Cheney, Thomas. High Time for Grass-fed Beef.
More Incredibly Bad Scientific discipline From Dr. Esselstyn's Establish-Based (Vegan) Nutrition Report
- May 14, 2017
- atherosclerotic cardiovascular disease, Diet and Heart Disease, Lifestyle and Heart Affliction
- 47 Comments
A while back the skeptical cardiologist exposed "The incredibly bad science behind Dr. Esselstyn's establish-based diet."
The diet has the catchy slogan "consume zilch with a face up or a mother" and Esselstyn was featured in the vegan propaganda picture show "Forks Over Knives."
After detailing the lack of science I concluded:
Any patients who were non intensely motivated to radically modify their diet would have avoided this crazy "study" like the plague. This "study" is merely a collection of 18 anecdotes, none of which would be worthy of publication in any current legitimate medical journal. Three of the 18 patients have died, one from pulmonary fibrosis, 1 presumably from a GI bleed, and one from depression. Could these deaths be related to the diet in some way? Nosotros tin't know because there is no comparison grouping.
The post garned little attention initially but in the concluding few months several hundred visitors per 24-hour interval apparently read it and Essesltyn followers have started leaving me testimonials to the diet along with nasty comments.
Here'south are some typical ones (with my comments in blood-red)
"If your (sic) not backed by some meat industry or cardiac bypass group I would be much surprised."
I am completely free of bias. Nobody is paying me anything to do the research and writing I do. My only purpose is to detect the truth about diet in order to educate my patients properly. I have saved many more patients from bypass surgery than I have referred for the procedure.
"it is so arrogant to think the merely science could come from clinical studies which may be funded by an interested party."
Doctors like randomized (and preferably blinded) clinical studies because they minimize the bias introduced by interested parties like patients and zealous investigators (like Dr. Eastward) motivated to see positive outcomes. Pocket-size, non-randomized studies can just generate ideas and hypotheses which larger, randomized studies tin can bear witness with a greater degree of certainty.
"the entire nentire western medical organisation is skewed due to the big pharma influence…unfortunately western medicine believes the only science is the pen and the scalpel..whereas …history is the best teacher of all…"
By pen I presume you mean medications. If we examine history as you propose we see that life expectancy was 50 years in 1945 merely today in developed countries it is around fourscore years. This advance corresponds to (among other things) advances in vaccines, antibiotics, anti-cancer drugs, cardiac and blood pressure medications and surgery: the pen and the scalpel. It does not correspond to following a vegan diet.
"Your foolishness is the embarrassment."
Thank yous for this insightful comment! I'yard because information technology as my epitaph.
One human felt that changing to the Esselstyn diet dramatically improved his cardiac situation and commented:
"Nothing like bashing something that works merely because you want to swallow meat. ."
I do relish meat in moderation simply I also really bask vegetables, basics, fish, legumes, olive oil and avocados. I looked into Esselstyn's diet in detail considering it stands out as especially misguided in banning nuts, avocados, fish and olive oil to heart patients.
..".So sicking (sic) to meet people talk trash about something that works so well… It saved my life…"
I'thousand happy you are doing well with your cardiac status but it is impossible to know what would take happened to y'all on a more reasonable nutrition such as the Mediterranean diet (which actually has legitimate scientific studies supporting information technology). And again criticizing Esselstyn's ideas and "study" can hardly be considered trash talk.
"I personally take followed dr. esselstyn'due south program for what volition be 5 years in 11/17 and have made tremendous gains in my cardio pulmonary part….my cardiologist looks at me in wonder…why are y'all here? and often says , if everyone did what you have…Id be out of business…so…isnt that telling and deplorable?"
I'm glad you're doing well with the program, most patients can't follow this kind of nutrition for more than than a few months. But perhaps nosotros shouldn't gauge its effectiveness until nosotros make certain you don't suffer a centre set on next week. Your cardiologist is wrong: see what I wrote virtually "dealing with the cardiovascular cards you've been dealt." Some individuals inherit genes that guarantee progressive and accelerated atherosclerosis that will impale them at an early on age despite the best lifestyle.
"…the phrase "follow the money" comes to mind…and since theres no big money to be made….scientific discipline will attempt to dispell the results and thousands of years of history that proves this dietary organization works…"
Using a scientific approach to analyze Esselstyn'southward diet (which tries to claim a scientific basis) seemed appropriate to me only I wasn't motivated by money. I'm looking for what is best for my patients, pure and simple.
The Plural of Anecdote Is Not Data
One man wrote:
"Merely since this is only anecdotal evidence – it must be junk science…"
Esseslstyn devotees like to post what their personal experience is with the diet but as skeptical medicine has pointed out "the plural of anecdote is not data."
One adult female described in detail a good response her married man had after starting the diet following a heart attack:
I'm concerned nigh the skeptical cardiologist going subsequently the person of dr. Esselstyn versus the scientific discipline, such as quoting how you States dr. Esselstyn came up with the diet. So at that place may exist a personal bias there. I'm certain there are more people out there on the esselstyn diet that are not noted in the study years ago. I promise there is another book coming out
I've reviewed in particular my comments about how Esselstyn came up with the nutrition but I am at a loss to discover whatever ad hominem attack.
This adult female went on to say
We will proceed you lot posted, as my hubby is willing to get another cardiac Cath and 12 months to visually come across the departure after the nutrition.
I take to betoken out that if his cardiologist performs a cardiac cath (which carries risks of stroke, center attack and death) for the sole purpose of checking the effect of the diet he is engaging in unethical medical behavior and likely insurance fraud. By the way, I promise that your married man is on a statin like most of Dr. Esselstyn's are!:)
and a man wrote
Calling Essylstein ilk shows a niggling too much biased hatred on your office
Please note the definition of ilk "a type of people or things similar to those already referred to." No pejorative in that location. And no ad hominem attack. I wrote:
It is possible that the type of vegan/ultra-depression fat diets espoused past Esselstyn and his ilk have some beneficial effects on preventing CAD, but there is nothing in the scientific literature which proves it.
