The American Heart Association has a PR problem

2. March 2011 William Davis (17)
The results of the latest Heart Scan Blog poll are in. The poll was prompted by yet another observation that the American Heart Association diet is a destructive diet that, in this case, made a monkey fat.

Because I am skeptical of "official" organizations that purport to provide health advice, particularly nutritional advice, I thought this poll might provide some interesting feedback.

I asked:

The American Heart Association is an organization that:

The responses:
Tries to maintain the procedural and medication status quo to benefit the medical system and pharmaceutical industry for money
240 (64%)

Doesn't know its ass from a hole in the ground
121 (32%)

Is generally helpful but is misguided in some of its advice
79 (21%)

Accomplishes tremendous good and you people are nuts
6 (1%)


Worrisome. Now, perhaps the people reading this blog are a skeptical bunch. Or perhaps they are better informed.

Nonetheless, one thing is clear: The American Heart Association (and possibly other organizations like the American Diabetes Association and USDA) have a serious PR problem. They are facing an increasingly critical and skeptical public.

Just telling people to "cut the fat and cholesterol" is beginning to fall on deaf ears. After all, the advice to cut fat, cut saturated fat, cut cholesterol and increase consumption of "healthy whole grains" in 1985 began the upward ascent of body weight and diabetes in the American public.

Believe it or not, my vote would be for something between choices 1 and 3. I believe that the American Heart Association achieves a lot of good. But I also believe that there are forces within organizations that are there to serve their own agendas. In this case, I believe there is a substantial push to maintain the procedural and medication status quo, the "treatments" that generate the most generous revenues.

I believe that I will forward these poll results to the marketing people at the American Heart Association. That'll be interesting!
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Comments (17) -

  • Tuck

    3/1/2011 11:46:38 PM |

    Did the monkeys get to vote? ;)

  • reikime

    3/2/2011 12:11:04 AM |

    I would LOVE to read a response from the AHA!

  • Anonymous

    3/2/2011 12:15:46 AM |

    Come on Doc, these statistics are obviously bias. That's like asking the readers of an vegan/animal-rights blog, "Do you think meat is murder?" and trying to transpose the results as being all encompassing.

  • Rick

    3/2/2011 1:32:30 AM |

    I have to agree with Anonymous here. Nothing surprising in the fact that the majority of readers of a blog that regularly criticizes the AHA have a critical stance towards the AHA.

    Move along, these are not the droids you're looking for.

  • Harold

    3/2/2011 2:34:28 AM |

    I think you are being a bit generous to them. I certainly agree about the ADA. They seem to be in it for the money and they are getting plenty of it from drug companies. I am a physician and a diabetic and if I followed their advice my blood sugars would be out of control. As it is I am on a very low carb life style and in excellent control!
    Thanks for your posts.

  • Real Food RD

    3/2/2011 4:13:16 AM |

    certainly it's not a random sample, but nonetheless, I would have to agree that all of these organizations and government agencies are losing credibility with the public and fast.  As a health professional myself, I can only hope my colleagues may begin to soften their stance before our credibility is completely shot with the public.

  • Anonymous

    3/2/2011 1:14:17 PM |

    Tuck, the monkeys must make up the extra 18%.

    Doctor, I truly appreciate your blog, read it religiously and follow much of your advice, but before forwarding to the AHA, you might want to check the numbers.

  • renegadediabetic

    3/2/2011 1:59:02 PM |

    I think the AHA has done a lot of good in the treatment of heart attacks and keeping people alive.  However, I was thinking mainly of the "prevention" side when I voted "Tries to maintain the procedural and medication..."

    Likewise, the ADA and other diabetes orgs are no doubt doing some good research into causes and prevention of type 1 diabetes, but their nutritional approach is a disaster.  Again, just maintaining the status quo for so long that they would be afraid to admit they were wrong if they finally did see the light.

  • Might-o'chondri-AL

    3/2/2011 5:24:44 PM |

    Their heart is in the right place. In another 40 years scientists will be deriding the intriguing bloggosphere theories.

  • reikime

    3/2/2011 5:53:19 PM |

    I just dislike these organizations jumping on a bandwagon d'jour, and trying to apply it to everyone blanketly.

    People are not a " one size fits all " species!  When will the AHA, ADA, etc, stop aligning with big agriculture and pharma and think of individual people and their specific needs?  Is that just a pipe dream?

  • Tara

    3/2/2011 11:20:06 PM |

    Real Food RD, I'm with you!

    I was going to throw the other ADA in that stack too.  I've let them know several times how I feel about their corporate sponsors and partners.  Disgusted.

  • Brian Vickerman

    3/3/2011 2:12:54 AM |

    To be honest... after promoting such a lifestyle for so many years... wouldn't a sudden change in opinion open them to law suits?

