Can Oatmeal Reverse Heart Disease?

Can Oatmeal Reverse Heart Disease?.jpeg

Fiber continues to be singled out as a nutrient of public health concern. We're getting only about half the minimum recommended intake on average. There is a fiber gap in America. Less than 3 percent meet the recommended minimum. This means that less than 3 percent of all Americans eat enough whole plant foods, the only place fiber is found in abundance. If even half of the adult population ate 3 more grams a day--a quarter cup of beans or a bowl of oatmeal--we could potentially save billions in medical costs. And that's just for constipation! The consumption of plant foods, of fiber-containing foods, may reduce the risk for diabetes, heart disease, stroke, cancer, and obesity as well.

The first to make this link between fiber intake and killer disease was probably Dr. Hugh Trowell. He spent 30 years practicing medicine in Africa and suspected it was the Africans high consumption of corn, millet, sweet potatoes, greens, and beans that protected them from chronic disease. This twisted into the so-called "fiber hypothesis," but Trowell didn't think it was the fiber itself, but the high-fiber foods themselves that were protective. There are hundreds of different substances in whole plant foods besides fiber that may have beneficial effects. For example, the fiber in oatmeal can lower our blood cholesterol levels so that less gets stuck in our arteries, but there also are anti-inflammatory and antioxidant phytonutrients in oats that can prevent atherosclerotic build-up and then help maintain arterial function (see Can Oatmeal Reverse Heart Disease?).

Visionaries like Trowell were not entrapped by the reductionist "simple-minded" focus on dietary fiber and insisted that the whole plant foods should receive the emphasis. Fiber intake was just a marker for plant food intake. Those with the highest fiber intake and the lowest cholesterol were those whose who ate exclusively plant-based diets.

Risk factors like cholesterol are one thing, but can these individual foods actually affect the progression of heart disease, the #1 killer of Americans? We didn't know until 2005. Hundreds of older women were subjected to coronary angiograms, where we inject dye into the coronary arteries of the heart to see how wide open they are. Each participant got an angiogram at the beginning of the study and one a few years later, all while researchers analyzed their diets. The arteries of women eating less than a serving of whole grains a day significantly narrowed, whereas the arteries of women who ate just a single serving or more also significantly narrowed, but they narrowed less. These were all women with heart disease eating the standard American diet, so their arteries were progressively clogging shut. But there was significantly less clogging in the women eating more whole grains, significantly less progression of their atherosclerosis. A similar slowing of their disease might be expected from taking cholesterol-lowering statin drugs. But do we want to just slow the rate at which we die from heart disease, or do we want to not die from heart disease at all?

A strictly plant-based diet has been shown to reverse the progression of heart disease, opening up arteries back up. Yes, whole grains, like drugs, can help counter the artery-clogging effects of the rest of the diet. Having oatmeal with bacon and eggs is better than just eating bacon and eggs, but why not stop eating an artery-clogging diet altogether?

Oatmeal offers a lot more than fiber, though. See Oatmeal Lotion for Chemotherapy-Induced Rash and Can Oatmeal Help Fatty Liver Disease?

Trowell's work had a big influence on Dr. Denis Burkitt. See Dr. Burkitt's F-Word Diet.

This reminds me of other interventions like hibiscus tea for high blood pressure (Hibiscus Tea vs. Plant-Based Diets for Hypertension) or amla for diabetes (Amla Versus Diabetes). Better to reverse the disease completely.

And for an overview of how whole plant foods affect disease risks, be sure to check out the videos on our new Introduction page!

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Image Credit: Rachel Hathaway / Flickr. This image has been modified.

Original Link

Can Oatmeal Reverse Heart Disease?

Can Oatmeal Reverse Heart Disease?.jpeg

Fiber continues to be singled out as a nutrient of public health concern. We're getting only about half the minimum recommended intake on average. There is a fiber gap in America. Less than 3 percent meet the recommended minimum. This means that less than 3 percent of all Americans eat enough whole plant foods, the only place fiber is found in abundance. If even half of the adult population ate 3 more grams a day--a quarter cup of beans or a bowl of oatmeal--we could potentially save billions in medical costs. And that's just for constipation! The consumption of plant foods, of fiber-containing foods, may reduce the risk for diabetes, heart disease, stroke, cancer, and obesity as well.

The first to make this link between fiber intake and killer disease was probably Dr. Hugh Trowell. He spent 30 years practicing medicine in Africa and suspected it was the Africans high consumption of corn, millet, sweet potatoes, greens, and beans that protected them from chronic disease. This twisted into the so-called "fiber hypothesis," but Trowell didn't think it was the fiber itself, but the high-fiber foods themselves that were protective. There are hundreds of different substances in whole plant foods besides fiber that may have beneficial effects. For example, the fiber in oatmeal can lower our blood cholesterol levels so that less gets stuck in our arteries, but there also are anti-inflammatory and antioxidant phytonutrients in oats that can prevent atherosclerotic build-up and then help maintain arterial function (see Can Oatmeal Reverse Heart Disease?).