I should be able to criticize the methods and ideas of Dr. E without it being considered an assail on his person
Completely wrong. Esselstyn has saved my life. His volume explains it all, how the endothelium cells go ruined, inflammation … heart assail proof (his words). Ane does not continue equally head of the Cleveland Wellness Middle if one is a quack.
Words are easy to come by on the interweb but Dr. Eastward'south are non supported by science and every bit for the "Cleveland Health Center" information technology is probably non wise to get me started. Dr. E 'southward program is listed as being part of the Cleveland Clinic Wellness Center which is an endeavor to capitalize on the market for pseudoscientific enterprises. He is not the manager. The managing director recently came under intense criticism for promoting anti vaccine quackery. (Run into hither).
The Wellness Center promotes so-called functional, integrative, complementary and culling approaches. (Functional medicine is false medicine!) These are approaches that have not been proven to work and could arguably be chosen quackery. (Permit me be clear, yet, I am not calling Dr. Esselstyn a quack simply the fact that he is part of the Wellness Center does not add any scientific validity to his work.)
"I'1000 sure in that location are more people out there on the esselstyn diet that are non noted in the study years ago. I promise in that location is some other volume coming out"
False News, Fake Scientific discipline
Every bit a matter of fact, Dr. E has been hard at piece of work over the last xxx years and has added a one thousand total of 176 patients who are considered "adherent" to the diet: nigh vi per year. The "original inquiry" was published in The Journal of Family Practise in 2014. Unfortunately the bad science present in the original publication has but been amplified.
In improver to any randomization or suitable command group for comparison, the information collection techniques are unacceptable:
"In 2011 and 2012 we contacted all participants past phone to assemble data. If a participant had died, we obtained follow-up medical and dietary data from the spouse, sibling, off-spring or responsible representative."
In other words, there was no actual systematic review of medical records, autopsies or decease certificates, just discussion of rima oris from whomever answered the phone.
"Patients who avoided all meat, fish, dairy, and knowingly, whatever added oils throughout the program were considered adherent."
Imagine, if you will, that your husband died 10 years ago and you received a call from Dr. E'southward office or perchance Dr. E himself and he asks you if your hubby "avoided all meat, fish, dairy and added oils." For ane thing, information technology would be very hard for you to respond that question with whatsoever degree of accuracy: was your husband cheating on Dr. E's nutrition when y'all weren't looking, do you lot retrieve his entire diet from 10 years ago?
For another thing, you know that the caller has an agenda. If your hubby died of a heart problem the caller is not going to be happy until he/she gets yous to admit that your married man had some guacamole on Cinco de Mayo in 2002. If he's alive and doing well, the caller is likely to be satisfied with a simple answer that , yes, he'due south post-obit the diet.
Yes, we have more than information from Dr. Eastward but information technology turns out to be even more incredibly bad than the outset lot.
Let the anecdotes and ad hominem attacks begin!
-ACP
Related
mccrackencomir1936.blogspot.com
Source: https://theskepticalcardiologist.com/2017/05/14/more-incredibly-bad-science-from-dr-esselstyns-plant-based-vegan-diet-study/
47 thoughts on "More Incredibly Bad Science From Dr. Esselstyn's Found-Based (Vegan) Diet Study"
Dr. P, I read your web log and find your opinions insightful and educational. I'grand wondering about your stance on Dr Dean Ornish's Reversal Protocol and the the 30 years of research he's done showing a vegetarian, ultra low fat diet can and does reverse blockages in your heart arteries.
I'one thousand non a radical animate being rights activist or vegiitarian simply person. I honey meat. All kinds, cheeseburgers, pizza, fried fish and chips, sausage, bacon…..love information technology all and existent butter too. Unfortunately at 33 years old I had my start 4xCABG. I followed the American Heart Associations protocol for my condition which in additional to nutrition included Phase 3 Cardiac Rehab for years. Virtually vii years later the ballon angioplasties started with restenosis after restenosis. 3 years later another emergency 4xCABG. Afterwards my recovery, I was having approx seven angina episodes every solar day with no exertion and was eating Nitrostat similar processed. This despite the efforts of some of the best cardios in the nation trying to help me. Luckily, I read an article in the Detroit newspapers virtually Dr'south Jodi and Felix Rodgers, cardiologists from Trenton, MI who had started a Orinish Reversal Ptrgram in their practice. Being out of options, I joined. After 6 weeks my angina episodes were down from vii a mean solar day to seven a month. After half dozen months, my angina was gone. After a year I was walking iv MPH about days, chasing the kids around, playing one-half court/full court basketball 4 days a week, moving heavy refrigerators and felt great. It wasn't like shooting fish in a barrel. Rarely ate out. My Top Physician'southward from Beaumont Infirmary In Royal Oak, MI were 100% supportive, eliminated some of my middle meds merely cautioned the diet might be too restrictive for nigh people to stay on. I lasted 4 years. And another maybe 2 years partially following the diet.
I've been completely off the Ornish Protocol for about 15 years now and after 4 stents, 2 AFIB ablutions, an Aflutter ablation and beingness told no more interventions are possible, I rue the solar day I vicious off the Ornish railroad vehicle. I'1000 currently trying to jump back on but find information technology very hard without the swell back up group I had in 1993. Is this scientific? No. But I am confident that Ornish'southward enquiry has held up and am praying it will assist me again.
