I refuse to tell you what to eat

 

A recent tweet from JAMA, the journal of the American Medical Association, urged me and other doctors to “include nutrition counseling into the flow of [our] daily practice.”

Along with the tweet came a link to an article that outlines “relatively small” dietary changes, based on the latest Dietary Guidelines for Americans, that can “significantly improve health.”

My response to the tweet was swift and knee-jerk.  I will not do it.  I simply will not.  I refuse to follow dietary guidelines or recommend them to my patients.

“What are you saying?!” “Are you the kind of self-interested doctor who only treats disease and cares nothing about prevention?!”  I imagine my outraged critics erupting in a chorus of disapproval.

Is my reaction unwarranted?  After all, the recommendations themselves seem sensible enough:  Eat fast food less often; drink fewer sugary sodas; consume more fruits and vegetables.  What’s not to like?

Unhealthy guidelines

I don’t know.  Perhaps it’s dietary guideline fatigue.

For more than 40 years, the nutrition experts have instructed us with guideline after guideline, food pyramid after food pyramid.  But what have they got to show for?  The obesity epidemic followed the introduction of dietary recommendations, and some doctors even blame those recommendations for causing the epidemic!

The blame may be far-fetched, but there’s something un-natural and perhaps even unhealthy about dietary guidelines.Read more

Am I a “statin denialist”?

 

As you may recall, in a previous video I addressed the topic of statin drugs, and whether these drugs are over-prescribed.  In that video, I criticized the approach of treating people’s cholesterol without any regard to the patient’s cardiovascular health or to other considerations.

Recently, Dr. Steve Nissen, chairman of cardiovascular medicine at the famed Cleveland Clinic and a very vocal proponent of statins, wrote an editorial in which he rebukes those who question the use of statins as “an internet-driven cult with deadly consequences,” a cult he calls “statin denial.”

Those are pretty strong words.  In fact, I think these are smearing words, meant to stifle any debate.

Am I a statin-denialist?  I’m not sure.  Dr. Nissen defines the problem as he sees it in 2 ways:  1) statin denial is “the proposition that cholesterol is not related to heart disease” and 2) statin fear is the notion that lowering serum cholesterol levels will cause serious adverse effects, such as muscle or hepatic toxicity—or even worse, dementia.”

Now, it’s true that some people hold an extreme position regarding statin drugs and, in my opinion, exaggerate their risk.  But it is undeniable that thousands, if not millions of healthy people are prescribed statin drugs—and therefore turned into patients, who need to worry and undergo constant monitoring.  The risk of being healthy yet turned into a patient is, in my opinion, very serious.Read more

Direct care: The option that saves time and money

Your Heart Health in a Heartbeat – Episode 7

* You can either read the transcript or watch the video at the bottom *


The direct care experience

Recently, a young man called my office wanting to be seen.  I spoke with him for a few minutes to better understand his concerns and plan for his visit.  It turned out that his girlfriend had been hearing a pulsating, “wooshing” sound whenever she would lean her head on his chest: woosh, woosh, woosh…Obviously, there was a concern that this had to do with his heart.  He was otherwise feeling well and was able to exercise without any difficulty.Read more