make sense to require various tests for asymptomatic adults (this is similar to the discussions over when to start recommending people get routine mammograms or prostate checks).
http://www.acc.org/latest-in-cardiology/articles/2014/05/20/14/40/cover-story-coronary-artery-calcium
Discussion of the issue.
Thanks! Very interesting - especially the acc.org one. Was interesting to read them singing the praises of Statins though. I just watched the movie Statin Nation a few months ago. The gist of it was that some evidence shows they only improve total morbidity for 1 in 100 people and have a lot of side effects for many. I guess that many have been discussed before so i'll do a search.0 -
That article is full of kinda truths and massive jumps in reaching conclusions.
Riskfactors for coronary artery disease are just that. Risk factors.
Some, like non familial cholesterol issues, obesity, smoking and the oxidative/inflammatory effects of each, some kinds of hypertension etc are modifiable.
Others, like age, gender, familial hypercholestemia, some types of hypertension, genetic predisposition, diabetes, clotting disorders etc etc are not.
This article is some guys muddied science with a dash of pseudoscience opinion.
I will concede though, there is some evidence that statins lower your cholesterol but not your risk of heart attack, necessarily. There is still s greater base of evidence that they help though, thus they are part of the goldstandard pharmaceutical management of coronary artery disease.
...........
I write this from the perspective of the nurse that deploys the stents in the blocked arteries of people having heart attacks.
Thanks for your thoughts. What do you think about calcium scoring MRIs as in his point 3? If they are as conclusive as the author states, I don't understand why the AHA would resist them?
Calcium scores are done as part of a CT angiogram. They are widely referred to here (in Australia) and considered as part of a patients risk burden for coronary artery disease, however my understanding is that the my can be very misleading particularly in the presence of comorbidity such as diabetes etc and their significance is open to broad interpretation.
CT coronary angiograms in themselves, though less invasive than formal angiograms. There are a lot of false positives and not quite right info deduced from them.
For example, CT might say moderate to severe lesion in the mid circumflex, when there’s really only a mild clinically insignificant lesion in the right coronary artery (which in some people supplies a similar territory of muscle). Sometimes they are spot on though.
Another interesting point is that anyone with a suspicion of coronary artery disease on CT (where they measure the calcium score) will be sent for a formal coronary angiogram in a cardiac catheterisation lab.
That makes 2 expensive investigations rather than just having a proper look the first time. The formal fluoroscopy angiogram is the gold standard. An interventionalist cardiologist can treat a severe lesion as they see it in most cases,
Also, not all blockages are calcified. And, not all calcified areas (while not great) are causing any impairment to blood flow to heart muscle.
........
The angry dude is not *wrong* exactly, really.
What he’s arguing has pretty well grounded and evidence based counter arguments to explain why he’s not right.
Also, using a person’s misfortune for what is essentially a political (him vs the machine that is the medical/cardiac patriarchy) is douchey.
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Notes upon reading link:
Ads, ads, ads.
"Wheat Belly"? Oh FFS.
"Big Pharma"?
There goes any credibility you might have from your white coat.
The AHA were not saying the heart attack counted as a success. Stop congratulating yourself on killing a straw man.
"Thinking that a statin drug (+ aspirin and a beta blocker) are sufficient to prevent coronary events is absurd and overly-simplistic" - no *kitten*. Who ever says that? Ever heard of exercise, genetics, general health? Oh, sorry, carry on killing your straw men.
So low carb is magic, and wheat is Teh Debbil? Hmmm. Have fun with your obscurity hanging on the coat-tails of a fad.11 -
Aaron_K123 wrote: »There is a word for people who become smug when someone they disagree with dies in an "ironic" manner (ie health professional dying of heart attack). They are called A**holes.
So much this.4 -
I once worked with a doctor who later retired early on account of ill health and then died of renal failure.
One of the doctors I currently work with has severe asthma
Does this mean the things doctors recomend for asthma or renal health are based on false assumptions????
That seems the same logic as the article is using and just as nonsensical
OP if your intention is to discuss the importance or otherwise of current cardiovascular risk factors or preventative strategies, both pharmecutical ( role of aspirin, statins etc) and non pharmecutical ( smoking, weight control, exercise etc) then not sure why you opened with this silly article??8 -
This is interesting - How would any of us create a healthier thyroid?0
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My cardiologist died of a massive coronary. He was outwardly one of the healthiest people I knew.
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snickerscharlie wrote: »My cardiologist died of a massive coronary. He was outwardly one of the healthiest people I knew.
