(This article was published in “The Louisiana Weekly” in the March 7, 2011 edition.)
If Saturdays find you in an easy chair with a magazine–weary from the workweek–when you should be outside weeding the garden, you’re not alone. New Orleans residents are less physically active in their leisure time than Americans in the West and parts of the North and Northeast, according to a study from the Centers for Disease Control and Prevention released in mid February.
The CDC found that American adults were inactive for anywhere between 10.1% and 43% of their free time in 2008. Counties in the southern U.S. and parts of Appalachia were the most inert, while those in the West and the Rockies were peppiest.
Along with Louisiana, residents of Alabama, Kentucky, Mississippi, Oklahoma and Tennessee were least likely to exert themselves in their down time.
In Louisiana’s Orleans Parish, 28.1% of adults were physically inactive during their leisure time in 2008, the CDC
Tag: Heart Disease
(This article was published in “The Louisiana Weekly” in the March 7, 2011 edition.)
There are some things in life that should clearly be ignored. The telemarketer who calls your house at all hours of the day and night, the endless commercials and newspaper ads claiming unbelievable weight loss results with minimal effort, and any health news story that promises a “miracle” or “cure.”
But, there is one thing in life that should never, ever be ignored, and that is your body. Your beautiful, precious, body that fuels your passions, hopes and dreams.
Being mindful of your body, paying attention to what your body is telling you, and loving your body can be helpful to protect you from heart
Dick Cheney is not heartless. He just has less of a heart. The New York Times says Cheney’s heart will never beat at full strength again. His new mechanical pump leaves patients without a pulse because it does not mimic the heart’s own beat.
So Dick Cheney has no pulse. Yet he walks among us. This is the Twilight Zone, verily.
He looks gaunt and frail, sitting down, holding a cane. What is scary is he looks almost human, an old man. It’s as if Darth Vader took off his cloak and it turned out to be the Tin Woodman looking for his heart.
The irony boggles the mind.
But there’s more. Within a few years he is going to probably need a full heart transplant.
Now we have the potential for the Great American Story. Imagine, said a colleague, that he gets the heart of an American soldier, brain-dead from being blown up in Iraq.
Then the war he unleashed based on fabricated intelligence would tick inside of him everyday. Would it drive him crazy? Or would it cause the heart to implode knowing it was trapped inside Dick Cheney?
For the last decade Dick Cheney has been the poster boy of evil, the grand vizier of an imperial presidency, sinister in his avuncularness. He was the one the anti-war people, the anti-neo cons, the anti-corporate types could all rally around. He was the one America loved to hate. He gave Bush cover. In 2007, Cheney came close to matching Dan Quayle for the least popular Veep ever with a 59% disapproval rating. At one point only 13 percent of Americans had a favorable rating of him. Though his ratings did improve after he left office in 2009 55% of Americans still disapproved of him.
Looking at his photograph now, you almost feel sorry for the man. You can hardly recognize the snarling Veep, the poster boy for evil incarnate, our Dr. Strangelove.
He is suddenly like any other aging war criminal, the Pinochets, unrepentant but frail, Goliaths turned David. I imagine the sympathy factor will rise.
And the bloodlust of the Impeach Cheney crowd will never be satisfied.
More importantly America will have to find another prototype for implacable evil, because its current model is falling apart.
But I cannot get over the image of Dick Cheney looking for a new heart. It could be our century’s version of Pilgrim’s Progress, traveling the world with his hunting rifle, weighed down by the burden of sin, seeking deliverance. What role will Harry Whittington play in that parable, shot in the face by Cheney, but big hearted enough to take the blame?
More likely it will be the Goldilocks story – looking for the perfect heart, not too soft, not too hard (remember he does accept his gay daughter) but just right for Dick Cheney. Now that would need to be some Brave Heart.
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Diabetes myths abound, so my gift to you this holiday season are five diabetes truths you must know. Diabetes is a complex condition, with numerous tasks a patient must do every day to be well. Whether you live a long and healthy life with diabetes often depends on whether you have accurate information and know what to do, when to do it, why, how and how much.
Decisions you make every day about food, carbohydrate counting, medicine, exercise, doctor visits, lab tests, blood sugar monitoring and more either increase or decrease your health.
What better gift to give yourself or a loved one for the holidays than better health?
Excerpt below from my book “50 Diabetes Myths That Can Ruin Your Life and the 50 Diabetes Truths That Can Save It” by Da Capo, a member of the Perseus Books Group.
1. MYTH: Diabetes is the leading cause of heart disease, blindness, kidney disease, and amputation.
TRUTH: Poorly-controlled diabetes is the cause of these outcomes. Well-controlled diabetes rarely is. Highly esteemed psychologist and certified diabetes educator, Dr. William Polonsky, says well-controlled diabetes is the cause of nothing. I like to add, except for a healthier and happier life.
2. MYTH: I must follow one specific “diabetic diet.”
TRUTH: There is no longer any such thing as a “diabetic diet.” The same dietary guidelines recommended for all Americans: eat a variety of vegetables and fruits (five cups/day), whole grains, lean protein, low-fat dairy, healthful fats, and fiber, are recommended for those with diabetes. Sweets are allowed in moderation and should be worked into your meal plan. A healthy meal plan is one that take calories, carbohydrates and fats into account so that you can reach and maintain your weight and health goals. If you need help designing a meal plan ask your doctor for a referral to a licensed dietitian.
3. MYTH: I don’t have to watch myself, because my doctor says I have “just a touch of sugar” or “I’m borderline.”
TRUTH: If your doctor says you have “just a touch of sugar” or “you’re borderline,” you have pre-diabetes. Pre-diabetes is characterized by higher than normal blood sugar but not as high as type 2 diabetes. However, pre-diabetes puts you at risk for type 2 diabetes within five to 10 years. Losing some weight, if you’re overweight, and getting more active can reduce your risk of getting diabetes. The landmark Diabetes Prevention Program in 1992 found that lifestyle changes, more than medication, reduced pre-diabetics’ risk of getting type 2 diabetes by 58 percent. In people over age 60 the risk was reduced by 71 percent!
4. MYTH: Type 2 diabetes is not as serious as type 1.
TRUTH: Type 1 and type 2 diabetes are equally serious because both can lead to the same debilitating diabetes complications, such as heart disease, blindness, kidney disease, and amputation. As I mentioned in myth number one, poorly-controlled diabetes — high blood sugar over years — causes these complications no matter what type of diabetes you have. While type 1 diabetes typically requires more intensive management, approximately 25 percent of people with type 2 diabetes have complications when diagnosed because they’ve usually had it for several years before diagnosis.
5. MYTH: If my doctor says it’s time for me to take insulin, I’ve failed.
TRUTH: You haven’t necessarily failed, type 2 diabetes is progressive for most people. Over time insulin-producing beta cells become compromised and produce less insulin and the body uses insulin less effectively. About 40 percent of people with type 2 diabetes will require insulin to control their blood sugar. While most doctors delay adding insulin to a patient’s treatment plan, the renown Joslin clinic starts type 2 patients immediately on insulin for effective blood sugar control. Also, if you’re thinking insulin causes diabetes complications, it doesn’t. Complications are due to years of uncontrolled high blood sugar.