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May be I am wrong what people consider meat in the Us, to me cheeseburgers, pizza, fried fish and fries, sausage, bacon it is non meat at all it is crap junk food full of bad heavy processed flour, sugarS, bad oils etc, fifty-fifty the bacon it is cheap pork fed with crap flours and so processed with cheap salts, preservatives and sugar. To me meat it is a skillful trout, salmon, sardines (mainly fresh) a good steak etc and my good extra virgin olive oil (abode made, we are in the season in my part of the world and just collecting the fresh olives), and with my 70 years I do non need a cardiologist or a doctor, 0 Coronary calcium score 2 years ago, perfect blood pressure and the only medication than I can think of in the last 40 years I antibiotics for an infection in my cut in my pes.
Regarding Dr. Due east I accept a proficient laugh near ii or 3 years ago when I relish a YouTube video from this pseudo researcher, to me was like ane of the classics videos from one of so many sect and churches exist in that country.
It is true anyone than stops consuming cheeseburgers, pizza, fried fish and chips, sausage, bacon and going in a fast (no nutrient) and having only h2o will better from that rubbish, from there to extrapolate than Dr. information technology is a Saint information technology is along way.
To exist healthy you accept feed the engine with the proper stuff and be prepared to spend the time in the kitchen (I dot meet more than one hour or Telly a week, I practice non have the time) or be prepared to spend the time in hospitals, clinics, doctors and pharmacies, yeah healthy food is not cheap but sickness information technology is a lot more than expensive and more than complicated.
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I am a woman and had a center attack at age 55 immediately following menopause. I had five bypasses
10 years later I felt I was on the verge of another heart assail even though I passed a stress exam and ok cholesterol scores
Cath was done and discovered 4 of 5 bypasses no longer working and bottleneck in a volunteer avenue.
I was fine with dying but my family freaked so I went to Cleveland and got a stent.
I too started on the Esselstyn nutrition 9 mo agone. I could not tell whatever difference in my energy etc but I lost most 18 pounds which was good for my self esteem.
My male parent had his first heart attack at 36, died at 57. I've never smoked, always been active and non obese. I don't retrieve you can fight genes. I stay on the nutrition 98% because it makes my family feel meliorate and I like existence thinner. Otherwise I doubt Esselstyns science but figure it can't hurt.
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I'k only now sitting through a mandatory "Ed actionable" video for workers comp injury rehab programme (don't fifty-fifty get me started on the land of physical therapy therapy ractice). It features Dr. Esselstyn's "remarkable" diet research and results. I smelled b.s. right from the beginning, when they mentioned the n=18 with no command group.
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Very interesting. One would think that the creators/proponents of these alternative approaches, be they diets or supplements would want to testify empirically that their wholistic approach/supplement or whatever is as expert equally or better than the "western medicine" arroyo that they and so rapidly dismiss. Why don't they subject their approaches to clinical study merely similar "big pharma" has to? Why does the FDA permit the supplement manufacturers and people like Dr. Esselstyn to say their product is effective without having to bear witness information technology? I for one am open to using any arroyo that is rubber and effective, simply how do I know a diet or supplement is either? At to the lowest degree with conventional drugs there was a rigorous protocol that had to be followed before it could be marketed. ________________________________
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Considering they know the results won't stand up up under legitimate study.
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Interesting point y'all made when y'all said diets should be subjected to the aforementioned rigorous tests as drugs. That would relieve us all from a lot of defoliation as long as the testing for diets was non funded by Big Pharma. Thank you.
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Equally a scholar and researcher–of form, primarily in the social sciences–I am very interested in the way that constructs develop over fourth dimension. Generally, my interest is piqued due to the accepted (admitting understandable) limiting frameworks on which you lot base of operations your arguments in this mail service. Specifically, I am interested in the point that y'all make that "The Health Center promotes so-chosen functional, integrative, complementary and culling approaches. (Functional medicine is imitation medicine!) These are approaches that accept not been proven to work and could arguably be chosen quackery. (Let me be clear, however, I am not calling Dr. Esselstyn a dishonest but the fact that he is part of the Wellness Eye does not add any scientific validity to his work.)."
Some historians or rather more accurately some Foucauldian scholars might debate that the practice of the predecessors of modern medicine was considered to be nothing more than quackery for years. From a reading of Foucault's (1963) "The Nascency of the Clinic," some could easily deduce that information technology was non until later connected work in establishing methods of scientific research and "scientistic bias" in addition to various image shifts in cultural norms and beliefs that this negative perception of medicine changed.
As a practitioner in a field and a scholar of the same, do you not find it problematic that all doctors should ignore clinical testify and disregard experienced observations just because they say they are not "scientific"? Are there not various forms of feasible empirical research that are not based on blinded studies? Are you discrediting ethnographic, phenomenological, and other qualitative and naturalistic methods simply because they don't follow your definition of rigorous scientific discipline? Do you discredit the peer-review process (I've noted that many if not nearly of these studies criticized are in refereed journals of medicine) and the reviewers that conduct the procedure, in my experience typically a double-blinded one? Are non new theoretical perspectives and conceptual frameworks as important to the advancement of medicine as any given field of science? Exercise you detect no value in evidence-based medicine (Bernstein, 2004; Diederich & Salzmann, 2015; Eckermann & Coelli, 2013) which "integrates clinical experience and patient values with the all-time available enquiry information" (Masic, Miokovic, & Muhamedagic, 2008)? (As a annotation, I realize there are specific criteria for evidence-based study, and I am enlightened of that criteria, but the quotes used in this comment go at the key nature). Can we so confidently dismiss empirical "information" (i.e. experiential information or that which is verifiable by ascertainment and experience) collected through ongoing practice, experience, and the development of expertise (eastward.g. a surgeon tin can learn surgery and even be able to perform it, but doesn't experience and do work to develop one's expertise in performing surgery)?
Additionally, should not medicine similar all sciences value continued evaluation and refinement and therefore give due consideration to "alternative approaches"? Should not emergent and nascent ideas be valued equally a motive to farther exam theories and hypotheses through various methodological approaches and non simply discredited? Should we likewise dismiss all institutions of higher pedagogy that have added colleges of osteopathic medicine to their programs too considering they exercise non follow the prescriptions of the degree of Md of Medicine — no pun intended (http://www.aacom.org/become-a-medico/us-coms)?