One of my colleagues, aged 55 - runs several triathlons a year - suffered a heart attack about a year ago. He survived thankfully but he lost his commercial pilot's medical. He's a physics Phd and all round smart guy. He's looked into it for himself and he concluded it was likely due to carb loading / hyper-insulinemia / inflammation over many years. He's since gone keto / LCHF (but uses a slow carb called Super Starch for event performance).
I can't speak with any expertise about whether he's correct but he's dropped about 8kg and recently beat his 22 year old son in a half marathon.
This heart surgeon seems to agree with him though....
"The rest of us have simply followed the recommended mainstream diet that is low in fat and high in polyunsaturated fats and carbohydrates, not knowing we were causing repeated injury to our blood vessels. This repeated injury creates chronic inflammation leading to heart disease, stroke, diabetes and obesity."
http://myscienceacademy.org/2012/08/19/world-renown-heart-surgeon-speaks-out-on-what-really-causes-heart-disease/?utm_content=bufferba509&utm_medium=share&utm_source=facebook&utm_campaign=msa
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Oh, is this now generally about heart disease?
Of course the majority of doctors and experts do not agree that the problem is carbs or too little fat, as you seem to suggest. That's why mainstream advice is such things as: more vegetables and fruits, whole grains (vs. refined) and other whole food sources of carbs (like legumes, tubers), lean meats, limit sat fat, limit added sugar and low nutrient treats. (It seems silly to try to attack the general medical/nutritional advice from the experts with an appeal to authority. Why is this random doctor more trustworthy?)
Anyway, with respect to the mainstream advice I listed above, I've yet to see any evidence that that is actually bad advice. It's pretty consistent with the blue zone diets (add in that they don't eat a lot of meat, and a good bit of that tends to be fish, and -- IMPORTANT -- have positive, healthy lifestyles with social connections and limited stress).
Living in the US without a traditional diet that takes care of it for me, I personally would pay attention to omega 3 to omega 6 ratio, avoid lots of highly processed oils like corn or soybean (which isn't something you need to think about if you eat a diet largely based on whole foods). But more than that I'd make sure I was eating lots of vegetables and not pretend that a diet is healthy based simply on macro ratio.
If one wants to think about inflammation (often just a buzzword these days), here's a good list of foods that contribute to and fight it: https://www.health.harvard.edu/staying-healthy/foods-that-fight-inflammation
(The specifics may be very different for some with digestive issues or autoimmune diseases, so this is not intended to apply to them. I know fiber can be an issue for some with Crohn's, for example, and there are specific trigger foods for some conditions that usually vary by person.)
Another thing worth thinking about some, IMO, is the gut biome, and it seems that lots of vegetables and fruit and sources of fiber are good for that too.4 -
lemurcat12 wrote: »Oh, is this now generally about heart disease?
Of course the majority of doctors and experts do not agree that the problem is carbs or too little fat, as you seem to suggest. That's why mainstream advice is such things as: more vegetables and fruits, whole grains (vs. refined) and other whole food sources of carbs (like legumes, tubers), lean meats, limit sat fat, limit added sugar and low nutrient treats. (It seems silly to try to attack the general medical/nutritional advice from the experts with an appeal to authority. Why is this random doctor more trustworthy?)
Anyway, with respect to the mainstream advice I listed above, I've yet to see any evidence that that is actually bad advice. It's pretty consistent with the blue zone diets (add in that they don't eat a lot of meat, and a good bit of that tends to be fish, and -- IMPORTANT -- have positive, healthy lifestyles with social connections and limited stress).
Living in the US without a traditional diet that takes care of it for me, I personally would pay attention to omega 3 to omega 6 ratio, avoid lots of highly processed oils like corn or soybean (which isn't something you need to think about if you eat a diet largely based on whole foods). But more than that I'd make sure I was eating lots of vegetables and not pretend that a diet is healthy based simply on macro ratio.
If one wants to think about inflammation (often just a buzzword these days), here's a good list of foods that contribute to and fight it: https://www.health.harvard.edu/staying-healthy/foods-that-fight-inflammation
(The specifics may be very different for some with digestive issues or autoimmune diseases, so this is not intended to apply to them. I know fiber can be an issue for some with Crohn's, for example, and there are specific trigger foods for some conditions that usually vary by person.)
Another thing worth thinking about some, IMO, is the gut biome, and it seems that lots of vegetables and fruit and sources of fiber are good for that too.
This is an excellent point. There's still a lot we don't know about diet and health, but I'm strongly convinced that anybody who is reducing it to a matter of pure macronutrient ratios is missing part of the picture.