You’ll find fuller explanations and more information on these and 45 other myths and truths, along tips and recommendations — on every aspect of diabetes health — from leading diabetes experts in my book 50 Diabetes Myths That Can Ruin Your Life and the 50 Diabetes Truths That Can Save It.”
You can read several more excerpts now to jump-start your improved health. What I know is the more you know, the better you’ll do.
For yourself, a loved one or a friend with diabetes, why not give the gift of diabetes health this holiday? Besides, it will solve your problem what to give Aunt Jesse, and you won’t have to play “diabetes police” anymore when your loved one realizes the impact of what he or she eats on their diabetes.
May the holidays be not just merry, but your or a loved one’s kick-off season for greater health and happiness.
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50 Diabetes Myths That Can Ruin Your Life: And the 50 Diabetes Truths That Can Save It
by Riva Greenberg
The ABCs Of Loving Yourself With Diabetes
by Riva Greenberg
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As lawmakers prepare for a new congressional session, attention is once again falling on whether and how to fix the recently-passed health reform law. Beginning in January, all eyes will be on Congress to see what changes, if any, are made and what lasting impact this could have on the future of our nation’s health care system.
By most accounts, there is growing concern that a movement toward cost cutting could lead to the loss of critical services for patients suffering from chronic illnesses such as cancer, diabetes or heart disease. One such program that is particularly vulnerable is Medicare (2010 budget: $453 billion). Having already given up $400 billion in the next decade as part of the health care reform law, the one program so vital to the treatment of the chronically ill once again faces the chopping block under the aim of a new entity known as the Independent Payment Advisory Board (IPAB). IPAB, which was created as part of the Affordable Care Act, is tasked with reducing the growth in Medicare spending. The board, made up of officials only accountable to the executive branch, will likely recommend broad cuts throughout every facet of Medicare, including the services in place for the prevention and management of chronic diseases. However, this would be a grave mistake for the nearly half of all Americans who suffer from chronic illnesses.
Focusing on prevention by advocating a healthier lifestyle and regular physician visits can help eliminate some of the leading Medicare cost drivers. However, given the power and mission bestowed upon IPAB, limiting preventative care will undoubtedly be considered for the immediate cost savings and limited short-term impact. What does this mean for patients on the slippery slope toward diabetes, heart disease and hypertension to name a few? It means they will not be forewarned of these medical red flags and will not take the appropriate steps to avoid a preventable diagnosis. Alternatively, successful management of chronic illnesses such as coordinating insulin schedules for diabetics and regular blood pressure monitoring for hypertension patients would reduce hospitalizations and emergency room visits, keeping the cost down.
So, what needs to be done? First, the goal of reform should be not only to provide appropriate care, but also to reduce the number of Americans affected in the first place. Rather than simply cutting payments to providers and increasing cost sharing to Medicare beneficiaries, future recommendations should focus on reducing chronic disease management and keeping chronically ill patients healthy.
Potentially preventable readmissions in the Medicare program over the next decade will cost nearly $250 Billion, costs that can be averted through evidence-based care coordination. Data from randomized trials show we can reduce the incidence of diabetes by 70 percent among overweight adults. We need to adopt these programs nationally, which will reduce weight and with it chronic disease and Medicare spending. These are just two of the common sense proposals that need to be included in future reforms.
Second, we need to better understand the needs of patients and tailor health management services to meet them in an efficient and thorough manner. The right plan should be built upon a foundation of consistent care and then personalized for each patient to ensure that each one is receiving only the tests and medicines that fit his or her treatment plan. By focusing on the patient’s specific needs, we can reduce the stress on the patient and the overall cost of services.
Finally, striking this important balance between affordability and quality care can’t come from one panel that shares the solitary motivation of cutting costs. It needs to be a joint effort among patients, providers and policymakers. While there is no question that decisions must be made to address rising health-care costs, we simply cannot accept any proposals that would cut the quality of that care.
The expression “let’s get to the heart of the matter” is well ingrained in the English language. When it comes to the heart itself, what is the heart of the matter? The question arose while thinking about open-heart surgery. Recently, two close relatives underwent the operation. One needed his aortic valve replaced. The other “only” needed her mitral valve repaired.
The idea that a highly trained stranger can literally hold a loved one’s stopped heart in his hands, fix it and then restart it, struck me as something so wondrous that it is difficult to capture the feeling in words. It brought me face-to-face with the miracle of medical science and the Source of life Who makes miracles possible.
If you think about it, it is beyond remarkable that it is possible to sedate someone, cut through the breastbone, hook up a machine to take over the function of the heart and lungs, then repair a stopped heart (it is typically stopped for three hours during the five to six hour surgery). Then, the person is sewn back up, the heart and lungs kick back in, walking starts within days and the patient is usually home in less than a week. Even though physical activity is minimized in many ways, according to the discharge instructions from the Mitral Value Repair Center at The Mount Sinai Hospital in New York City, if the patient is interested, it is fine to resume sexual activity!
Where does the patient go when the heart stops?
Sleep is part of the spectrum of consciousness. If you have dreams, it is possible to remember them (meaning you are conscious of them). If someone tries to cut your chest open while you sleep, chances are excellent you will wake up from the pain and try to stop them. But under anesthesia, something else happens: You are gone. It is as if the patient has left her body and taken a vacation while the heart is reduced to a mechanical object in need of repair. The “you” that is your identity, including awareness of yourself and the world, has disappeared (or has it?). Moreover in open-heart surgery, the stopped heart implies a level of disconnection from the patient’s essential self that is mystifying. How is possible to come back from such an invasion of you who are?
Kabbalah, Heart and Soul
Judaism and Kabbalah provide one answer as to how the essence of an open-heart surgery patient (as well as the rest of us) stays connected to the body: each of us has a soul that is transcendent to the physical body and is connected to the Divine. The soul has five levels intertwined with the human body in varying degrees. Nefesh, or vital soul, is the densest level and is most connected to physicality. It can be thought of as the life force, or chi, in the Taoist tradition. Ruach, wind or spirit, is related to the breath and is identified with emotional awareness. Neshamah, also related to breath, can be thought of as a defining quality of consciousness. Chaya, living essence, is a more refined level of soul connected to a transcendent level of consciousness. Yechidah, unity, is the soul in its essence; a spark of God beyond the plane of duality and in some sense is beyond the body.
This perspective of levels of soul implies that even as an indispensable part of the physical body and one’s consciousness is out of commission, there is a level of connection to the body that is maintained on planes beyond normal consciousness.
Science, Heart and Soul
From a science perspective, there is an assumption that the brain produces consciousness, yet science has no explanation for how it works. New York Times bestselling author Dr. Larry Dossey asserts, “…consciousness can operate beyond the brain, body and the present, as hundreds of experiments and millions of testimonials affirm. Consciousness cannot, therefore, be identified with the brain.”