Visionaries like Trowell were not entrapped by the reductionist "simple-minded" focus on dietary fiber and insisted that the whole plant foods should receive the emphasis. Fiber intake was just a marker for plant food intake. Those with the highest fiber intake and the lowest cholesterol were those whose who ate exclusively plant-based diets.

Risk factors like cholesterol are one thing, but can these individual foods actually affect the progression of heart disease, the #1 killer of Americans? We didn't know until 2005. Hundreds of older women were subjected to coronary angiograms, where we inject dye into the coronary arteries of the heart to see how wide open they are. Each participant got an angiogram at the beginning of the study and one a few years later, all while researchers analyzed their diets. The arteries of women eating less than a serving of whole grains a day significantly narrowed, whereas the arteries of women who ate just a single serving or more also significantly narrowed, but they narrowed less. These were all women with heart disease eating the standard American diet, so their arteries were progressively clogging shut. But there was significantly less clogging in the women eating more whole grains, significantly less progression of their atherosclerosis. A similar slowing of their disease might be expected from taking cholesterol-lowering statin drugs. But do we want to just slow the rate at which we die from heart disease, or do we want to not die from heart disease at all?

A strictly plant-based diet has been shown to reverse the progression of heart disease, opening up arteries back up. Yes, whole grains, like drugs, can help counter the artery-clogging effects of the rest of the diet. Having oatmeal with bacon and eggs is better than just eating bacon and eggs, but why not stop eating an artery-clogging diet altogether?

Oatmeal offers a lot more than fiber, though. See Oatmeal Lotion for Chemotherapy-Induced Rash and Can Oatmeal Help Fatty Liver Disease?

Trowell's work had a big influence on Dr. Denis Burkitt. See Dr. Burkitt's F-Word Diet.

This reminds me of other interventions like hibiscus tea for high blood pressure (Hibiscus Tea vs. Plant-Based Diets for Hypertension) or amla for diabetes (Amla Versus Diabetes). Better to reverse the disease completely.

And for an overview of how whole plant foods affect disease risks, be sure to check out the videos on our new Introduction page!

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Image Credit: Rachel Hathaway / Flickr. This image has been modified.

Original Link

What Happened to the Rice Diet?

What Happened to the Rice Diet?.jpeg

During his career at Duke, Dr. Walter Kempner treated more than 18,000 patients with his rice diet. The diet was originally designed as a treatment for kidney failure and out-of-control high blood pressure at a time when these diagnoses were essentially a death sentence. Patients who would have died in all other hospitals had a reasonable chance for survival if they came under Kempner's care.

The results were so dramatic that many experienced physicians suspected him of falsifying data, because he was essentially reversing terminal diseases with rice and fruit, diseases understood to be incurable by the best of modern medicine at the time. Intensive investigations into his clinic vindicated his work, however, which other researchers were then able to replicate and validate.

Kempner was criticized for his lack of controls, meaning that when patients came to him he didn't randomly allocate half to his rice treatment and put the other half on conventional therapy. Kempner argued that the patients each acted as their own controls. For example, one patient, after the medical profession threw everything they had at him, still had blood pressure as high as 220 over 160. A normal blood pressure is considered to be around 120 over 80--which is where Kempner's rice diet took him. Had the patient not been given the rice diet, his pressures might have been even lower, though: zero over zero, because he'd likely be dead. The "control group" in Kempner's day had a survival expectancy estimated at 6 months. To randomize patients to conventional care would be to randomize them to their deaths.

We can also compare those who stuck to the diet to those who didn't. In one study, of those who started the rice diet but then stopped it within a year, 80% died. For those who made it a year but then gave up the diet, instead of an 80% chance of dying, they had about a 50% chance, a flip of the coin. Of those that stuck with the program, 90% lived to tell the tale.

Beginning in the late 1950's, drugs became available that effectively reduced blood pressure and hypertension, leading to a decreased demand for the rice diet. What conclusions can we draw from this all-but-forgotten therapy for hypertension? Not only was it the first effective therapy for high blood pressure, it may be equal to or more effective than our current multi-drug treatments. See Drugs & the Demise of the Rice Diet.

This causes one to speculate on the current practice of placing patients on one drug, then another, and perhaps a third until the blood pressure is controlled, with lip-service advocacy of a moderate reduction in dietary sodium, fat, and protein intake. At the same time, the impressive effectiveness of the rice-fruit diet, which is able to quickly stop the leakage from our arteries, lower increased intracranial pressure, reduce heart size, reverse the ECG changes, reverse heart failure, reduce weight, and markedly improve diabetes, is ignored.