Ultimately, I see that these new alternative views accept a value to the progress of new thoughts in medicine that are facing more or less the same criticisms and challenges that modern medicine did when information technology was emerging as a scientifically based practice. To assume that new findings in medicine historically did non occur afterwards new theories and evidenced-based observations that "integrate individual clinical expertise with the all-time available external clinical testify from systematic research" (Sackett, 1996) is disturbing. Equally with any new medicine that is showtime administered in human trials, the enquiry for the upshot in will have in humans is non-existent. For case, when new medical treatments are beginning tried on humans no one can truly say that the research is bachelor for how well humans would respond to it. It can exist inferred from the laboratory trials but whether humans will respond positively is a matter of study. Could information technology be possible that found-based scientific discipline as a nascent and emerging quest for improved health is no different? These questions are not intended to exist antagonistic. My apologies if they come beyond as such. I am merely establishing a line of inquiry equally someone very interested in not only in this topic of constitute-based health but also in the social and cultural constructs that define and legitimize enquiry.
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Pitiful about my delayed response to this. I was on holiday in Europe and the enormity of the questions required a more thoughtful response than I could muster while traveling.
You ask "should not medicine like all sciences value continued evaluation and refinement and therefore requite due consideration to "culling approaches"? Should not emergent and nascent ideas be valued as a motive to further test theories and hypotheses through diverse methodological approaches and not simply discredited?"
I (and speaking for)/medical scientific discipline definitely value connected evaluation and refinement. It is the essence of the scientific method and it is how nosotros go along to refine medicine and empathise what truly works. But emergent and nascent ideas before they are accepted as true must be tested in some mode. In one case they are tested and proven benign they are added to our medicinal or surgical armamentarium .
"Should nosotros as well dismiss all institutions of college instruction that have added colleges of osteopathic medicine to their programs as well because they do not follow the prescriptions of the degree of Doctor of Medicine — no pun intended"
Doctors of osteopathy become through allopathic , scientific medicine preparation like MDs and often end upwards in similar mail service graduate training programs so they are not dismissed.
On the other hand doctors of naturopathy and chiropractic are not practicing scientific discipline-based medicine, nigh of them are quacks and charlatans and are dismissed.
In the skillful clinician physician there is a combination of science-based treatment and decisions likewise as experience-based decisions. We just don't accept show to apply to every situation that comes up and therefore nosotros MDs take to brand judgements based on our best guess of the event and our experience in the past.
However, time and fourth dimension once again, we have found that when certain treatments that we presumed were effective are really tested scientifically they plow out to be no better than placebo or worse. Therefore, whenever we tin can, we rely on proven treatment modalities.
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I noticed yous mentioned the increment in life expectancy since 1945. It brought to heed a figure I saw, a year or two agone, about the United kingdom. Until about 1960, the modal historic period of death was ane.
So a huge chunk of that increase in life expectancy came from reducing infant mortality.
Near the simply useful affair that might have come out of Dr. Esselstyn may be the observation about eating a lot of meat. That does seem to exist something typical of the USA. And then he goes to the opposite farthermost.
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I appreciate your skepticism! Not all physicians have a lot of diet training (how people like me, who do have grooming keep our jobs!) and at that place are those who permit their personal bias to color how they view their "studies." I concord that small studies are sometimes how nosotros get to bigger studies, but lack of funding is not an excuse for publishing information that has not been well corroborated. I also like to bespeak out to folks that because a person calls themselves, "Dr," they could have a phd in history and still use the term, so you take to read carefully and understand who it is you lot are listening to. Keep up the darned fine piece of work!
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I'm grateful to proceed to receive, via email, updates on this interesting thread. My persistent comment, over the past 25 years of doing Cyberspace diet debates, is that choosing a personal nutrition programme is not like choosing treatment for sepsis or pancreatic cancer, wherein one has merely a single opportunity to choose curative showtime line therapy.
Let'south just take a step back and accept a deep jiff. Really, permit'due south commencement with a cocky inventory.
Body mass index. Serum metabolic indices. Blood force per unit area. Possibly even a CT angio and calcium score. Look in the mirror. Are we happy with what nosotros see?
if everything is proficient, so … what's the trouble? Just go along doing it. If things are not going so great, and if 1 is worried about it, then try something different. Any makes sense and appeals to you. Endeavour it for a couple of years. See where y'all are. If you are happy, and so keep doing it. If you aren't happy, then get on to program B.
I truly believe that health care practitioners would best serve their patients — from a weight and diabetes and middle disease and cancer prevention point of view — from following an individualized arroyo to life way management, considering what's best for both health and happiness, on an individual basis, than trying to advance the bespeak of view that in that location is 1 best diet and exercise plan which is optimum for everyone on the planet, against all logic, in the context of all noesis.
– Larry Weisenthal (Med Onc in Huntington Beach CA and recent year 2019 Boston Marathon qualifier)
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Larry,
That all makes sense to me
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Anyone who believes our bodies were designed to swallow other animals is misguided in my opinion.
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And so we humans take been doing it all wrong for the last several 1000000 years? Nature is the greatest laboratory and human history is the longest running "dietary study". If humans are non designed to eat animals, at that place should be flourishing naturally occurring human being vegan cultures. There are none, and the advent of virtually long term vegans tells the whole story
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Dr. Anthony, having merely come across your website, I'yard eager to know your thoughts on Heterozygous Familial Hypercholesterolemia? I have non been genetically tested, however, PCP believes this is what I have. My brother, besides a K.D., was introduced to the Esselstyne theory/diet/protocol, whatever i chooses to telephone call information technology. History, I'yard mail menopausal at 55, brother is 44. Father had AMI in early 60's, ultimately leading to a 4vCABG. His father's brothers, European descent, 4 of them, DIED of AMI in their early 50'due south. Fast forward to now. But had a Quest Lab Cardiac IQ done on myself. We eat a Mediterranean Nutrition for the record with the exception of no pork and no shellfish. Full fat dairy, olive oil, grass fed beef…..My total cholesterol is 291, LDL 199, Lipoprotein Subfractions high, CRP 3.0. I am non-diabetic or overweight, I do not take hypertension and take never accept HRT. My brother'due south lab is similar. Simply he has had a significant increase in LDL's in final 8 weeks.