Dr. Allan Hamilton, Harvard-trained neurosurgeon and author of The Scalpel and the Soul, relates an experience with a patient who was temporarily rendered brain dead during surgery. After she recovery, this woman could reiterate entire conversations conducted during her surgery. According to science, this is impossible. As Stephen Stills wrote, “There’s something happening here, what it is ain’t exactly clear…”
A Spectacular Success Story
The fact that thousands of people a day go through open-heart surgery with a stunning success rate implies a connection between mind/body/spirit beyond any mechanical/chemical explanation of how people work. There is an intelligent life force flowing through us that accepts and allows the miracle of open-heart surgery. As marvelous as the technology and skill set of a medical team are, there is an even more fantastic Force within us so vibrant and powerful that a person can withstand open-heart surgery and thrive.
I am very grateful for both science and the Source of it. Without them, my loved ones would not have the chance for many more years of healthy and productive living. To life!
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If someone said to you that your lifetime risk of a heart attack was close to 100 percent, you’d probably want to do everything you could to either prevent that fate or delay it by as long as possible, right?
Heart attacks continue to be the number-one killer of Americans; 1.5 million heart attacks occur in the United States each year, with 500,000 deaths. Costs related to heart attack exceed $60 billion per year.
Most of us are aware of the ways in which we can help keep our hearts healthy:
Eating a sensible, balanced diet high in healthy fats and low in saturated fat.
Keeping our cholesterol and blood pressure under control.
Maintaining a regular exercise routine that gets our heart pumping faster.
But what about sleep? How does that factor in?
Turns out that sleep factors in big time: a new study shows that poor sleep may worsen heart health by increasing inflammation. Chronic inflammation has gained a lot of attention in recent years due to the associations found between this bodily process and an array of illnesses and disease. While inflammation is a normal physiological process and part of our immune system, when it runs amok it can wreak havoc on our cells and tissues. This explains why inflammation can play a major role in heart health, as it can lead to restricted blood flow and increase the risk of heart attack and stroke.
This recent study found that regular bouts of insomnia and poor sleep quality may increase inflammation throughout the body, which may be further aggravated by high cholesterol, resulting in heart complications. The specifics:
After surveying 525 participants on their sleep habits, researchers from Emory University measured their levels of certain inflammatory hormones, including the famous C-reactive protein that’s used as a biomarker for inflammation.
They found that individuals who regularly got the least sleep were significantly more likely to have high levels of the hormones and, consequently, inflammation.
In fact, adults who slept for six or fewer hours had higher levels of all three inflammatory markers that the researchers measured.
The researchers at Emory also noticed that men and women with poor sleep quality had higher blood pressures.
There was something else that the researchers discovered to their surprise: men — not women — who experienced poor sleep quality had less flexible arteries. This condition also contributes to hypertension and puts more stress on the heart.
The reason for this could be due to certain hormones or other variables going on in women that help explain the discrepancy. This doesn’t mean women can get away with poor sleep. It just means that we need to study gender differences when it comes to health and their separate risk profiles.
Fibrinogen, one of the other markers observed in this study, forms a fibrous mesh that slows blood flow, thus increasing blood pressure and potentially causing hypertension. This fibrous mesh quickens the time it takes for your blood to clot, which can cause a stroke or heart attack.
So it goes without saying that we all need to keep sleep on our list of priorities for keeping our hearts healthy and strong.
Bottom line: Rest up to keep your heart up and running. You may feel like a ticking time bomb as you juggle too many to-dos and run around like mad addressing your commitments and obligations. But that ticking time bomb can be real if you’re simultaneously throwing sleep out the window. Add more minutes to your life just by adding more quality sleep minutes to your time in bed.
It really could be as easy as that.
Michael J. Breus, Ph.D.
The Sleep Doctor
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Brought to you by Deepak Chopra, MD, Alexander Tsiaras, and TheVisualMD.com
A smoker’s body shows evidence of the habit’s deadly effects from head to toe. The way tobacco smoke ravages lung tissue is well known. The cardiovascular system is also imperiled as smoking damages the cells lining blood vessels and causes arteries to constrict. Smokers’ risk of heart disease is 2 to 4 times that of nonsmokers, and their risk of sudden death from a heart attack is twice that of nonsmokers. Smokers also are more likely to suffer vision loss from cataract development or macular degeneration. Expectant mothers who smoke expose the fetus to grievous harm. Smoking causes the uterine blood vessels to narrow. As a result, overall fetal growth is slowed and brain development can be seriously impeded. The likelihood of premature birth and other delivery complications is higher for smokers. The effects of smoking also include slower healing of wounds, muscle fatigue and premature aging. Smoking is an all-out assault on nearly every function of the body.
Learn more about the benefits of smoking cessation:
TheVisualMD.com: Never Smoke. If you Smoke Now, Quit
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Muhammad: A Story of the Last Prophet
by Deepak Chopra
The Ultimate Happiness Prescription: 7 Keys to Joy and Enlightenment
by Deepak Chopra
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Earlier this week, Barbra Streisand wrote an important reminder of the specific vulnerabilities that bear on the hearts of women and why we need to study this more closely. And as if in answer to this, an important review is about to reach print . This review looked asked the question: Why are women at risk for coronary heart disease? And the answers were very interesting. Depression, anxiety disorders, anger suppression and stress associated with relationships and family responsibilities contributed significantly to coronary heart disease in women but general anxiety, hostility and work-related stress had similar effects on men and women. Definitely disturbing, but what does this mean?
At the most basic level, why do the hearts of women strain when feelings get out of control? And what do these different factors have in common?
They are all about stuckness: People talk about depression as if it is about sadness when at a fundamental level, it is also as much about stuckness. Anxiety leads to “freezing” stuck responses too, and anger suppression is also about something not being able to make its way out. Even stress is about stuckness when it causes memory circuits to become activated so that only old habits of being are recreated. In a sense, these factors, when they strike, are like jamming the brakes. And the heart has to work that much harder to keep things moving and happening.
But these findings are also interesting because it is not general anxiety but anxiety disorders that pose a risk; it is not hostility but the suppression of anger that is also a risk; and not work-related stress but the stress of social relationships that pose the tremendous risk that burden a woman’s heart. It appears that a certain threshold has to be crossed before the heart starts to strain. While anxiety and anger may both be signals of impending heart strain in women, they have to reach proportions of “disorder” or be so high as to need to be suppressed for the risk to reveal itself. The bad news is that this happens at all. The good news is that we an do something about this.
This study would seem to suggest that general anxiety itself does not confer specific risk to coronary heart disease in women, but it may signal the beginning of a disorder. This would suggest that rather than waiting for the anxiety to be out of control, it would probably in the best interest of women to decrease the anxiety at that stage rather than wait for the full-blown disorder to occur. The same for anger. Early constructive expression may prevent the need for suppression, and if expectations about relationships and family responsibilities are managed earlier on, there may be less of a need for the heart to “feel” as though it needs to work harder. The point here is that it seems that much of this is preventable, and that setting up systems to prevent progression of anxiety depression and anger may actually also prevent heart disease. In fact, the study supported this in part because the review also showed that supportive social relationships and positive psychological factors may be associated with reduced risk of coronary heart disease.
Thus, a review like this raises awareness that our brains and hearts are very connected and that our moods can be a real weight that prevents vital body organs from getting blood. And it also emphasizes that heart disease may be modifiable at a more basic level.