Should we return to the Kempner protocol of starting with the most effective therapy, saving drugs for patients who fail to respond or who are unable or unwilling to restrict their diet? Today many people follow a plant-based diet as a choice, which is similar to what Kempner was often able to transition people to. After their high blood pressure was cured by the rice diet, patients were often able to gradually transition to a less strenuous dietary regime without adding medications and with no return of the elevated blood pressure.

If the Kempner sequence of a strictest of strict plant-based diets to a saner plant-based type diet offers the quickest and best approach to effective therapy, why isn't it still in greater use? The powerful role of the pharmaceutical industry in steering medical care away from dietary treatment to medications should be noted. Who profits from dietary treatment? Who provides the support for investigation and the funds for clinical trials? There is more to overcome than just the patient's reluctance to change their diet.

What Kempner wrote to a patient in 1954 is as true now as it was 60 years ago:

"[D]rugs can be very useful if properly employed and used in conjunction with intensive dietary treatment. However, the real difficulty is that Hypertensive Vascular Disease with all its possible complications--heart disease, kidney disease, stroke, blindness--is still treated very casually, a striking contrast to the attitude toward cancer. Since patients, physicians, and the chemical industry prefer the taking, prescribing, and selling of drugs to a treatment inconvenient to patient and physician and of no benefit to the pharmaceutical industry, the mortality figures for these diseases are still rather appalling."

Despite hundreds of drugs on the market now, high blood pressure remains the #1 cause of death and disability in the world, killing off 9 million people a year. A whole food plant-based diet treats the underlying cause. As Dr. Kempner explained to a patient, "If you should find a heap of manure on your living room floor, I do not recommend that you go buy some Air-Wick [an air freshener] and perfume. I recommend that you get a bucket and shovel and a strong scrubbing brush. Then, when your living room floor is clean again, why, you may certainly apply some Air-Wick if you wish."

As the great physician Maimonides said about 800 years ago, any illness that can be treated by diet alone should be treated by no other means.

For background on this amazing story, see Kempner Rice Diet: Whipping Us Into Shape. He would be proud that there is a whole medical specialty now: Lifestyle Medicine: Treating the Causes of Disease.

This reminds me of the role statin cholesterol-lowering drugs have played in seducing people into the magic bullet approach, but as with all magic it appears to mostly be misdirection:

Check out a couple of my recent overview videos for more on this topic: How Not to Die from Heart Disease and Taking Personal Responsibility for Your Health.

In this day and age, What Diet Should Physician's Recommend?

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Image Credit: Sally Plank / Flickr. Image has been modified.

Original Link

What Happened to the Rice Diet?

What Happened to the Rice Diet?.jpeg

During his career at Duke, Dr. Walter Kempner treated more than 18,000 patients with his rice diet. The diet was originally designed as a treatment for kidney failure and out-of-control high blood pressure at a time when these diagnoses were essentially a death sentence. Patients who would have died in all other hospitals had a reasonable chance for survival if they came under Kempner's care.

The results were so dramatic that many experienced physicians suspected him of falsifying data, because he was essentially reversing terminal diseases with rice and fruit, diseases understood to be incurable by the best of modern medicine at the time. Intensive investigations into his clinic vindicated his work, however, which other researchers were then able to replicate and validate.

Kempner was criticized for his lack of controls, meaning that when patients came to him he didn't randomly allocate half to his rice treatment and put the other half on conventional therapy. Kempner argued that the patients each acted as their own controls. For example, one patient, after the medical profession threw everything they had at him, still had blood pressure as high as 220 over 160. A normal blood pressure is considered to be around 120 over 80--which is where Kempner's rice diet took him. Had the patient not been given the rice diet, his pressures might have been even lower, though: zero over zero, because he'd likely be dead. The "control group" in Kempner's day had a survival expectancy estimated at 6 months. To randomize patients to conventional care would be to randomize them to their deaths.

We can also compare those who stuck to the diet to those who didn't. In one study, of those who started the rice diet but then stopped it within a year, 80% died. For those who made it a year but then gave up the diet, instead of an 80% chance of dying, they had about a 50% chance, a flip of the coin. Of those that stuck with the program, 90% lived to tell the tale.

Beginning in the late 1950's, drugs became available that effectively reduced blood pressure and hypertension, leading to a decreased demand for the rice diet. What conclusions can we draw from this all-but-forgotten therapy for hypertension? Not only was it the first effective therapy for high blood pressure, it may be equal to or more effective than our current multi-drug treatments. See Drugs & the Demise of the Rice Diet.