We both have started low dose Lipitor, ugh. Much to my concern. I have read your criticism of Esselstyne, but what do those who take a possible genetic anomoly practice? I don't believe I could stick with such a regimen, however, I don't want to die either of a cardiac consequence that could have been reversed. Any suggestions?
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Robin,
I recommend you read this postal service (https://theskepticalcardiologist.com/2014/xi/15/dealing-with-the-cardiovascular-cards-youve-been-dealt/) which I wrote in 2014. There are inherited conditions similar FH and lipoprotein(a) which even the best lifestyle cannot overcome.
For such individuals, statins are crucial. Patients like you and your brother with very high LDL and associated early on atherosclerosis in the family often benefit from multiple approaches to lowering gamble, including PCSK9 inhibitors, ezetimibe and aphaeresis. Consultation with a board-certified lipidologist is a consideration.
Despite the bad press statins go online they are a very safe and effective treatment.
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Thanks very much. Exactly what we thought!
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Why don't you offering to debate him?
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Do you also criticize the studies by Dean Ornish who recommends a very comparable diet? As a physician having reviewed his results I would experience it is unethical no to nowadays the Ornish program every bit an alternative to invasive procedures. I feel full unbiased explanation of both should be presented to patients. Those who recollect they are adequately motivated to make and maintain the lifestyle changes required should have the opportunity to make this option. Invasive cardiac procedures take complications and are definitely unwarranted in asymptomatic patients.
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I've discussed the limitations to Ornish's study in response to comments and am close to expanding that to a full post.
I would concord with your terminal argument and am close to some other post discussing whether patients with very high gamble calcium scores should become stress testing.
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Jeanne, you're creating a false dilemma or a straw argument hither. I don't see where the writer suggested nobody should be shown other options, but the reference that most patients adhere to a vegan diet for simply a few months (fifty-fifty when it'due south potentially terminal).
There are two sides to this:
i) the knife isn't always the offset fix or peradventure the best (you're operating based on odds, right? Equally a physician yous know that you're doing that – there are few definites that you can tell when something isn't absolute)
ii) in a situation where diet can be helpful, only adherence is low, and then suggesting it every bit an alternative (and not replacement for) may be warranted.
If we're creating hypothetical situations, as you have, let'due south assume that you take a patient that comes in with cardiovascular problems and a history of being not-compliant. Do you beat the drum about diet to them over and over indefinitely, or practise you lot say at some betoken "a surgical solution may be better for you lot because you don't follow directions". Of course, people being soft forces y'all to say it differently.
I'one thousand sure patients are ofttimes dishonest with you, too, out of a desire to avoid conflict or for some other reason.
I'g virtually 40 pounds overweight. It's not a smart thing, but at this indicate, I don't have hypertension of bloodwork issues. I'm but a bit fat. My physician is an advocate of 75 minutes of exercise per twenty-four hour period. That'south dandy – I'll never do it. He asked if I wanted to talk about how I became overweight, and I said "because I swallow also much. It's non that complicated. In fact, I'k surprised i'm not more overweight given how much I eat".
He said that he rarely gets that response from people. I told him that at some betoken, I'll either be forced to lose weight (maybe I'll even die, but the odds aren't for that at this betoken), or I will choose to without being forced considering I *want* to lose weight more than I *want* to overeat.
How many of your patients are honest enough that you tin can actually pretend to be every bit definitive as your assertion was? How exercise you lot know that a specific diet is really the commuter hither and it isn't just losing weight (I'd bet the correlation to better health from weight loss without any specific nutrition being tied to it is much stronger than the additional contribution past diet type above weight loss or reduced food consumption). Why are yous wedded to the diet that you just mentioned vs. anything else?
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I had my first MI at 42 in 2015 and 2 stents in RCA all other arteries we normal. I then went on an esselstyn diet strict to 99% for about iii years then I started adding a bit more than fish and basics even then everything was make clean and whole. Last week during a routine treadmill stress test at high work load my readings showed a at depression at 144bpm and 12mins and the balance was stopped. An angio was conducted the other day and the diease has progressed to my left side LAD previous stents are clear.
Now question is did the nutrition piece of work? I wasn't taking statins equally TC was 4 , LDL 2 HDL 1.three and trig 0.eight but now the drs want me on a statin . So confused
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Honey this blog post! It so perfectly demonstrates the terrible quality of 'how to think' that has been taught in our pedagogy systems. I also love the line: "The Plural of Anecdote Is Not Data" because that is exactly what the un-thinkers use as "evidence" to brand their points. What this post also demonstrates is how readily some people are inclined to believe the latest (or any) Guru. You tin can requite them Anthony Storr's "Feet of Clay" to read and they still won't recognize information technology as applying to their special guru. And information technology is _always_ evil intent past "Big Pharma" that makes all criticisms of science valid.
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Interesting debate.
Dr A, your thoughts on my experience
I am 57, In 2008 I was diagnosed with Angina in one case, I changed lifestyle and never got symptoms again
from 2008 I had five CT angiograms that all confirmed two lxx% blockages in LAD
Then in 2013 I had a Gold Standard Angiogram to investigate more accurately which confirmed the same ii blockages in LAD as 80%. My cardio said that considering I was symptom costless and in relation to the big courage studies, I could chose medical therapy or stents. He recommended stent and i chose to go along medical therapy.