To start this journey toward modification of risk factors then, ask yourself first: Are you in the brake-jam phase of life where nothing seems to be moving fast enough? Because if you are, your heart is probably feeling this as well. The heart tells the stories of its well-being in the language of feelings. Listen to your heart when it tells you stories in the languages of depression and anxiety, for if you do, you may be able to change the language of its stories, and in so doing, have the very change of heart you desire — at a very literal level.
1.Low, C.A., R.C. Thurston, and K.A. Matthews, Psychosocial factors in the development of heart disease in women: current research and future directions. Psychosom Med, 2010. 72(9): p. 842-54.
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by Srinivasan S. Pillay MD
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The Heart Attack Grill’s latest promotion — obese people eat free! — is one of the best weapons in our current health crisis.
Change.org’s Sustainable Food department recently Heart Attack Grill is sent out the news that Arizona’s offering their Double Bypass Burgers and Flatliner Fries free to customers weighing in at 350 lbs. and over. Change.org has a petition protesting the way this gimmicky restaurant undermines America’s current health crisis.
However, after watching the HAG’s video for “The Heart Attack Grill Diet Program,” I have to wonder whether HAG owner Jon Basso is actually working for the American Dietetic Association. This faux commercial is genius: It outlines exactly what will happen as a result of eating at the HAG, including “sudden weight gain, male breast growth, loss of sexual partners, stroke… In some cases, mild death may occur.”
I understand why Change.org is up in arms about HAG’s latest shock value gimmick, but at least HAG is being honest about exactly what will happen when customers choose to indulge in their food. What the Heart Attack Grill serves up is just a larger version of what used to be considered an occasional treat, yet what most American eating establishments offer, and people eat, every day — despite hearing time and again that this kind of food is unhealthy.
It’s not that HAG’s patrons, referred to as “patients,” don’t know what they’re getting when they order a Quadruple Bypass Burger and Flatliner Fries that are served by a woman in a nurse’s uniform. Imagine the heart attack lawsuit courtroom scene: “But your honor, I thought the commercial with the 570-lb. man and all that talk of food-related diseases was a joke.”
The HAG is a joke — the surgeon general’s warning sign at the restaurant’s door, the chef wearing a stethoscope, the wheelchair out to the parking lot for anyone who finishes the HAG’s largest meal. And, like some jokes, there’s truth in the punchline. The Heart Attack Grill isn’t hiding anything, and their fake diet plan commercial is a warning about the “side effects” — like “mild death” — that come when we choose to eat the typical American diet.
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If you eat the standard western diet that most people eat in the modern world, it’s quite likely you will develop heart disease. But there are other options. When it comes to treating heart disease, most doctors promote drugs, expensive, invasive testing, high-tech medical procedures and heart surgery as the standard options. A significant number of research studies have documented that heart disease is easily and almost completely preventable through a diet rich in plant produce and lower in processed foods and animal products.
In a recent CNN interview, Bill Clinton reminded Americans of these other options. When asked about his recent weight loss, he explained that his heart disease had progressed after bypass surgery, requiring his recent additional surgery to place stents. This experience led him to learn about the successes of lifestyle changes at reversing heart disease. He is now following a plant-based diet, similar to those described by Dean Ornish, M.D. and Caldwell Esselstyn, M.D. — Clinton has cut out all meat (except for occasional fish) and dairy from his diet — he says that he lives on “beans, legumes, vegetables, fruit.” Drs. Ornish and Esselstyn then also appeared on CNN where they explained that removing the foods that cause blood vessel damage and providing the body with copious phytonutrients can facilitate the body’s natural healing processes to reverse existing heart disease and restore quality of life.
This was an excellent reminder to Americans that cholesterol-lowering drugs, stents and bypass surgery are not magic bullets to cure heart disease. Some studies suggest that cholesterol-lowering drugs carry serious side effects, and there is no evidence that statin use reduces risk of death in individuals with elevated cholesterol when used as primary prevention. (1-3) Most patients who undergo stent and bypass procedures have not removed the cause of their disease, and so they continue to experience progressive disability and most often die a premature death as a result of their heart disease. (4) Nevertheless, drugs and surgical procedures are still the standard care for treatment of elevated cholesterol and coronary artery disease.
Some studies show that atherosclerotic plaque can be reversed, and cholesterol lowered without drugs or surgery. Making significant dietary and lifestyle changes allow many people who suffer with coronary heart disease, high cholesterol, obesity and/or high blood pressure to reduce or even eliminate their dependence on medications and avoid invasive surgical procedures.
But what is the optimal diet for heart disease prevention and reversal?
Certainly not the small dietary changes recommended by government agencies and other organizations — these are only modest changes to the average American’s diet, and the average American starts developing heart disease during childhood. (5) Unfortunately, these widely voiced recommendations have made many people think by eating reduced-fat, processed foods and replacing red meat with egg whites, fish and chicken, they will be protected. They will not. These changes are simply not rigorous enough to assure predictable reversal.
Low-fat vegetarian diets are a vast improvement. The low-fat, vegetarian diet devised by Dean Ornish, M.D. provided the first hard evidence that heart disease could be reversed — that atherosclerotic plaques could regress — with diet and lifestyle changes alone. (6) Similar results were found by Caldwell Esselstyn, M.D. (7)
I propose that a high-nutrient, vegetable-based diet can be even more effective. According to a study published in the American Journal of Cardiology, comparing the effects of dietary interventions on LDL cholesterol levels, a low-fat vegetarian diet reduces LDL by 16 percent, but a high-nutrient, vegetable-based diet including daily nuts and seeds reduces LDL cholesterol by 33 percent. (8, 9) This result suggests that if we improve the low-fat, vegetarian diet by making it more nutrient-dense, and include more greens, beans, seeds and nuts we may reverse heart disease even faster, and reduce heart disease risk even more.
What is a high-nutrient, vegetable-based diet? I call this a nutritarian diet, because it is guided by the ratio of micronutrients to calories in foods. 90 percent of calories come from nutrient-rich plant foods: vegetables, beans, fruits, nuts and seeds.
Not just vegetarian, nutritarian: vegetable-based and nutrient-dense. We need to take vegetables out of the role of side dish, even in low-fat, vegetarian diets, whose calories are generally derived mainly from grains and other starches. To provide optimal levels of protective micronutrients, a diet must be vegetable-based, not grain-based. Vegetables and beans are far superior to grains and white potato when it comes to nutrient density. Furthermore, low-fat, high carbohydrate diets tend to increase triglyceride levels, a risk factor for heart disease. In contrast, a high-nutrient, vegetable-based diet with beans as the preferred carbohydrate source decreased triglycerides, lower blood glucose and accelerate fat loss. (8, 10)
Not low-fat: include healthy fats from nuts and seeds. Seeds and nuts are indispensable for cardiovascular health. The protective properties of nuts against coronary heart disease were first recognized in the early 1990s, and a strong body of literature has followed, confirming these original findings. (11) In spite of this wealth of data and all of the press on healthy fats, a “low-fat” diet is still viewed in a positive light. Certainly adding fats in the form of oils is fattening and unhealthy, but naturally fat-rich foods like nuts and seeds have profound cardiovascular benefits. Moderate use of nuts also encourages weight loss, not weight gain. (12) By avoiding nuts and seeds you may be missing out on these benefits. A recent meta-analysis of 25 clinical studies that compared a nut-eating group to a control group solidified the LDL-lowering effects of nuts. (13) According to a study published in The Journal of Nutrition, nut consumption reduces coronary heart disease risk far more than can be explained by cholesterol lowering alone — 35 percent reduction in risk for five or more servings of nuts per week. (14)
These additional effects are only beginning to be discovered — recent data has shed light on the protective properties of almonds and walnuts on vascular health. (15, 16) The Physicians Health Study demonstrated that eating nuts and seeds regularly protects against sudden cardiac death caused by arrhythmia. The data suggests that following a low-fat diet for a long period of time, though effective at reducing atherosclerotic plaque, could actually increase the risk of sudden cardiac death. (17)
I have seen a nutritarian diet produce astounding results in my practice. Hundreds of my patients, readers of my books and members of my website have dropped their cholesterol levels into the favorable range and reversed their existing heart disease — without drugs — using high nutrient eating, which places vegetables — not meat, and not grains — at the base of our food pyramid.