To conclude that someone developed heart disease due to carbohydrate loading . . . that's missing a lot of the context of the overall diet (and lifestyle).5 -
For healthy thyroid function the dietary recommendation is to consume 150 microns of iodine a day, amounts to about half a teaspoon in a year! If you think, for example, there are about 3 iodine microns in 100g of peas. 1 medium egg has 24. 100 ml, milk has 30, Yoghurt doubles this to 60, other sources are available, ensuring you achieve all this can be complicated. One also needs selenium zinc and other minerals and various vitamins.
Someone who is hypothyroid could well need more iodine. Thyroid conditions are far more complicated than many give them credit for, even members of the medical profession. Most hypothyroid persons in the western world actually have Hashimoto's thyroiditis which is an autoimmune problem and is identified by antibodies. These antibodies are known to attack the thyroid because they mistake some alien particle for those of the thyroid gland, it is possible for these antibodies to attack other organ tissues.
Dietary deficiency is caused by a poor diet, often due to poor soil quality caused by over working without adding compostable vegetation, soils lacking the organisms, worms and other minute creatures and particles to make it adequate for the plants and animals we feed on.
Hyperthyroid conditions (over activity) and thyroid cancers are very different and are not in my sphere of reference.5 -
lemurcat12 wrote: »Oh, is this now generally about heart disease?
Of course the majority of doctors and experts do not agree that the problem is carbs or too little fat, as you seem to suggest. That's why mainstream advice is such things as: more vegetables and fruits, whole grains (vs. refined) and other whole food sources of carbs (like legumes, tubers), lean meats, limit sat fat, limit added sugar and low nutrient treats. (It seems silly to try to attack the general medical/nutritional advice from the experts with an appeal to authority. Why is this random doctor more trustworthy?)
Anyway, with respect to the mainstream advice I listed above, I've yet to see any evidence that that is actually bad advice. It's pretty consistent with the blue zone diets (add in that they don't eat a lot of meat, and a good bit of that tends to be fish, and -- IMPORTANT -- have positive, healthy lifestyles with social connections and limited stress).
Living in the US without a traditional diet that takes care of it for me, I personally would pay attention to omega 3 to omega 6 ratio, avoid lots of highly processed oils like corn or soybean (which isn't something you need to think about if you eat a diet largely based on whole foods). But more than that I'd make sure I was eating lots of vegetables and not pretend that a diet is healthy based simply on macro ratio.
If one wants to think about inflammation (often just a buzzword these days), here's a good list of foods that contribute to and fight it: https://www.health.harvard.edu/staying-healthy/foods-that-fight-inflammation
(The specifics may be very different for some with digestive issues or autoimmune diseases, so this is not intended to apply to them. I know fiber can be an issue for some with Crohn's, for example, and there are specific trigger foods for some conditions that usually vary by person.)
Another thing worth thinking about some, IMO, is the gut biome, and it seems that lots of vegetables and fruit and sources of fiber are good for that too.
Personally not arguing with anything you've said - I have no expertise in this area. But here's a top UK cardiologist Dr Aseem Malhotra who also seems to think inflammation from the wrong (refined carby) diet is more to blame for CVD and cholesterol is much less important than is commonly believed (statins!).
I don't really have a dog in the fight as such but, I suppose, given that we are largely losing the war against obesity, Type2 diabetes and CVD, I guess I lean towards giving the new theories of insulin resistance, hyperinsulinemia and inflammation (and gut biome) a full hearing - the 30 year old advice based on eat less, move more doesn't seem to be working for the vast majority...
http://doctoraseem.com/the-truth-about-fat-and-sugar/7 -
That's because the vast majority are eating more and moving less.4
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Seriously, the advice "save some of your money for retirement" doesn't seem to be working for the vast majority, either, because they don't follow it. Should we tell everybody to bet on horses?9
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NorthCascades wrote: »Seriously, the advice "save some of your money for retirement" doesn't seem to be working for the vast majority, either, because they don't follow it. Should we tell everybody to bet on horses?
This is a great analogy.
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All the cardiologists I work with acknowledge the role of inflammation in the development of coronary heart disease, and the growing evidence base to support this.
They don’t all attribute that to carbs though.
One in particular does push for intake of good saturated fats and asks his patients to incorporate coconut oil to their diets as he states there is evidence (there is some) it can play a protective role
Our counter argument to that is that why then are the people of PNG who eat a diet rich in coconut oil so susceptible to coronary heart disease?
The answer is something something more than one factor etcetera and so forth.4
This discussion has been closed.
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