So for 12 years I know I have had ii blockages just never symptoms and live fine.
However in March 17 afterward good living I had another Ct angiogram which said one 50% block LAD and nothing else. So again in Feb 20 where it said one 70% LAD and same in the RCA ( I know these two years in between my diet took in much more than sugar, cheese and bread and coke)
In conclusion I have now gone back to strict nutrition of vegs, fruits and occasional meats once or twice a week and fish a little more oftentimes. Just I am targeting the vegs and salads and fruits, nuts etc. I have lost iv kgs in 3 weeks.
Will I go for the stent for prevention? fourth dimension volition tell but it seems with existence very aware of having an underlying condition, I can at least take good care avert stress and bad foods and keep learning about health living.
But information technology notwithstanding annoys me that in my 30s I had a bad diet for 15 years, I remember and I recollect my arteries took the fallout, much to my regret.
And it annoys me that I have this risk only Like I said Ive had it for 12 years and all I ever heard from various cardiologists was Accept A STENT, never considerations to a wholistic way.
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I don't see whatever compelling indication for stent in patients with no symptoms. Even in patients with symptoms at present the ISCHEMIA trial suggests medical therapy and stents take equivalent outcomes.
For some lifestyle change is appropriate but statins are the most powerful tool to prevent progression of the CAD.
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Howdy Dr A
Cheers for your reply and consideration of my situation
Its reassuring to have a professional view that concurs with mine.
I will for at present continue on a good plant based diet, fruits & mixed with a balance of fish, occasional meat, nuts and exercise and put the focus on good counterbalanced health eating
I practice believe that a very good nutrition, medical therapy can keep my disease stable and without issues providing I now work difficult on little stress and healthy lifestyle, and avoiding sugar
Kind regards
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Thanks Dr A
Makes skilful sense to me, appreciate your insight
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Hi Dr A,
In relation to my last post hither, and now the Carona virus–
I am aware that I autumn into the high take a chance category considering I take heart disease, though its stable, i am healthy, non smoker, practise & symptom free for 12 years , Im known to have 2 ten 70% lad blockages etc from 2013 angiogram.
Practise you see me still fitting into the
Loftier risk category in relation to the to a higher place?
Tin can a expert immune arrangement assist me lessen the category risk?
Thanking you!
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I'grand not a doctor (actuary, instead – and for the rabid – pensions. Please don't arraign me for your health claims issues or auto/homeowners/business insurance problems).
I'm always surprised how people get married to an answer and become emotional equally adults. Perchance surprised isn't the right word, but disappointed. Unless our parents are mild and observing, and employ their observations to improve, nearly of usa are like that when we're young. As I get older, I like to be right. Not in a way that becomes "I'm right and you lot're wrong", merely I detect the same satisfaction that others do in trying to go the right answer.
And when I'thousand incorrect, age has made information technology feel skillful to me to say it flatly. I'g wrong (of form, as an actuary, living a life where the world seems more than like a group of odds or maybes, I more than often say "information technology appears that I'm wrong, or I recall I'yard likely incorrect"). Real progress is made both when we're right and when we listen and figure out that we're not.
I just watched the esselstyn documentary. It was pretty cleverly done compared to some others where the participants aren't equally mild and they come across equally more militant, but someone similar me (with no medical experience) will take other data points that we've nerveless and we can't help only say "if it'southward this unproblematic, I should be able to find no criticism of this video, or no legitimate criticism, and lots of trials that back it upwards".
Years ago, a vegan told me that vegans don't get cancer or eye illness. I told the person in this case that I thought that sounded odd, but I wouldn't be surprised to see the rates were lower and would be curious about how much lower. I didn't find the deviation in rates to be big enough to warrant changing my diet to vegan for health reasons, but saw enough to effigy I may be more selective with meat and eat a niggling bit less of it. I'm in a globe of odds, and so is anybody else. What happens to each of united states of america may be more definite, but it's not as if we necessarily take the strings to pull to know how to dispense the definites, so we bargain in odds.
Thanks for advocating for the group of folks who are trying to find amend answers, and not just finding something that'southward pleasing to hear or recollect then hoping to find the answer that makes it and then.
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funny if he is such a quack and his way of eating for heart patients or whomever does information technology is quackery, and so why is he and his family then darned healthy? He's in his 80s still hiking and being vital, his wife Jane, the same; his children( adults now) very fit, healthy and vital! Whose the dishonest here?
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Suzanne,
I discourage judging a diet by how its leading advocates are doing. Take a expect at my posts on the decease of George Atkins to see why this makes no sense.
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Dear Dr. A,
I am dislocated as what to do. I am a 58-twelvemonth-sometime male person on fourscore mg of atorvastatin and 10 mg of Zetia for cholesterol, besides as valsartan, amlodipine, and metoprolol for hypertension and heart shell. I had a CT angiogram with a total is calcium score of 1050. RCA 505, LAD 320, LCCA 173, and LCA 52. I get somewhat winded when I am walking. I become somewhat winded when I am walking fast and talking at the same time. Because of this my cardiologist recommended (If I am comfortable) and I am scheduled for cardiac Catheterization in a week. I am very anxious.
I am a 58 year one-time male with family unit history of CAD. At 56, my dad had a Severe LAD blockage and coded for many minutes during a cath which was washed through his groin. He was resuscitated stabilized, had emergency emergency bypass surgery. Needless to say, he ended up with massive brain damage. He lived some other nine years simply did not die of CAD. My older brother had chest pains at 56 despite clear stress test and bloodwork. He also had an 98% LAD blockage, was catheterized through the wrist and received a stent.
I thought passing 56 without episode dodged a bullet, guess non!
I have read and viewed nearly establish-based CAD reversal and would love to avoid catheterization if possible.
Do you think I should/could avoid or delay this catheterization with my present medical therapies for cholesterol and hypertension and calculation plant-based diet?