In this video, Ronnie Valentine tells his remarkable story of using a high-nutrient diet to reverse his heart disease and restore his health. After having quadruple bypass surgery, and then three stents and an angioplasty, he went to the internet for answers and decided to try a nutritarian diet. Ronnie has undergone a remarkable transformation.
The main point is not just the wonderful numbers he earned; it is that even after an angioplasty and with a medicine cabinet full of pills, he could not walk one block because of severe chest pain due to significant atherosclerosis and restenosis. Yet, in less than a year he became free of heart disease; he now runs, plays sports, and has a full, healthy, active life and needs no medications.
With the help of the Nutritional Research Project, I am in the planning stages of a scientific study that will document the extent of atherosclerotic plaque regression on the nutritarain diet.
1.Ray, K.K., et al., Statins and all-cause mortality in high-risk primary prevention: a meta-analysis of 11 randomized controlled trials involving 65,229 participants. Arch Intern Med, 2010. 170(12): p. 1024-31.
2.Hippisley-Cox, J. and C. Coupland, Unintended effects of statins in men and women in England and Wales: population based cohort study using the QResearch database. Bmj, 2010. 340: p. c2197.
3.Sattar, N., et al., Statins and risk of incident diabetes: a collaborative meta-analysis of randomised statin trials. Lancet, 2010. 375(9716): p. 735-42.
4.Esselstyn, C.B., Jr., Resolving the Coronary Artery Disease Epidemic Through Plant-Based Nutrition. Prev Cardiol, 2001. 4(4): p. 171-177.
5.Berenson, G.S., et al., Atherosclerosis of the aorta and coronary arteries and cardiovascular risk factors in persons aged 6 to 30 years and studied at necropsy (The Bogalusa Heart Study). Am J Cardiol, 1992. 70(9): p. 851-8.
6.Ornish, D., et al., Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. Lancet, 1990. 336(8708): p. 129-33.
7.Esselstyn, C.B., Jr., et al., A strategy to arrest and reverse coronary artery disease: a 5-year longitudinal study of a single physician’s practice. J Fam Pract, 1995. 41(6): p. 560-8.
8.Barnard, N.D., et al., Effectiveness of a low-fat vegetarian diet in altering serum lipids in healthy premenopausal women. Am J Cardiol, 2000. 85(8): p. 969-72.
9.Jenkins, D.J., et al., Effect of a very-high-fiber vegetable, fruit, and nut diet on serum lipids and colonic function. Metabolism, 2001. 50(4): p. 494-503.
10.Sarter, B., T.C. Campbell, and J. Fuhrman, Effect of a high nutrient density diet on long-term weight loss: a retrospective chart review. Altern Ther Health Med, 2008. 14(3): p. 48-53.
11.Fraser, G.E., et al., A possible protective effect of nut consumption on risk of coronary heart disease. The Adventist Health Study. Arch Intern Med, 1992. 152(7): p. 1416-24.
12.Mattes, R.D., P.M. Kris-Etherton, and G.D. Foster, Impact of peanuts and tree nuts on body weight and healthy weight loss in adults. J Nutr, 2008. 138(9): p. 1741S-1745S.
13.Sabate, J., K. Oda, and E. Ros, Nut consumption and blood lipid levels: a pooled analysis of 25 intervention trials. Arch Intern Med, 2010. 170(9): p. 821-7.
14.Kris-Etherton, P.M., et al., The role of tree nuts and peanuts in the prevention of coronary heart disease: multiple potential mechanisms. J Nutr, 2008. 138(9): p. 1746S-1751S.
15.Jenkins, D.J., et al., Dose response of almonds on coronary heart disease risk factors: blood lipids, oxidized low-density lipoproteins, lipoprotein(a), homocysteine, and pulmonary nitric oxide: a randomized, controlled, crossover trial. Circulation, 2002. 106(11): p. 1327-32.
16.Ma, Y., et al., Effects of walnut consumption on endothelial function in type 2 diabetic subjects: a randomized controlled crossover trial. Diabetes Care, 2010. 33(2): p. 227-32.
17.Albert, C.M., et al., Nut consumption and decreased risk of sudden cardiac death in the Physicians’ Health Study. Arch Intern Med, 2002. 162(12): p. 1382-7.
This Blogger’s Books from
Eat to Live: The Revolutionary Formula for Fast and Sustained Weight Loss
by Joel Fuhrman
Disease-Proof Your Child: Feeding Kids Right
by Joel Fuhrman M.D.
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Women have broken through some of the hardest glass ceilings. We’ve had women explore the depths of outer space, a woman run for President of the United States, and we’ve had a woman serving as Speaker of the House, a position that is just two heartbeats away from the Presidency. Many consider politics as one of the last bastions of the boys club and thankfully — although slowly — women are finally making real inroads.
But there is another boys club that until recently many people either didn’t know about or talk about. It came as a big shock to me to discover that gender inequality still prevails in the medical sciences when it comes to research and treatment of some illnesses. I consider myself a well-informed person, but I only became aware of this fact when learning about women and heart disease, and I was stunned.
Heart disease is the number one killer of women in our country, more than all cancers combined. Today, heart disease kills more women than men. When I started to think about this, it was not surprising. More women are taking on the stresses of juggling household demands, of being wife, mother and breadwinner. All of these modern day strains add to higher blood pressure, lack of physical activity, quick and unhealthy food choices, and weight gain — all major contributors to heart disease.
Despite the statistics, for years, most of the medical community has been treating our mothers, wives, daughters, sisters and friends inadequately because they based their treatment protocols on research outcomes done mostly on male patients. Cardiologists treating women certainly intended to provide their patients with quality care, but they could only depend on the research that was available and known to them.
In 1991, Dr. Bernadine Healy, the first woman director of the US National Institute of Health, studied the gender bias in the treatment of coronary heart disease. Termed the Yentl syndrome (a surprising coincidence), the study revealed that “once a woman showed that she was just like a man by having severe coronary artery disease, she was then treated as a man would be.” This would make sense if women’s hearts were biologically the same as men’s hearts — but they aren’t! And because of the biological differences, heart attacks present differently in women than they do in men. Instead of the classic attack — clutching a painful chest — women often have indigestion and fatigue. Plus, women are more likely than men to develop micro-vascular disease, which affects the heart’s smallest arteries.