This causes one to speculate on the current practice of placing patients on one drug, then another, and perhaps a third until the blood pressure is controlled, with lip-service advocacy of a moderate reduction in dietary sodium, fat, and protein intake. At the same time, the impressive effectiveness of the rice-fruit diet, which is able to quickly stop the leakage from our arteries, lower increased intracranial pressure, reduce heart size, reverse the ECG changes, reverse heart failure, reduce weight, and markedly improve diabetes, is ignored.

Should we return to the Kempner protocol of starting with the most effective therapy, saving drugs for patients who fail to respond or who are unable or unwilling to restrict their diet? Today many people follow a plant-based diet as a choice, which is similar to what Kempner was often able to transition people to. After their high blood pressure was cured by the rice diet, patients were often able to gradually transition to a less strenuous dietary regime without adding medications and with no return of the elevated blood pressure.

If the Kempner sequence of a strictest of strict plant-based diets to a saner plant-based type diet offers the quickest and best approach to effective therapy, why isn't it still in greater use? The powerful role of the pharmaceutical industry in steering medical care away from dietary treatment to medications should be noted. Who profits from dietary treatment? Who provides the support for investigation and the funds for clinical trials? There is more to overcome than just the patient's reluctance to change their diet.

What Kempner wrote to a patient in 1954 is as true now as it was 60 years ago:

"[D]rugs can be very useful if properly employed and used in conjunction with intensive dietary treatment. However, the real difficulty is that Hypertensive Vascular Disease with all its possible complications--heart disease, kidney disease, stroke, blindness--is still treated very casually, a striking contrast to the attitude toward cancer. Since patients, physicians, and the chemical industry prefer the taking, prescribing, and selling of drugs to a treatment inconvenient to patient and physician and of no benefit to the pharmaceutical industry, the mortality figures for these diseases are still rather appalling."

Despite hundreds of drugs on the market now, high blood pressure remains the #1 cause of death and disability in the world, killing off 9 million people a year. A whole food plant-based diet treats the underlying cause. As Dr. Kempner explained to a patient, "If you should find a heap of manure on your living room floor, I do not recommend that you go buy some Air-Wick [an air freshener] and perfume. I recommend that you get a bucket and shovel and a strong scrubbing brush. Then, when your living room floor is clean again, why, you may certainly apply some Air-Wick if you wish."

As the great physician Maimonides said about 800 years ago, any illness that can be treated by diet alone should be treated by no other means.

For background on this amazing story, see Kempner Rice Diet: Whipping Us Into Shape. He would be proud that there is a whole medical specialty now: Lifestyle Medicine: Treating the Causes of Disease.

This reminds me of the role statin cholesterol-lowering drugs have played in seducing people into the magic bullet approach, but as with all magic it appears to mostly be misdirection:

Check out a couple of my recent overview videos for more on this topic: How Not to Die from Heart Disease and Taking Personal Responsibility for Your Health.

In this day and age, What Diet Should Physician's Recommend?

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Image Credit: Sally Plank / Flickr. Image has been modified.

Original Link

What’s the Optimal Cholesterol Level?

Optimal Cholesterol Level.jpg

No matter where we live, how old we are or what we look like, health researchers from the Institute of Circulatory and Respiratory Health have discovered that 90% of the chance of having a first heart attack "can be attributed to nine modifiable risk factors." The nine factors that could save our lives include: smoking, too much bad cholesterol, high blood pressure, diabetes, abdominal obesity, stress, a lack of daily fruit and veggie consumption, as well as a lack of daily exercise.

Dr. William Clifford Roberts, Executive Director of Baylor Heart and Vascular Institute and long-time Editor in Chief of the American Journal of Cardiology, is convinced, however, that atherosclerosis has a single cause--namely cholesterol--and that the other so-called atherosclerotic risk factors are only contributory at most. In other words, we could be stressed, overweight, smoking, diabetic couch potatoes, but if our cholesterol is low enough, there may just not be enough cholesterol in our blood stream to infiltrate our artery walls and trigger the disease. Thus, the only absolute prerequisite for a fatal or nonfatal atherosclerotic event like a heart attack is an elevated cholesterol level.

It was not appreciated until recently "that the average blood cholesterol level in the United States, the so-called normal level, was actually abnormal," accelerating the blockages in our arteries and putting a large fraction of the normal population at risk. That's cited as one of the reasons the cholesterol controversy lasted so long--an "unwillingness to accept the notion that a very large fraction of our population actually has an unhealthily high cholesterol level."

Normal cholesterol levels may be fatal cholesterol levels.

The optimal "bad cholesterol" (LDL) level is 50 to 70. Accumulating data from multiple lines of evidence consistently demonstrate that that's where a physiologically normal LDL level would be. That appears to be the threshold above which atherosclerosis and heart attacks develop. That's what we start out at birth with, that's what fellow primates have, and that's the level seen in populations free of the heart disease epidemic. One can also look at all the big randomized controlled cholesterol lowering trials.