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Peter,
Clearly based on your calcium score yous have advanced coronary atherosclerosis for your age.
The test that yous had, the CT angiogram (aka CCTA) is typically performed with Iv contrast and gives data on the degree of blockage in the coronaries. Was that reported out to you?
Y'all are on an splendid combination of cholesterol lowering drugs which will substantially lower your long term risk. Consider getting tested for lipoprotein (a) if not already done. For such advanced plaque for age I usually set a goal of LDLC<60.
Dr Peaerson
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I am a male person in my late 60'southward, diagnosed past a cardiologist, after testing, (ecg. treadmiill stress, and angiogram) as having stable exercise induced angina as well as CAD, (40% blockage in 4 arteries). My father died of a heart set on at historic period eighty. I am taking 40mg of rosvastatin and v mg of ramipril and take been post-obit the Essetyn diet. for two months. ,
M angina symptoms appear to exist getting worse not better through so I am wondering if continuing with the diet is a proficient idea. What diet would recommend rather than the Esselsyn one?. I am motivated to follow whatsoever diet has the best adventure of working.
My problems with the Esseltyn diet are that it appears to be somewhat inconsistant, incomplete and is quite dated. It requires a lot of guesswork from the reader. Examples are: 1 wondering if hemp seeds would exist an alternative to flax seeds for omega three considerations. In that location is no mention of that in the book. ii the book has desert recipes using calorie-free tofu in a blender, rather than regular, simply isn't that merely regular tofu with a higher water content. 3 Near proper noun brand products mentioned are no longer available. 4 Does the book, copyright 2007, reflect current medical noesis. or is it desperately outdated. v The volume mentions absolutely no oils, and then some recipes phone call for things similar "spray with Pam".
I am also concerned that the book may be missing important aspects that are not discussed. For example rigorously following the diet means consuming a lot of legumes and flaxseeds, which are known to be very high in estrogen. Maintaining a testosterone/ estrogen balance is eseential for skillful health and people of my historic period confront declining testosterone levels anyway, Then maybe the Esselstyn diet may be increasing non reducing cardiac risk or at best breaking even..
I'd b interested in you thoughts.
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Andrew,
Thanks for your thoughtful observations on the diet. As you say, it is "inconsistent, incomplete and is quite dated."
Given these issues plus the full absence of evidence supporting it I don't recommend it to patients in your situation.
I have a recent postal service on heart healthy diets which includes a link to a podcast where I expound on the diet I recommend, a variation of the Mediterranean.
I had a conversation yesterday with a man age 45 who had an MI and stenting two years ago which I'd like to expound on in a post soon. I had to spend a lot of time convincing him not to worry about all saturated fats in his diet. He also was on high intensity statin therapy and I told him as long equally you lot proceed to take the statin, don't fume, exercise regularly, keep close to platonic body weight and we document your apo B <seventy you will do fine with plaque regression and no further events.Beyond those factors I mentioned, radical depression fat/vegan diets have no proven benefit.
Dr P
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Dr. Pearson,
Thought you lot'd be interested in some other case report. I take a lot of heart disease in my family on my father's side. My father had 2 heart bypasses and passed away at 50 due to spasm after jogging. I was mildly overweight from babyhood but didn't accept high cholesterol. Around Age 32 I became enamored with the low-carb move and became a devotee to that nutrition "ideology" and despite losing about 20 lbs initially, my LDL shot up quite a bit and stayed pretty elevated. That ideology says LDL and Cholesterol are meaningless (except for HDL and Triglicerides), then I didn't worry nearly it. I refused statins because of the bad press, in particular in the low-carb customs. I connected eating this way through my mid 40'southward and my weight fluctuated quite a bit. At my highest I was at a BMI of about 33.
At the age of 45, I started having back hurting whenever I walked. I could only walk for maybe 5-10 seconds before the hurting fabricated information technology difficult. I wasn't doing whatsoever other exercise at the time, other than walking. Afterward talking to principal care physician, they said I should get checked out past a cardiologist just in case due to my family history. I did, and this cardiologist recommended an angiogram because it was the gold standard to figure out if it was something centre-related. I relented because I wanted to know for sure. The angio revealed a agglomeration of blockages, 3 of which were 80% or higher. They could just stent ane of these (the one that was 99% blocked, and that mitigated all the associated back hurting. Merely there were a couple of other blockages of effectually 80% and some others in the fifty% range.
I went on meds and asked my doctor what diet to follow. The guy was not very interested in diet, but he said he thought Mediterranean had the most evidence behind it, then I began on what I thought of as a Mediterranean diet. Adequately plant-based, but lots of fish (generally salmon) and a flake of chicken too – white meat without skin more often than not. My idea was to try to do a Mediterranean nutrition that was as depression-carb every bit I could brand it. So I didn't eat a lot of grains. I by and large ate veggies and fish, lots of olive oil, hummus, falafel, etc. I didn't really pay attention to sodium, which I'thou sure was well above the ane,500mg AHA recommendation.
A little afterwards a year after this, I decided some muscle aches I was having were statin-related and asked my md to get off of them. He said I could take 1 dose per week rather than per day, which I started doing.
A piffling after iii years mail service stent, I started having the same dorsum pain when walking. It wasn't near as severe, but information technology was definitely present and worrying. An echo stress test didn't reveal annihilation, and then my cardiologist didn't suggest I change anything or become any additional tests. However, this acquired me such concern that I felt like I was going to be in the same gunkhole equally I'd been in earlier, would take to go another angiogram or worse. Then I started researching angina relief and came across Dr. Esselstyn. I'd done many 'crazy' diets in my past and was always good at being 100% compliant for long periods if I wanted to, so I challenged myself to do his for a month to run into if I could. Quite the 180 from a low-carb, meat-based diet! I figured if I could make it through that month and I felt better, than I might get for 3 and come across how I felt, etc. Then that's what I did. I lost weight, and so of form I felt better, although the back pain didn't actually diminish. I had high hopes given Forks Over Knives, Esselstyn's book and many anecdotes I found online. I read a lot with the intention, in a sense, to become "indoctrinated" so that I would be motivated to continue to practise the diet. And that's basically what happened.