We can no longer afford to naively assume that this is only a man’s disease — it’s now a woman’s epidemic. We may be almost 50 years behind in our research knowledge that informs diagnosis and treatment regimens for women with heart disease, but we are finally starting to close that gap. The Women’s Heart Center at Cedars Sinai Medical Institute is helping to lead the way in this effort as one of few institutions in the country on the cutting edge of this research. The Center is led by Dr. Noel Bairey Merz, a Harvard Medical School graduate. Dr. Merz has published over 180 scientific publications and more than 200 abstracts and has received numerous awards recognizing her as one of the field’s leading experts on preventive cardiology, women’s heart disease and mental stress. It was clear to me that I had to get involved when I heard that this brilliant woman was doing lifesaving work that would ultimately impact women all over the world — right in my own backyard!
But it’s all of our responsibilities to be advocates on this issue and to demand that gender inequality, especially when it comes to life and death issues, is not acceptable. This is a call to action and I hope you all will join me in supporting the new and vital work that is being done on women’s heart health. If you want to learn more, visit: CrowdRise.com/barbrastreisand
I recall reading a scientific paper in the Journal of the American Medical Association a number of years ago by Dr. David Jenkins from the University of Toronto. He showed that using a combination of soy, fiber, almonds, and plant sterols (cholesterol-lowering fats) could lower cholesterol levels as much as statin medications.(i) Diet can lower cholesterol as much as statins–a surprise to many but common in my practice. Using a comprehensive approach of diet and lifestyle change, I routinely see effects that are more powerful than any medication. That was not why the article struck me. It was a finding buried in the text of the paper.
What I found fascinating was that the patients who lowered their cholesterol with statins had higher levels of insulin, while those who lowered their cholesterol through diet had lower insulin levels. Why is that important? Because elevated insulin levels are the first step on the road to diabetes–they make you gain weight around the middle, cause high blood pressure, increase inflammation, and promote stickiness of the blood. Each of these conditions, in turn, contributes to heart attacks and heart disease.
On reading this, the question that lingered in my mind was: Did statins contribute to the development of pre-diabetes and diabetes which are among the most significant risk factors for heart disease? In other words, did lowering cholesterol with statins–a treatment purported to reduce the risk of heart disease–actually increase the risk of heart disease by some other mechanism?
In treating thousands of patients with pre-diabetes, diabetes, high cholesterol, and heart disease, I have noticed one thing: Lowering insulin through diet and lifestyle corrects almost all of the risk factors for heart disease. It lowers blood pressure, increases good cholesterol (HDL), lowers triglycerides and bad cholesterol (LDL), leads to weight loss, lower levels of inflammation (C-reactive protein), and thins the blood. Lowering insulin even increases the light fluffy harmless cholesterol and lowers the level of small dense harmful cholesterol particles.
Lowering insulin is a good thing. However, statins–the best selling class of drugs on the market–appear not to do this. Do they actually increase the risk for diabetes and thus heart disease by increasing insulin levels?
The Truth about Statins and Insulin
The answer, according to a recent study in the Lancet, is yes statins do increase the risk of diabetes.(ii) The authors completed a meta-analysis of both published and unpublished randomized controlled trials from 1994 to 2009 for a total patient group of 91,140 who were treated with statins or a placebo. In the patients treated with statins there was a 9 percent increase in the risk of diabetes. The authors suggest this is a minimal risk and that current guidelines for cholesterol treatment should not change. I would suggest we think a little more deeply.
The study did not analyze any data for pre-diabetes, which dramatically increases the risk of heart disease well before a formal diagnosis of diabetes can be made. It could be that by taking these medications many people developed pre-diabetes or their pre-diabetic condition worsened. If this is true, the full risk of statins was not appreciated. The researchers also failed to consider a simple question: Why should we use a medication with significant potential risks when other treatments have proven MORE effective for reducing the risk of heart disease?
The treatment I’m talking about is dietary and lifestyle change–popularly referred to as lifestyle medicine. The recent “EPIC” study published in the Archives of Internal Medicine studied 23,000 people’s adherence to 4 simple behaviors–not smoking, exercising 3.5 hours a week, eating a healthy diet (fruits, vegetables, beans, whole grains, nuts, seeds, and low meat consumption), and keeping a healthy weight (BMI less than 30). In those that adhered, 93 percent of diabetes, 81 percent of heart attacks, 50 percent of strokes, and 36 percent of all cancers were prevented. (iii)
The fundamental focus of lifestyle or functional approaches (which includes nutrition, exercise, and stress management) is the restoration of normal function and balance in each individual. When you do this, risk factors and symptoms go away automatically. Conventional interventions, on the other hand, are primarily focus on blocking, interfering with, or excising a biochemical or physical manifestation of disease. This is the reason biology shifts towards normal when using lifestyle medicine, instead of medication, and the only side effects are good ones: weight loss, more energy, better sleep, increased well being, a reduction of most disease, and increased longevity.
While it is still a matter of public debate, there is ample evidence that lifestyle therapies equal or exceed the benefits of conventional therapies such as medication and surgery. Nutrition, exercise, and stress management can no longer be considered alternative medicine. They are essential medicine, and often the most effective and cost-effective therapies to deal with the chronic disease epidemic that afflicts millions of Americans and is now the primary cause of death worldwide.
Addressing the Global Burden of Chronic Disease
Chronic disease has replaced infectious and acute illnesses as the leading cause of death in the world, both in developed and developing countries.(iv) In 2002, the leading chronic diseases, including heart disease (17 million), cancer (7 million), chronic lung diseases (4 million), and diabetes (1 million), caused 29 million deaths worldwide. These ailments are almost entirely attributable to lifestyle risk factors including poor diet, sedentary lifestyle, and tobacco and alcohol use. The misperception that these diseases affect primarily developed and affluent societies has led to a misappropriation of resources, which fails to deal with the exponential growth of chronic lifestyle- and diet-related disease.
By 2030, fifty million will die from preventable chronic diseases compared to less than 20 million from infectious diseases. We need to include chronic disease in our global efforts to improve health. In Haiti, the poorest nation in the Western hemisphere, the major admitting diagnoses to the largest and main public health hospital where I worked after the earthquake in January 2010 was not tuberculosis or AIDS, but heart disease, diabetes, and hypertension related heart failure.
The major global health policy makers and agencies do not allocate appropriate resources to the prevention of chronic lifestyle diseases either because they have yet to recognize the problem or the economic and social benefits of focusing on chronic disease are underestimated. Heads of state, health ministries, the World Health Organization, academic and research institutions, non-governmental organizations, private donors, the World Bank, and the United Nations allocate only a fraction of their resources to chronic disease prevention despite a rich evidence base for the role of lifestyle and diet in the prevention of the major chronic diseases.
When compared to doing nothing, the argument can be made for high cost, technological interventions. When compared to changing our medical care system from one focused on treating end-stage disease, to one whose goal is to prevent disease and promote optimal health through nutrition, lifestyle, stress management, and adjunctive complementary therapies, the conversation shifts dramatically.