In my video, Optimal Cholesterol Level, you can see graphing of the progression of atherosclerosis versus LDL cholesterol. More cholesterol means more atherosclerosis, but if we draw a line down through the points, we can estimate that the LDL level at which there is zero progression is around 70. We can do the same with the studies preventing heart attacks. Zero coronary heart disease events might be reached down around 55, and those who've already had a heart attack and are trying to prevent a second one might need to push LDL levels even lower.

Atherosclerosis is endemic in our population in part because the average person's LDL level is up around 130, approximately twice the normal physiologic level. The reason the federal government doesn't recommend everyone shoot for under 100 is that despite the lower risk accompanying more optimal cholesterol levels, the intensity of clinical intervention required to achieve such levels for everyone in the population would "financially overload the health care system. Drug usage would rise enormously." But, they're assuming drugs are the only way to get our LDL that low. Those eating really healthy plant-based diets may hit the optimal cholesterol target without even trying, naturally nailing under 70.

The reason given by the federal government for not advocating for what the science shows is best was that it might frustrate the public, "who would have difficulty maintaining a lower level," but maybe the public's greatest frustration would come from not being informed of the optimal diet for health.


It's imperative for everyone to understand Dr. Rose's sick population concept, which I introduced in When Low Risk Means High Risk.

What about large fluffy LDL cholesterol versus small and dense? See Does Cholesterol Size Matter?

More from the Framingham Heart Study can be found in Barriers to Heart Disease Prevention and Everything in Moderation? Even Heart Disease?.

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Image Credit: lightwise © 123RF.com. This image has been modified.

Original Link

What’s the Optimal Cholesterol Level?

Optimal Cholesterol Level.jpg

No matter where we live, how old we are or what we look like, health researchers from the Institute of Circulatory and Respiratory Health have discovered that 90% of the chance of having a first heart attack "can be attributed to nine modifiable risk factors." The nine factors that could save our lives include: smoking, too much bad cholesterol, high blood pressure, diabetes, abdominal obesity, stress, a lack of daily fruit and veggie consumption, as well as a lack of daily exercise.

Dr. William Clifford Roberts, Executive Director of Baylor Heart and Vascular Institute and long-time Editor in Chief of the American Journal of Cardiology, is convinced, however, that atherosclerosis has a single cause--namely cholesterol--and that the other so-called atherosclerotic risk factors are only contributory at most. In other words, we could be stressed, overweight, smoking, diabetic couch potatoes, but if our cholesterol is low enough, there may just not be enough cholesterol in our blood stream to infiltrate our artery walls and trigger the disease. Thus, the only absolute prerequisite for a fatal or nonfatal atherosclerotic event like a heart attack is an elevated cholesterol level.

It was not appreciated until recently "that the average blood cholesterol level in the United States, the so-called normal level, was actually abnormal," accelerating the blockages in our arteries and putting a large fraction of the normal population at risk. That's cited as one of the reasons the cholesterol controversy lasted so long--an "unwillingness to accept the notion that a very large fraction of our population actually has an unhealthily high cholesterol level."

Normal cholesterol levels may be fatal cholesterol levels.

The optimal "bad cholesterol" (LDL) level is 50 to 70. Accumulating data from multiple lines of evidence consistently demonstrate that that's where a physiologically normal LDL level would be. That appears to be the threshold above which atherosclerosis and heart attacks develop. That's what we start out at birth with, that's what fellow primates have, and that's the level seen in populations free of the heart disease epidemic. One can also look at all the big randomized controlled cholesterol lowering trials.

In my video, Optimal Cholesterol Level, you can see graphing of the progression of atherosclerosis versus LDL cholesterol. More cholesterol means more atherosclerosis, but if we draw a line down through the points, we can estimate that the LDL level at which there is zero progression is around 70. We can do the same with the studies preventing heart attacks. Zero coronary heart disease events might be reached down around 55, and those who've already had a heart attack and are trying to prevent a second one might need to push LDL levels even lower.

Atherosclerosis is endemic in our population in part because the average person's LDL level is up around 130, approximately twice the normal physiologic level. The reason the federal government doesn't recommend everyone shoot for under 100 is that despite the lower risk accompanying more optimal cholesterol levels, the intensity of clinical intervention required to achieve such levels for everyone in the population would "financially overload the health care system. Drug usage would rise enormously." But, they're assuming drugs are the only way to get our LDL that low. Those eating really healthy plant-based diets may hit the optimal cholesterol target without even trying, naturally nailing under 70.

The reason given by the federal government for not advocating for what the science shows is best was that it might frustrate the public, "who would have difficulty maintaining a lower level," but maybe the public's greatest frustration would come from not being informed of the optimal diet for health.


It's imperative for everyone to understand Dr. Rose's sick population concept, which I introduced in When Low Risk Means High Risk.