    How can they respond to that?

  • reikime

    3/3/2011 3:14:54 AM |

    Great point Brian. I hadn't even thought of it.

    Wouldn't it be the same with any condition that current medical research might up- end the treatment protocols?
    ie..remember when patients with gastric ulcers were advised to drink milk and cream and avoid spicy foods etc?  
    Then enter H. Pylori...albeit some 10 years after published studies and much derision from U.S. gastros. Treatment standards changed dramatically. Never heard of lawsuits over that.

  • Anonymous

    3/3/2011 3:16:21 AM |

    Could people leave more than one response?  The percentages add up to more than a hundred.
    Bob

  • Bob

    3/3/2011 3:27:57 AM |

    OK, I did the math.  Apparently about 375 unique respondents, with 70 or so choosing more than one answer.

  • mongander

    3/3/2011 4:05:38 AM |

    My impression is that 'disease associations' exist primarily to ensure their continued existance.

    I have heard good reports on the Muscular Distrophy Assoc.

  • Anonymous

    3/3/2011 8:37:54 PM |

    Dr D, I don't think the AHA is sending you a Christmas card this year

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Cholesterol follies

Cholesterol follies

11. January 2008 William Davis (5)
Rudy is a 59-year old man. He's had three heart catheterizations, two of which resulted in stent implantations. Obviously, Rudy should be the beneciary of a prevention program.

His basic cholesterol values:

Total cholesterol 164 mg/dl--pretty good, it seems.

LDL cholesterol 111 mg/dl--Wow! Not too bad.

HDL cholesterol 23 mg/dl--Uh oh, that's not too good.

Triglycerides 148 mg/dl--By national (NCEP ATP-III) guidelines, triglycerides of 150 mg/dl and below fall within the desirable range.


So we're left with an apparently isolated low HDL cholesterol, nothing more. On the surface, it doesn't seem all that bad.

Of course, we need to keep in mind that this pattern landed Rudy in the hospital on several occasions and prompted several procedures.

Should we rely on these results? How about Rudy's lipoproteins?

Here they are (NMR; Liposcience):

LDL particle number 2139 nmol/l--Representing an effective LDL of 213--over 100 mg higher than the standard value (above) suggests.

Small LDL particles 2139 nmol/l--In other words, 100% of all Rudy's LDL particles are small. (Thus, weight-based measures of LDL cholesterol fail to tell us that he has too many small particles.)

Large HDL 0 (zero) mg/dl--Rudy has virtually no functional HDL particles.


If we had relied only on Rudy's standard cholesterol values, we would have focused on raising HDL. However, lipoprotein analysis uncovered a smorgasbord of additional severe patterns. The high LDL particle number comprised 100% of small particles is especially concerning.

Truly, conventional cholesterol testing is a fool's game, one that time and again fails to fully uncover or predict risk for heart disease. One look at Rudy's lipoproteins and it becomes immediately obvious: This man is at high risk for heart disease and the causes are clear.

Of course, many physicians and insurance companies argue that the added information provided by this portion of the lipoprotein test added around $70 more to the expense.

When you see results like this, is there even a choice?
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Comments (5) -

  • Thomas

    1/11/2008 4:02:00 AM |

    It's this type of analysis that's most instructive and most interesting. If I were 20 years younger reading this post, I'm confident I'd have avoided open    heart surgery I went through this past April.

  • Andy

    1/11/2008 1:04:00 PM |

    I couldn't find another place to give you general feedback, so it goes here:  thanks for what you do.  

    I've been an insulin dependent diabetic for 6 years now with a family history of CAD.  While I have moderately good scores (59 for HDL, triglycerides below 60), I've been concerned about getting a better picture.

    I had a CT Heart Scan Wednesday, which resulted in a wonderful 0 reading.  While I plan to push my family practitioner for NMR tests in the future, it's nice to get some validation now.  At $125, the price was a major bargain, as well.

    Again, thanks for sharing what you know.

  • Dr. Davis

    1/11/2008 1:19:00 PM |

    Well, then, more to come!

  • keith

    1/11/2008 1:40:00 PM |

    Interestingly, given a LDL particle count of 2139, Rudy would have been better off with a LARGER standard LDL cholesterol value, as this would imply his particles were larger and hence less atherogenic.

  • Dr. Davis

    1/11/2008 5:07:00 PM |

    Yes, ironically.

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Calculus of the cardiologist

Calculus of the cardiologist

2. November 2006 William Davis (1)
I call this the "calculus of the cardiologist":

Heart procedures = big money

More procedures = more big money

You do the math. If you do more procedures, you get more money.
What if your patients don't need more procedures? That's easy. You lower the bar on reasons to do procedures. You scare the pants off people and lead them to think that all heart disease or questions about heart disease are potentially life-threatening. You could even appear to be doing the patient a big favor. "My Lord! This is potentially dangerous. We need to perform a procedure without delay!"

