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

Cardiac arrest in marathons and triathlons

Your Heart Health in a Heartbeat – Episode 6

LINKS:

Cardiac arrest during marathons: 10 facts to consider.

Study of triathlon deaths concludes more screening is needed.

Interesting research studies from the American College of Cardiology 2016 meeting.

TRANSCRIPT:

Hello everyone,

There has been bad news coming from the marathon and triathlon communities regarding cardiac deaths during these events.  At the London marathon, a middle aged man suffered a cardiac arrest, and in Canada, a few days ago, a middle-aged woman also had a cardiac arrest and died during the swim portion of a triathlon.

So I thought I would take a few minutes today to go over what we know about cardiac arrest at these endurance events, and then go over some new recommendations for screening that were proposed at a recent meeting of the American College of Cardiology.Read more

Blood pressure and exercise

Your Heart Health in a Heartbeat – Episode 5

Document mentioned: 

Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 6: Hypertension

Transcript:

Hello everyone and thank you for joining me.

I’m Dr. Accad, medical director of Athletic Heart of San Francisco, and today I would like to talk about high blood pressure in relationship to exercise.  I am doing this in light of a document recently published jointly by the American College of Cardiology and American Heart Association that makes some recommendations for competitive athletes who have blood pressure concerns.Read more

535 kids screened!

Again, Athletic Heart SF is delighted to have participated in a screening event for school kids age 12-18 that took place on January 26, 2016, at Sacred Heart High School in Menlo Park.  The event was organized by Via Heart Project, and the kids also received instructions in basic CPR.

A total of 535 kids were screened, a 3 were found to have conditions that put them at risk of serious cardiac complications.  Others were also found to have some structural anomalies of the heart or aorta that would need further follow-up.

If you think your school district could benefit from a screening and would like to get involved, I encourage you to contact the non-profit Via Heart Project organization.  Also, don’t forget that the availability of AED is essential to increase survival rates in case of cardiac arrest.  If your local school is not properly equipped, Via Heart also helps with that.

The proper management of high blood pressure

 

If you have a high blood pressure concern, or you are on treatment for hypertension, you may wish to watch this video.  The transcripts are below, but let me also point you to this medical journal article, called On Redefining Hypertension.   I wrote it with my colleague Dr. Herbert Fred and you may find it informative.

 

TRANSCRIPT:

Hello everyone

Today I’d like to talk about high blood pressure management, because I think this is one area where there is a lot of confusion, even among doctors.  Just in the last couple of years, there have been studies and recommendations that conflict with each other about what constitutes high blood pressure, how to treat it, and so forth.

I will talk briefly about what high blood pressure is, why there is confusion about it, and what I think is the proper way to deal with people who have blood pressure concerns.Read more

Water intoxication during exercise and athletic activities

Your heart health in a heartbeat _ Episode 3

TRANSCRIPT:

Hello Everyone,

Today I’d like to talk about a topic that has nothing to do with heart disease, but one which I think should be of interest to athletes and to people who do intense exercise and sports.  The topic is “water intoxication.”

I bring that up because a young man came to Athletic Heart SF just the other day to be evaluated. He had had really bad symptoms during an intense workout, and there was a concern it might be his heart, but we figured out that the most likely cause of his symptoms was water intoxication.Read more

Why are screening tests controversial?

Your heart health in a heartbeat – Episode 2

Mammograms, PSA tests, heart scans, lung scans are all subject of debate and controversy.  Why is that?  Join me as I clarify the reason why screening should not be viewed only from the perspective of public health,


Transcript

Today, I’d like to talk about screening tests in general and why there seems to be so much debate and confusion about them.  It seems that every other week there is a new report in the media raising doubt about the value of this screening test or that screening test, whether it’s mammography, the PSA test for prostate cancer, colonoscopy, heart scans, or what have you.  And you hear one group of people advising one way and another advising another way, and it’s very confusing.

So how do we make sense of that?Read more

Are statin drugs over-prescribed?

Your heart health in a heartbeat – Episode 1

If your cholesterol is high, should you immediately start lifelong medication?  Join me as I discuss a new study which addresses this important question.

Link to the study discussed in this episode:

Implications of Coronary Artery Calcium Testing Among Statin Candidates According to American College of Cardiology/American Heart Association Cholesterol Management Guidelines

Related blog post about the heart scan:

The heart scan as a “mammogram of the heart”