Why Do Heart Doctors Favor Surgery and Drugs Over Diet?

on June 2nd, 2015

Fully Consensual Heart Disease Treatment
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When he was a surgeon at the Cleveland Clinic, Dr. Caldwell Esselstyn Jr. published a controversial paper in the American Journal of Cardiology, highlighted in my video, Fully Consensual Heart Disease Treatment, noting that heart bypass operations carry significant risks including the potential to cause further heart damage, stroke, and brain dysfunction. Angioplasty isn’t much better, also carrying significant mortality and morbidity, and often doesn’t work (in terms of decreasing the risk of subsequent heart attack or death). “So,” he writes, “it seems we have an enormous paradox. The disease that is the leading killer of men and women in Western civilization is largely untreated.” The benefits of bypass surgery and angioplasty “are at best temporary and erode over time, with most patients eventually succumbing to their disease.” In cancer management, we call that palliative care, where we just kind of throw up our hands, throw in the towel, and give up actually trying to treat the disease.

Why does this juggernaut of invasive procedures persist? Well one reason he suggests is that performing surgical interventions has the potential for enormous financial reward. Conversely, lack of adequate return is considered one of the barriers to the practice of preventive cardiology. Diet and lifestyle interventions lose money for the physician.

Another barrier is that doctors don’t think patients want it. Physician surveys show that doctors often don’t even bring up diet and lifestyle options because they assume that patients would prefer to be on cholesterol-lowering drugs every day for the rest of their lives rather than change their eating habits. That may be true for some, but it’s up to the patient, not the doctor, to decide.

According to the official AMA Code of Medical Ethics, physicians are supposed to disclose all relevant medical information to patients. “The patient’s right of self-decision can be effectively exercised only if the patient possesses enough information to enable an informed choice. The physician’s obligation is to present the medical facts accurately to the patient.” For example, before starting someone at moderate risk on a cholesterol-lowering statin drug, a physician might ideally say something like:

“You should know that for folks in your situation, the number of individuals who must be treated with a statin to prevent one death from a cardiovascular event such as a heart attack or stroke is generally between 60 and 100, which means that if I treated 60 people in your situation, 1 would benefit and 59 would not. As these numbers show, it is important for you to know that most of the people who take a statin will not benefit from doing so and, moreover, that statins can have side effects, such as muscle pain, liver damage, and upset stomach, even in people who do not benefit from the medication. I am giving you this information so that you can weigh the risks and benefits of drugs versus diet and then make an informed decision.”

Yet, how many physicians have these kinds of frank and open discussions with their patients? Non-disclosure of medical information by doctors—that kind of paternalism is supposed to be a thing of the past. Today’s physicians are supposed to honor informed consent under all but a very specific set of conditions (such as the patient is in a coma or it’s an emergency). However, too many physicians continue to treat their patients as if they were unconscious.

At the end of this long roundtable discussion on angioplasty and stents, the editor-in-chief of the American Journal of Cardiologyreminded us of an important fact to place it all in context. Atherosclerosis is due to high cholesterol, which is due to poor dietary choices, so if we all existed on a plant-based diet, we would not have even needed this discussion.

The lack of nutrition training in medical school is another barrier. See, for example, my videos Doctors’ Nutritional Ignorance andDoctors Know Less Than They Think About Nutrition.

Shockingly, mainstream medical associations actively oppose attempts to educate physicians about clinical nutrition. See my 4-part video series:

  1. Nutrition Education Mandate Introduced for Doctors
  2. Medical Associations Oppose Bill to Mandate Nutrition Training
  3. California Medical Association Tries to Kill Nutrition Bill
  4. Nutrition Bill Doctored in the California Senate

For more on why doctors don’t make more dietary prescriptions, see my video The Tomato Effect, Lifestyle Medicine: Treating the Cause of Disease, and Convincing Doctors to Embrace Lifestyle Medicine.

Heart disease may be a choice. See Cavities and Coronaries: Our Choice and One in a Thousand: Ending the Heart Disease Epidemic.

-Michael Greger, M.D.

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Vegan diet may reduce pain from Type 2 diabetes: study

A low-fat vegan diet may help people with Type 2 diabetes reduce physical pain related to the condition, suggests a small new study.

“This new study gives a ray of hope for a condition where there are no other good treatments,” said Dr. Neal Barnard, the study’s lead author and president of the Physicians Committee for Responsible Medicine, a non-profit organization that promotes a vegan diet, preventive medicine and alternatives to animal research.

Most people with Type 2 diabetes will develop peripheral diabetic neuropathy, the researchers write in Nutrition and Diabetes. People with the condition may feel pain, burning and numbness in their body’s extremities.

“For an individual patient, it can be miserable and depressing because there are no good treatments, and it just gets worse and worse,” said Barnard, who is also affiliated with the George Washington University School of Medicine in Washington.

“By setting aside animal products and oily foods, you can become healthier, and your pain can diminish and perhaps even go away,” he told Reuters Health in an e-mail.

Type 2 is the most common form of diabetes and is often linked to obesity. In Type 2 diabetes, the body’s cells are resistant to the hormone insulin, or the body doesn’t make enough of it. Insulin gives blood sugar access to the body’s cells to be used as fuel.

The disease is thought to interfere with the ability of nerves to signal the brain about pain, light touch and temperature. Anti-seizure medications and antidepressants help relieve nerve pain in some patients, but it may also have unpleasant side effects.

For the new study, the researchers recruited 35 adults with Type 2 diabetes and painful diabetic neuropathy. They randomly assigned 17 participants to follow a low-fat vegan diet and take B12 supplements for 20 weeks, with weekly support classes. The other 18 were instructed to take B12 supplements but maintain their normal diet.

The vegan diet focused on vegetables, fruit, grains and legumes. Over all, most participants on the vegan diet appeared to avoid animal products and about half stuck to low-fat diets throughout the study.

After 20 weeks, those on the vegan diet lost an average of about 15 pounds, compared with about one pound among those in the comparison group. Several other measures of health, including blood pressure, improved among the participants on the vegan diet compared with the control group.

Those on the vegan diet also reported a much greater drop in pain compared with the control group, the researchers report. A test of the nerves in the foot also suggested the vegan diet may have slowed or halted nerve function decline compared with the control group.

There was also a suggestion that the overall quality of life of those on the vegan diet improved compared with the control group. The difference may have been due to chance, however.

Barnard and his team acknowledged larger trials would still be needed to show a vegan diet helped relieve pain related to Type 2 diabetes.

Dr. Stuart Weiss, an endocrinologist at NYU Langone Medical Center in New York, said the study was “kind of cool,” though the number of participants was small and the length of the study was short.

“We always talk about diabetes and diabetes control being about diet and exercise, but we end up prescribing a lot of medications and don’t really focus that much on diet and exercise because that’s not easy,” said Weiss, who was not involved in the study.

Weiss told Reuters Health he typically advises patients to eat fewer processed and refined foods and not overeat.

“It might be that eating less of that in a plant-based diet might be helpful (in reducing inflammation), but again it was just 20 weeks and it takes years and years for neuropathy to develop,” Weiss said. “We need to see long-term [results], and nobody’s going to pay for that.”

While Weiss said it was exciting that researchers were looking for an alternative to medication, he cautioned that not everyone would go for a vegan diet.