There are incentives beyond direct cash payment. A patient of mine today showed me a memo to employees in his company that showed why certain hospitals are targeted for care. The criteria for choosing centers was based on number of procedures performed. In other words, the more procedures performed at a hospital, the more procedures will be directed there. Of course, this makes sense at some level. More procedures can also mean greater skill.

But have we lost sight of the fact that the mission is not more procedures and more money, but to get rid of a disease? If the intensity of effort devoted to heart procedures were re-directed to early detection, prevention, and reversal of disease, we'd have half the hospitals we now have. We'd also chop a huge chunk out of the national healthcare budget.
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Comments (1) -

  • Anonymous

    11/3/2006 1:29:00 AM |

    Dr. Davis,
    Another well-written post!  

    Joe

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Carrot Cake

Carrot Cake

5. October 2011 William Davis (14)
This is among my favorite recipes from the Wheat Belly book. I reproduce it here for those of you who read the Kindle or audio version and therefore didn't get the recipes.

I made this most recently this past weekend. It was gone very quickly, as even the 13-year old gobbled it up.

(I reduced the sour cream in this version from 8 to 6 oz to reduce cooking time. Also, note that anyone trying to avoid dairy can substitute more coconut milk, i.e., the thicker variety, in equivalent quantities.)

Makes 8-10 servings



 

 

 

 

 

 

Ingredients:
Cake:
2 cups carrots, finely grated
1 cup chopped pecans
1 cup coconut flour
1 tablespoon ground flaxseed
2 teaspoons ground cinnamon
1 teaspoon allspice
1 teaspoon nutmeg
1 teaspoon baking powder
2 tablespoons freshly grated orange peel
Sweetener equivalent to ½ cup sugar (e.g., 4 tablespoons Truvia)
½ teaspoon sea salt
4 eggs
1/2 cup butter or coconut oil, melted
2 teaspoons vanilla extract
½ cup coconut milk
6 ounces sour cream

Icing:
8 ounces cream cheese or Neufchâtel cheese, softened
1 teaspoon lemon juice
1 tablespoon Truvía or 1/8 teaspoon stevia extract powder or ¼ cup Splenda

Preheat oven to 325° degrees F. Grate carrots and set aside.

Combine coconut flour, flaxseed, cinnamon, nutmeg, baking powder, orange peel, sweetener, and salt in large bowl and mix by hand.

Put eggs, butter or coconut oil, vanilla coconut milk, and sour cream in mixing bowl; mix by hand. Pour liquid mixture into dry pecan/coconut flour mixture and blend with power mixer until thoroughly mixed. Stir carrots and pecans in by hand with spoon. Pour mixture into greased 9- or 10-inch square cake pan.

Bake for 60 minutes or until toothpick withdraws dry. Allow to cool 30 minutes.

Place Neufchâtel cheese in bowl. Add lemon juice and sweetener and mix thoroughly. Spread on cake.
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Comments (14) -

  • Sue

    10/5/2011 1:03:36 PM |

    Thanks for posting this.  My Kindle edition did include recipes, carrot cake included.

  • Pater Fortunatos

    10/5/2011 4:18:02 PM |

    Hi !
    Great recipe, thank you ! But where could we find "clean" orange peel these days ? Only if you have acces to an organic orchard.
    Offtopic> You have an outdated link  - Dr.Davis' Blog

  • Heidi

    10/5/2011 10:45:51 PM |

    I made this cake earlier today (it became my dinner, lol) and it was heavenly. I didn't have any nutmeg, allspice, or orange peel on hand, so I omitted them and I also had to omit the icing. Still a delicious cake! I can't wait to try out the icing next time. Thanks for mentioning this recipe; I've got lots more to try out from your book.

  • Dr. William Davis

    10/6/2011 12:20:10 PM |

    Carrot cake for dinner--can't beat that!

    The spices can really add pizzazz, as does the orange peel. You'll like it even better when you add these components.

  • MARY PAT GALLIVAN

    10/7/2011 3:45:33 AM |

    Wonderful recipe but Doc - PLEASE - no never no splenda!!!!!!  We all know why!

  • Teresa

    10/7/2011 3:19:25 PM |

    While on the subject of recipes, my mom used to make these sesame crackers for my dad.  It is from the cookbook 'Very Basically Yours', by the Human Ecology Study Group of Chicago, circa 1980.  

    Sesame crackers

    Grind toasted or raw sesame seeds (1lb.), about a cup at a time in a blender.  Add 2 oz. sunflower or sesame oil and 2 oz. water, and blend with a fork.  Add 1T. oregano and scant T. salt.  Mix well, pat into a shallow baking dish, cutting into squares and pricking squares with a fork.  Bake at 375 degrees, (10-15 min.).