I became a huge adherent of Dr. Esselstyn and plant-based diets, I drank the Kool-Assist, and then to speak. I did have success in that my LDL plummeted to the 60's, at least after the start 6 weeks on the diet, and I had to get off my BP meds considering I was getting featherbrained due to lowered BP. I also lost so much weight that after 6 or 9 months on the diet I was lower than I ever really remember myself weighing (only really weighed myself in college) and so probably was lowest since high school. BMI was around 21 or 22. My pain seemed to be getting better, but but very subtly, due to my heart not having to piece of work equally difficult since I weighed less.
In found-based circles, there is this fake dichotomy that's but out – diet and lifestyle vs. medication and procedures/surgery. Either y'all "live correctly" or you take to resort to extraordinary measures that basically due a poor chore of patching you up and don't solve the underlying issues that lifestyle does, or so the thinking goes. As such, taking medication is seen more every bit a "failure" that you're non doing lifestyle correctly. And if you lot are "reversing" your heart disease, then you should NEED medication, right? So taking medication is just telling yourself you still have disease and you're supposed to be curing it with the nutrition. Thus, I felt it my responsibility to go off all my meds. I had already by and large gotten off the statin, and had totally gotten off my BP medication, so the main one left was a beta-blocker which was also serving equally an anti-anginal (Metoprolol). He said I could try to wean off of it, and while my angina had gotten a little ameliorate, later on cutting down the Metoprolol 1/4 dose, I found the angina came back and was at least as bad as it had been since information technology had restarted, possibly worse. So I stayed at that 1/iv dose, convinced that eventually the angina would improve enough for me to finally get off of information technology.
Fast forrard half-dozen months or so. So this was about one.v years into the nutrition, and exactly five years after my initial stent, I awoke to dorsum hurting more extreme and different from anything I'd had. Went to ER and they determined I'd had an NSTEMI and they wanted to do another angio to stent if necessary/possible. Turned out that my previous stent (which was in the 2nd diagonal avenue) had not been placed all the way in so was protruding a bit into the LAD and that was providing something for particles to latch onto in the LAD. That buildup was pegged at about a xc% blockage. They stented the LAD. Interestingly, they said the only other blockages they saw other than that one were at 40% or less, which seems a lot improve than the info I had gotten 5 years earlier. I figured that this was still a 'win' for the nutrition, but I straightened upward and took the full dose of meds now as prescribed.
So, what do I take from the higher up? I retrieve if I had remained on the statin, perhaps that buildup wouldn't have happened or it would take taken a lot longer to happen.
Ultimately, work of some other plant-based doctors who have been calling our Dr. Esselstyn's claims (most notably Dr. Avi Bitterman) have convinced me that his claims are not evidence-based and his studies are quite flawed, as you've noted. I don't think in that location'southward anything necessarily harmful almost doing his diet, but as you notation information technology is very strict and then many people only tin't follow information technology or follow information technology for very long. I followed it for almost 4 years without whatsoever problems, simply in the last twelvemonth have been adding nuts, avocados, tofu, and tempeh occasionally. When eating out, I will eat things that I know may take a very small corporeality of oil. Since it was sustainable for me to consume without all these things, it's essentially icing to be able to eat these even occasionally. I still don't consume fauna products because I believe that with the exception of fish and at least some forms of dairy, we have decent evidence that they can actually increase chance, unless eaten in very pocket-sized amounts. Only I feel like fifty-fifty if I could swallow those small amounts and get away with it, and certainly probably could get away with eating a minor amount of fish, which has been shown to reduce risk in many studies, I adopt to opt out of doing so for both environmental and animal-welfare reasons. Simply at to the lowest degree I'm intellectually honest in that I don't have to for wellness reasons. Some people do have problems in that they can lose Also much weight due to how low-fatty Dr. Esselstyn'south diet is, but as long as that isn't the instance, I believe one can consume a vegan diet, if that is your option (a personal decisions) and get all the right nutrients from it save a few that can be supplemented.
Unfortunately, I think the "vegan doctors" similar Dr. Esselstyn, McDougal, Greger, Bardnard, et al, take decided that veganism itself is a more than important line in the sand, and they volition make claims to push button that vegan line in the sand regardless of the evidence. Thus I've stopped listening to them. There are a select number of vegan doctors and nutritionists out at that place who don't play this game, they give the evidence regardless if it "hurts the cause" because they believe that ultimately people should decide for themselves based on the truth and in that location are certainly other reasons to give up animal products (as I've noted). Unfortunately, the big personalities like Dr. Esselstyn accept gained a somewhat cultish post-obit. Dr. Esselstyn in particular is an extremely caring doctor, but he simply is biased. I believe he truly cares for people, just that doesn't atone his claims that tin can definitely cause harm (on his website and book he talks about being "center attack proof" by eating his diet and merely getting your LDL under fourscore, plus dismisses the helpfulness of medication, and, in nearly cases, procedures).
Anyhow, deplorable for this exceedingly long postal service, but I thought yous'd like to hear from someone who went the full gamut – from low-carb ideolog, to vegan ideologue, to finally someone who is trying to seek the truth regardless of what "side" it favors.
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Levi,
Thank you for sharing your story and in such a wonderfully-detailed, thoughtful way.
I'd beloved to mail service this a divide mail on my weblog if you are OK with that. Even without my input there are tremendous points on the vegan credo and paths to the truth.
I'm sure at that place are many who accept followed this trajectory but are unwilling to share that they were deluded for so long.
It could be totally anonymous or with whatever degree of identification of your preference.
Dr P
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