What about large fluffy LDL cholesterol versus small and dense? See Does Cholesterol Size Matter?

More from the Framingham Heart Study can be found in Barriers to Heart Disease Prevention and Everything in Moderation? Even Heart Disease?.

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Image Credit: lightwise © 123RF.com. This image has been modified.

Original Link

Medical Care: The Third Leading Cause of Death

NF-Nov10 Why Prevention is Worth.jpg

An ounce of prevention is worth a pound of cure, but a pound isn't that heavy. Why change our diet and lifestyle when we can just wait and let modern medicine fix us up? In my video The Actual Benefit of Diet vs. Drugs, I noted that patients tend to wildly overestimate the ability of cancer screening and cholesterol-lowering medications to prevent disease. Surveyed patients report they were told the truth about how little they'd benefit, 90% said they wouldn't even bother.

The reason we should eat healthier, rather than just counting on a medical technofix, is that we may hold this same overconfidence for treatment, too. In a massive study of more than 200,000 trials, researchers discovered that pills and procedures can certainly help, but genuine, very large effects with extensive support from substantial evidence appear to be rare in medicine. Further, large benefits for mortality--making people live significantly longer--are almost entirely nonexistent. Modern medicine is great for acute conditions--broken bones and curing infections--but for chronic disease, our leading causes of death and disability, we don't have much to offer. In fact, we sometimes do more harm than good.

In my Uprooting the Leading Causes of Death presentation, I noted that side-effects from prescription drugs kill an estimated 100,000 Americans every year, making medical care the sixth leading cause of death in the United States. There are another 7,000 deaths from getting the wrong medicine by mistake and 20,000 deaths from other errors in hospitals. Hospitals are dangerous places. An additional 99,000 of us die from hospital-acquired infections. But can we really blame doctors for those deaths, though? We can when they don't wash their hands.

We've known since the 1840's that the best way to prevent hospital-acquired infections is through handwashing, yet compliance rates among healthcare workers rarely exceeds 50%, and doctors are the worst, as highlighted in my video Why Prevention is Worth a Ton of Cure. Even in a medical intensive care unit with a "contact precautions" sign, signaling a particularly high risk patient, less than a quarter of doctors were found to wash their hands. Many physicians greeted the horrendous mortality data due to medical error with disbelief and concern that the information would undermine public trust. But if doctors still won't even wash their hands, how much trust do we deserve?

We could go in for a simple operation and come out with a life-threatening infection, or not come out at all. 12,000 more die from surgeries that were unnecessary in the first place. For those keeping score, that's 225,000 people dead from iatrogenic ("relating to medical care") causes. And that's mostly just for patients in a hospital. In an outpatient setting, side-effects from prescription drugs send millions to the hospital and result in perhaps 199,000 additional deaths. This is not including all those non-fatally injured (such as the case where doctors accidentally amputated the tip of a man's penis. Oops).

These estimates are on the low end. The Institute of Medicine estimated that deaths from medical errors may kill up to 98,000 Americans. That would bump us up to 284,000 dead. Even if we use the lower estimate, the medical profession constitutes the third leading cause of death in the United States. It goes heart disease, cancer, then... me.

One respondent pointed out that it was misleading to call medicine the third leading cause of death since many of those we kill also had heart disease or cancer. It's not like doctors are out there gunning down healthy people. Only people on medications are killed by medication errors or side-effects. You have to be in the hospital to be killed by a hospital error.

To which I respond: Exactly.

That's why lifestyle medicine is so important. The most common reasons people are on drugs and in hospitals is for diseases that can be prevented with a healthy diet and lifestyle. The best way to avoid the adverse effects of medical care is to not get sick in the first place.

For more background on how scandalous our handwashing history has been, see my Q&A: What about Semmelweis and medicine's shameful handwashing history? It's truly an unbelievable story.

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Image Credit: Portal PBH / Flickr

Original Link

How Well Do Cholesterol-Lowering Drugs Actually Work?

NF-Nov8 The Actual Benefit  copy.jpg

One of the reasons people may undervalue diet and lifestyle changes is an overconfidence in the ability of pills and procedures to prevent disease. For example, people tend to wildly overestimate the power of things like mammograms and colonoscopies to prevent deaths from breast and bowel cancer, or the power of drugs like Fosamax to prevent hip fractures, or the power of cholesterol drugs to prevent fatal heart attacks. Patients believe statin drugs like Lipitor are about 100 times more effective than they actually are in preventing heart attacks. Studies show most people wouldn't take multiple blood pressure medications if they knew the truth.

For most people, the chance of benefit is normally less than 5 percent over five years for cholesterol, blood pressure, and blood thinning drugs. Patients don't want to take drugs unless they have at least a one in five chance--even those who just had a heart attack. It's no wonder, then, that doctors seldom share these figures. Informing patients of the percentage chance of benefit from preventive drug strategies would likely substantially reduce the likelihood that patients would agree to take the drugs every day for the rest of their lives.