Diet, Lifestyle, and Chronic Disease: A Model for Increased Quality of Care and Lower Costs
Let’s briefly look at the science of nutrition and compare it to efforts for preventing or treating chronic disease with medication. This will highlight the powerful, cost-effective, and critical role nutrition plays in the cause, prevention, and treatment of chronic illness.
Science provides a firm foundation for moving nutritional and lifestyle interventions to the center of medical practice and public policy.(v) A single nutrient, food, or lifestyle habit when studied as an isolated intervention, while helpful, may not show significant effect, but when assessed collectively, the power of lifestyle over pharmacological approaches to prevent and treat chronic disease is overwhelming. That is why we have to stop looking at single nutrients or interventions and look at the whole picture. In his recent article in the Journal of the American Medical Association, Dr. David Ludwig of Harvard calls for a shift from a nutrient-based to a whole foods based approach to our dietary guidelines.(vi) He indicts our current dietary guidelines showing how these recommendations have led to our chronic disease epidemic. Let us eat food, he says–real, whole, fresh, complex, interesting food. It’s the whole picture, not just fats or carbs or this or that nutrient that makes a difference.
For example, healthful lifestyle practices in an elderly population that included eating a whole foods Mediterranean-style diet, exercising moderately, not smoking, and moderate alcohol consumption were associated with nearly a 70 percent reduction in death from all causes.(vii) What’s remarkable is that these people didn’t start this healthy lifestyle until they were 70 years old, yet they still reduced their risk of death by 70 percent compared to a similar group of elderly who didn’t follow a healthy lifestyle.
Other studies(viii), (ix), (x) showed similar results including an 83 percent reduction in heart disease,(xi) 91 percent reduction in diabetes in women,(xii) and a 71 percent reduction in colon cancer in men.(xiii)
The Lyon Diet Heart Study,(xiv) showed a 79 percent reduction in heart disease in patients with established heart disease after a few years of following a Mediterranean diet. In another study of patients with existing heart disease, an integrated lifestyle approach of a plant-based diet, exercise, smoking cessation, and stress reduction found a 50 percent reduction in heart attacks and heart disease related deaths.(xv)
The evidence is simply overwhelming that healthful dietary patterns which include whole grains, legumes, nuts, vegetables, fruits, olive oil, fish, and, perhaps, moderate alcohol intake are associated with a decrease in chronic disease and death from all causes. The harmful effects of trans and certain saturated fats, refined carbohydrates, and other food additives or toxins are well known in the medical literature.
It is time to start putting into practice what we know, and stop the domination of our medical practice by the pharmaceutical industry. The Lancet paper on how statins increase the risk of diabetes should be front-page news. Medications such as statins that cost more, are less effective, and lead to serious side effects including diabetes should not be our first line of treatment for preventing or treating heart disease. The recent proposal that statins be handed out with cheeseburgers and fries at fast food restaurants is dangerous and misses the point.
You can’t eat a horrible diet, avoid exercise and expect to be healthy. A whole foods, plant-based diet, moderate physical activity, not smoking, and creating a supportive social network of friends and family is the best medicine. It works in ways we don’t yet understand and don’t need to–just eat real food, enjoy, and don’t worry. Your body knows what to do from there.
To your good health,
Mark Hyman, MD
(i) Jenkins D.J., Kendall, C.W., Marchie, A., et. al. 2003. Effects of a dietary portfolio of cholesterol-lowering foods vs Lovastatin on serum lipids and C-reactive protein. JAMA. 290(4): 502-10
(ii) Sattar, N., Preiss, D., Murray, H., et. al. 2010. Statins and risk of incident diabetes: A collaborative meta-analysis of randomised statin trials. Lancet. 375(9716): 735-42.
(iii) Ford E.S., Bergmann M.M., Krger J., et. al. 2009. Healthy living is the best revenge: findings from the European Prospective Investigation Into Cancer and Nutrition-Potsdam study. Arch Intern Med. 169(15): 1355-62.
(iv) Yach D., Hawkes C., Gould C.L., et. al. 2004. Global burden of chronic diseases: Overcoming impediments to prevention and control. JAMA. 291(21): 26
(v) Rimm E.B., and M.J. Stampfer. 2004. Diet, lifestyle, and longevity–the next steps? JAMA. 292(12): 1490-2. No abstract available.
(vi) Mozaffarian, D. and D.S. Ludwig. 2010. Dietary guidelines in the 21st century–a time for food. JAMA. 304(6): 681-682.
(vii) Knoops K.T., de Groot L.C., Kromhout D., et. al. 2004. Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: The HALE project. JAMA. 292(12): 1433-9.
(viii) Trichopoulou A., Costacou T., Bamia C., et. al. 2003. Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med. 348(26): 2599-608.
(ix) Salmeron J., Manson J.E., Stampfer M.J., et. al. 1997. Dietary fiber, glycemic load, and risk of non-insulin-dependent diabetes mellitus in women. JAMA. 277(6): 472-477.
(x) Liu S., Willett W.C. 2002. Dietary glycemic load and atherothrombotic risk. Curr Atheroscler Rep. 4(6): 454-461.
(xi) Stampfer M.J., Hu F.B., Manson J.E., et. al. 2000. Primary prevention of coronary heart disease in women through diet and lifestyle. N Engl J Med. 343: 16-22.
(xii) Hu F.B., Manson J.E., Stampfer M.J., et al. 2001. Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N Engl J Med. 345: 790-797.
(xiii) Platz E.A., Willett W.C., Colditz G.A., et. al. 2000. Proportion of colon cancer risk that might be preventable in a cohort of middle-aged US men. Cancer Causes Control. 11(7): 579-588.
(xiv) de Lorgeril M., Renaud S., Mamelle N., et. al. 1994. Mediterranean alpha-linolenic acid-rich diet in secondary prevention of coronary heart disease. Lancet. 343: 1454-1459. [published correction appears in: Lancet. 1995; 345(8951): 738]
(xv) Ornish D., Scherwitz L.W., Billings J.H., et. al. 1998. Intensive lifestyle changes for reversal of coronary heart disease. JAMA. 280: 2001-2007.
Mark Hyman, M.D. is a practicing physician, founder of The UltraWellness Center, a four-time New York Times bestselling author, and an international leader in the field of Functional Medicine. You can follow him on Twitter, connect with him on LinkedIn, watch his videos on YouTube, become a fan on Facebook, and subscribe to his newsletter.
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Imagine we found the cure for heart disease or diabetes, but as a society chose to withhold that treatment from those who need it most. Would it be ethical to withhold effective treatments when the result is unnecessary suffering and death that costs our health care system hundreds of billions of dollars a year?
The answer is obvious, yet that is exactly what occurs today in America. We know the most effective treatments for some of the deadliest diseases of our time, but millions are denied access to them. In effect, we are conducting a large experiment on our population without their consent. This happened in America once before. It is a dark stain on our scientific history that most of us would rather forget. It was the Tuskegee experiment.
Tuskegee: Human Experimentation Without Consent
From 1932 to 1972 scientists from the US Public Health Service conducted the Tuskegee syphilis study on 399 impoverished African American sharecroppers from Tuskegee, Alabama without their consent. They withheld a known effective treatment for syphilis–namely penicillin–in order to observe what happened over time to those with untreated syphilis. Scientists wondered how the disease affected the body and mind, so they drew blood from these men and monitored their progress but did nothing to stop the progression of the illness even though they knew they could cure it and prevent horrid disability with a few simple shots of penicillin.