For the individual, this is unlikely to be detrimental; after all, there's a 95 percent chance it won't do anything for them. But for the population at large, it would make a difference, so doctors and drug companies oversell the benefits by conveniently not mentioning how tiny they actually are, knowing most patients wouldn't take them if doctors divulged the truth. To practice non-lifestyle medicine is to practice deceptive medicine.

The best that cholesterol-lowering statin drugs appear to do is an absolute risk reduction of 3.1 percent over six years. If Dr. Esselstyn's work can be replicated in a randomized, controlled trial, then a whole foods plant-based diet will have been shown to work twenty times better, an absolute risk reduction of 60 percent after less than four years. In Esselstyn's study, 99.4 percent of high-risk patients that stuck with the diet avoided major cardiac events, such as death from heart attack.

When we have to decide whether we want to go diet versus drugs, we're not making a choice between eating healthy to prevent a heart attack or taking a pill to prevent a heart attack. Because in 97 percent of cases in the near-term, pills don't do anything. We're risking side effects for nothing, whereas if we treat the underlying root cause of the disease by eating a healthy, cholesterol-free diet, we may even reverse the progression of the disease, as seen in my video The Actual Benefit of Diet vs. Drugs.

If we stop eating an artery-clogging diet, our bodies can start dissolving that plaque away, opening up arteries in some cases without drugs or surgery. A healthy whole food plant-based diet by itself may work 20 times better than drugs to combat our #1 killer.

Now that's something doctors may want to tell their patients.

Yes, an ounce of prevention is worth a pound of cure, but a pound isn't that heavy--why change our diet and lifestyle when we can just wait and let modern medicine fix us up? Turns out we overestimate the efficacy of treatment as well, the subject of my video Why Prevention is Worth a Ton of Cure.

Sometimes preventive medicine procedures can even be harmful. See Cancer Risk From CT Scan Radiation and Do Dental X-Rays Cause Brain Tumors?

I've previously noted how an honest physician-patient interaction might go in Fully Consensual Heart Disease Treatment, Optimal Diet: Just Give it To Me Straight, Doc and Disclosing Conflicts of Interest in Medical Research. What should we be saying? See: What Diet Should Physician's Recommend?

So why don't more doctors do it? See Barriers to Heart Disease Prevention and Find Out If Your Doctor Takes Drug Company Money.

More on Dr. Esselstyn's heart disease reversal study in: Evidence-Based Medicine or Evidence-Biased?

Of course then there's just the brute force method: Kempner Rice Diet: Whipping Us Into Shape.

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Image Credit: [akz] © 123RF.com

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Flax Seeds Can Have Profound Effect on Hypertension

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A recent article in the journal, Meat Science, acknowledged that a sector of the population perceives meat as a food that is detrimental to their health because of studies associating meat consumption with heart disease and cancer. So, the article continues, meat consumers may look for healthier food alternatives as a means to maintain good health, which represents a good opportunity for the meat industry to develop some new products. The industry felt that natural foods could be added to meat to reach those health-oriented consumers by boosting antioxidants levels, for example. Foods like flax seeds and tomatoes are healthy, associated with reduced risks of cancer and cardiovascular disease. So by making flax-y tomato burgers, they figure they can reduce saturated fat intake and maybe eat less sugar somehow. Wouldn't it be easier to just cut out the middle-cow and eat flax seeds ourselves?

Flax seeds have been described as a "miraculous defense against some critical maladies." I'm a fan of flax, but this title seemed a bit over-exuberant; I figured something just got lost in translation, but then I found a prospective, double-blinded, placebo-controlled, randomized trial--you know how hard that is in a nutrition study? For drugs, it's easy: you have two identical looking pills, one's active, one's placebo, and until the end of the study, neither the researcher nor the patient has any idea which is which, hence "double blind." But people tend to notice what they're eating. So how did they sneak a quarter cup of ground flax seeds into half of the people's diets without them knowing? They created all these various flax or placebo containing foods, and even added bran and molasses to match the color and texture, so it was all a big secret until six months later when they broke the code to see who ate which.

Why test it on hypertension? Because having a systolic blood pressure over 115--that's the top number--may be the single most important determinant for death in the world today. If you take a bunch of older folks, most of them on an array of blood pressure pills, and don't improve their diet at all, despite the drugs, they may start out on average hypertensive and stay hypertensive six months later. But those who were unknowingly eating ground flaxseeds every day, dropped their systolic blood pressure about ten points, and their diastolic, the lower number, by about seven points. That might not sound like a lot, but a drop like that could cut stroke risk 46 percent and heart disease 29 percent, and that ten point drop in the top number could have a similar effect on strokes and heart attacks. And for those that started out over 140, they got a 15-point drop.

In summary, flaxseed induced one of the most potent antihypertensive effects ever achieved by a dietary intervention. In other words, the magnitude of this decrease in blood pressure demonstrated by dietary flaxseed, is as good or better than other nutritional interventions and comparable to many drugs, which can have serious side effects. And they're not exaggerating about the comparable to drugs bit. The flax dropped systolic and diastolic up to 15 and 7. Compare that to powerful ACE inhibitors like Vasotec, which may only drop pressures five and two, and calcium channel blockers like Norvasc or Cardizem which drop pressures eight and three. Side effects of these drugs include a large list of serious medical issues, as seen in my video Flax Seeds for Hypertension, compared to the side effect of flax seeds, "its pleasant nutty flavor."

During the six-month trial there were strokes and heart attacks in both groups, though. Even if the flax seeds can cut risk in half, any avoidable risk is unacceptable. Isn't high blood pressure just inevitable as we get older? No - the prevalence of hypertension does increase dramatically with age, but not for everyone. People who eat more plant-based diets or keep their salt intake low enough tend not to exhibit any change in blood pressure with advancing age. It's always better to prevent the disease in the first place.

And that's not all flax can do. Check out:

Hibiscus tea may help with high blood pressure as well: Hibiscus Tea vs. Plant-Based Diets for Hypertension

Diet can also play an important role in preventing heart disease (How Not to Die from Heart Disease and One in a Thousand: Ending the Heart Disease Epidemic) and diabetes (How Not to Die from Diabetes and Plant-Based Diets and Diabetes). In some cases diet can even reverse some of the worst ravages of high blood pressure: How Not to Die from High Blood Pressure and Kempner Rice Diet: Whipping Us Into Shape.

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Image Credit: Veganbaking.net / Flickr

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How to Eliminate 90 Percent of Heart Disease Risk

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Medical myths and dogmas die hard. Researchers creating a new body of knowledge for prevention and control of heart disease had to disprove a bunch of doozies. For example, we used to think that heart disease, high cholesterol and high blood pressure were just inevitable consequences of aging. All these are now bygone notions, refuted by massive data. Other long-standing myths and dogmas about our number one killer epidemic persist, however. For example, many still think that major risk factors like cholesterol account for a minority of risk, and that many people have heart attacks with no risk factors at all.

There are rare genetic conditions that give people high cholesterol no matter what they eat, but such genetic defects occur in no more than 1 in 200 people. As you can see in my video, Eliminating 90% of Heart Disease Risk, this means that most people with atherosclerosis acquire it by what they put in their mouth.

One study showed that for men and women, old and young, and in all areas of the world, nine potentially modifiable factors like diet, exercise, and smoking, accounted for over 90 percent of the proportion of the risk of having a heart attack. This has also been confirmed in prospective studies such as the Harvard Health Professional's Follow-up, which showed that making healthy lifestyle choices are associated with a 90 percent drop in risk in men followed over time. This is true for women as well, who had a 92 percent drop in risk.

The same goes for diabetes--91 percent of cases could be attributed to bad habits and behaviors. And the same healthy lifestyle, which includes not smoking, eating a healthy diet, exercising and maintaining an optimal body weight, may reduce the risk of multiple chronic diseases such as stroke. Up to 80 percent of strokes are avoidable with simple lifestyle changes.

How does this all compare to drugs? Why change our diet, lose weight and start exercising if we can just pop some pills? Pharmacological therapies, including cholesterol lowering statin drugs and blood pressure pills, typically only reduce cardiovascular disease risk by 20 percent to 30 percent, not 90 percent like lifestyle changes. So even on drugs, 70 to 80 percent of heart attacks still occur.

One of the great things about the Harvard Health Professional's Follow-up is that they also looked at the effect of lifestyle changes on people already on medications. Even those on cholesterol and blood pressure lowering drugs may be able to get a further 78 percent drop in risk by eating and living healthfully. So the choice isn't diet or drugs. Cardiovascular medications "should be used as an adjunct to, not just a replacement for, healthy lifestyle practices."

It takes time for new science to trickle down into mainstream medical practice. The practice of cardiology and medicine in general may correspond, on average, to what was being published 10 or 20 years before. So it's important to know if your doctor is still stuck practicing 20th century medicine.

Chronic disease, then--the leading cause of death and disability--may be a choice. See for example, Cavities and Coronaries: Our Choice. What do you choose?

Why reduce a preventable disease just 90%? How about 99.9%? See One in a Thousand: Ending the Heart Disease Epidemic

More from the field of lifestyle medicine:

In health,
Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live year-in-review presentations Uprooting the Leading Causes of Death, More Than an Apple a Day, From Table to Able, and Food as Medicine.

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