Right now we are in the midst of a similar experiment, but few know about it. The tragedy of this experiment happened in my own family. My stepfather, who had diabetes and heart disease, was a victim of our modern Tuskegee experiment. He ultimately died last year as a result, and cost our health care system $400,000 along the way. If he were simply provided the choice of a different treatment–a treatment that is proven to be more effective and cost less than medication and surgery–namely a program for sustainable and comprehensive lifestyle change, perhaps he would still be alive and our national debt would be reduced by $400,000.
My stepfather was diabetic. He had the best medical, pharmaceutical, and surgical care available. Nonetheless, he suffered from very poor health and functioning. He went to the emergency room with chest pain and was treated with a cardiac bypass operation, even though evidence has shown no reduced mortality for cardiac bypass or angioplasty in diabetics.(i) Not providing effective treatment is one thing, but providing harmful, costly, and ineffective treatment like this is unethical.
Physicians do what they know (often as a result of training in a medical educational system dominated by Big Pharma) and what is paid for by insurance. Having a cardiac bypass after experiencing chest pain isn’t the best treatment option for diabetics, but it is what is paid for by insurance. After the bypass post-operative infection of his sternum with MRSA (an antibiotic-resistant staph bacteria) lead to a month in the intensive care unit, plastic surgery to repair the chest defect, and “mini-strokes” following bypass surgery which led to memory loss or “pre-dementia”,(ii) and a protracted recovery from hospitalization requiring months of home care.
The surgery and subsequent medical therapy with blood pressure medication, cholesterol-lowering medication, and blood thinners did not enhance the quality of his health and life. In fact, he continued to be sedentary, craved sugars and refined carbohydrates, and rapidly declined physically and mentally.
My stepfather was not offered a treatment that exists today, would have cost less than 2 percent of the $400,000 his care cost, and would have likely created an infinitely enhanced quality of life. It should be our right to have access to proven treatments that provide better value for the individual and for the health care system. This shift must be made if we are going to significantly impact our chronic disease epidemic and the frightening convergence of the GDP and health care cost curves.
How is our modern Tuskegee experiment happening today? How did this happen to my stepfather? What treatment was he denied that may have saved his life? Let me explain.
Treatments We are Denied by Conventional Medicine
Overwhelming evidence proves that the most effective prevention and treatment for chronic diseases such as heart disease and diabetes is what we eat, how much we exercise, how we handle stress, and our social connections. These factors are often referred to collectively as “lifestyle medicine.” Environmental toxins are also known to play a role in these epidemics but are less modifiable.
Lifestyle medicine is not just about preventing chronic diseases but also about treating them. It is often more effective and less expensive than relying exclusively on drugs and surgery. Nearly all the major medical societies recently joined in publishing a review of the scientific evidence for lifestyle medicine both for the prevention and TREATMENT of chronic disease. That report is called the ACPM Lifestyle Initiative, and I encourage you to read it. It concluded there is strong evidence that a lifestyle-based approach to chronic disease often works better than medication or surgery and saves money.
Taken collectively, the evidence is actually overwhelming. Lifestyle intervention is often more effective in reducing cardiovascular disease, hypertension, heart failure, stroke, cancer, diabetes and all cause mortality than almost any other medical intervention.(iii) This data in conjunction with a number of extraordinary recent research papers that call into question the very foundations of our current approach–treating risk factors such as high blood pressure, high cholesterol, or high blood sugar to prevent heart disease and diabetes–forces us to rethink our whole approach to medicine. These studies showed that lowering blood pressure, blood sugar, and cholesterol in pre-diabetics with medication didn’t reduce the risk of heart attacks or death and created unnecessary side effects.(iv),(v),(vi),(vii)
We’re targeting the wrong things–we need to treat the cause, not the effects. High blood pressure, high cholesterol, and high blood sugar are NOT the cause of heart disease or diabetes. The real culprit is what we eat, how much we exercise, stress, and environmental toxins. Our lifestyle and environment influences the fundamental biological mechanisms that lead to disease: Changes in gene expression, which modulate inflammation, oxidative stress, and metabolic dysfunction. Treating risk factors is like blowing away the smoke while the fire rages on. Lifestyle medicine puts out the fire.
Unfortunately, insurance doesn’t usually pay for it. No one profits from lifestyle medicine, so it is not part of medical education or practice. It should be the foundation of our health care system, but doctors ignore it because doctors do what they get paid to do. They get paid to dispense medication and perform surgery. They also need to be paid to develop and conduct practice-based and community programs in sustainable lifestyle change such as those pioneered by Dr. Dean Ornish.
The new health care bill provides for community based wellness initiatives like these, and that’s a step in the right direction. The National Council on Prevention, Health Promotion, and Public Health has begun to develop policies that will create a healthier nation. But what’s missing is insurance and Medicare reimbursement for treatments known to be effective for heart disease and diabetes–lifestyle-based therapies that are critical not just for prevention but also for the treatment and reversal of these modern epidemics. By not offering reimbursement for these treatments we have, in effect, begun the Tuskegee experiment of the 21st century.
The future of medical care must be to transform general lifestyle guidance–the mandates to eat a healthy diet and get regular exercise that many physicians try to provide to their patients–into individually-tailored lifestyle prescriptions for both the prevention and treatment of chronic diseases. The only way this is going to happen is if doctors are paid to do it. Lifestyle is often the best medicine when applied correctly, and it is the only thing that will end our modern Tuskegee experiment.
To your good health,
Mark Hyman, MD
(i) BARI 2D Study Group, Frye R.L., August P., Brooks M.M. et al. 2009. A randomized trial of therapies for type 2 diabetes and coronary artery disease. N Engl J Med. 360(24): 2503-15.
(ii) Neurological Outcome Research Group and the Cardiothoracic Anesthesiology Research Endeavors Investigators, Newman M.F., Kirchner J.L., Phillips-Bute B.,et al. 2001, Longitudinal assessment of neurocognitive function after coronary-artery bypass surgery. N Engl J Med. 344(6): 395-402.
(iv) The ACCORD Study Group. 2010. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med. 362(17): 1575-1585.
(v) The NAVIGATOR Study Group. 2010. Effect of nateglinide on the incidence of diabetes and cardiovascular events. N Engl J Med. 362(16): 1463-1476.
(vi) The NAVIGATOR Study Group. 2010. Effect of valsartan on the incidence of diabetes and cardiovascular events. N Engl J Med. 362(16): 1477-1490.
(vii) Ray K.K., Seshasai S.R., Wijesuriya S, et al. 2009. Effect of intensive control of glucose on cardiovascular outcomes and death in patients with diabetes mellitus: A meta-analysis of randomized controlled trials. Lancet. 373(9677): 1765-72.
Mark Hyman, M.D. is a practicing physician, founder of The UltraWellness Center, a four-time New York Times bestselling author, and an international leader in the field of Functional Medicine. You can follow him on Twitter, connect with him on LinkedIn, watch his videos on YouTube, become a fan on Facebook, and subscribe to his newsletter.
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