    Please don't fuss about the sunflower oil - don't use it if you don't want to.  I'm not sure what size pan to use, but the dough should be about 1/4" thick or less.  Use a non-stick pan or parchment paper.  These don't cut well after baking.  If you forget, just break apart.  Pricking with a fork keeps them from bubbling up.  Keep an eye on them for the last few minutes.  They can go from done to burned quickly.  I haven't made these myself, but I can remember after 30 years how good they were!

  • Dr. William Davis

    10/7/2011 11:01:57 PM |

    Sounds delicious, Teresa!

    I'm going to try with a little tweaking. Thanks for posting.

  • Dr. William Davis

    10/8/2011 2:21:31 AM |

    Hi, Mary Pat--

    Because individual experiences with sweeteners vary, I try to specify something like "sweetener equivalent to 1/2 cup sugar." You might choose stevia, you might choose erythritol, some might choose sucralose. So I'm not telling anybody to choose just one, but suggesting a choice among several.

    By the way, if you are referring to the rat study in which bowel microorganisms were reduced by sucralose, if true it means to me that perhaps we should not consume this sweetener habitually but only occasionally. Avoiding wheat is, I believe, a much more potent way to maintain normal bowel bacteria.

  • Babs

    10/28/2011 3:39:51 AM |

    I would really love to try the carrot cake. Can you tell  me what the stats/caloric/nutrient content is?

  • Louise

    10/28/2011 9:41:07 PM |

    Thanksgiving is approaching!  I am thinking of roasted turkey, pureed cauliflower, salad, green beans..Now what about stuffing?  Can you come up with a nongrain stuffing  type of thing for us to make?  And oh, what about a cranberry dish?

  • Dr. William Davis

    10/29/2011 10:47:27 PM |

    Will do, Louise! You are thinking along the same lines as I am.

  • Dr. William Davis

    10/29/2011 10:52:43 PM |

    No, sorry, Babs, I intentionally left it out to convey the notion that calories and fat content are NOT important.

  • Susan

    12/18/2011 4:56:27 AM |

    Hello, I've just finished reading Wheat Belly and want to try some of the delicious sounding recipes.  I'm a cook and baker, and as such have several ideas of my own, but first a question about the flaxseed contained in many of the recipes.  Does ground flaxseed = flaxseed meal?  I've been eating and using flaxseed meal in dishes for years, so I really hope they are one and the same.  Smile

    Thanks, Dr. Davis, for producing such wonderful sounding recipes along with the eye-opening book.  Have you considered writing a recipe book?  I imagine it would be well received.

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The Big Squeeze

The Big Squeeze

20. June 2008 William Davis (5)
Some colleagues of mine brought this scary phenomenon to my attention last evening.

As insurance and Medicare reimbursement to doctors and hospitals fall (Medicare is enacting a series of substantial cuts, which will be followed by the private health insurers), you would expect the use of hospital procedures to drop. Makes sense, right? Less money paid per procedure, less incentive to do them.

Unfortunately, that's not how it's playing out in the real world. Your neighborhood interventional cardiologist or cardiothoracic surgeon is accustomed to a level of income and lifestyle. That lifestyle is now threatened by shrinking reimbursement. True to the Law of Unintended Consequences, rather than reducing use of procedures, diminishing procedural fees are prompting a good number of practitioners to do more.

In other words, if each heart catheterization pays less, why not do more of them, along with more stents, pacemakers, defibrillators, and the like? If four heart catheterizations per day pays less, why not do five to make up the difference?

Voila! Income protected. Of course, it comes at the cost of more work. But I will give one thing to my colleageus: They are a generally hard-working bunch who rarely balk at 12-16 hours days in the hospital.

How do you do more procedures? Easy. Just lower the bar on who to do a procedure on. Use more aggressive criteria for pacemaker implantation. Interpret the always-fuzzy nuclear stress tests weighed more towards abnormal. Use scare tactics: "You never know--that chest pain could be the last warning you're going to have!" Because the criteria for performing procedures is "soft" in the real world, it is easy to bend the criteria any way you want.

It's too early to measure the full impact of this unintended consequence of reduced reimbursement. But don't allow yourself to become a casualty in the reimbursement war. Remain vigilant. Recognize that, despite the fuzziness at the edges, there are still rational reasons for performing heart procedures. Always be armed with information and the right questions. Never submit unquestioningly or without satisfactory answers to your questions.
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Comments (5) -

  • Anonymous

    6/20/2008 6:03:00 PM |

    Absolutely incredible!  What a perverted system!  

    I was speechless with my mouth open when my new cardiologist looked at me and wondered aloud why the previous cardiologist had installed a pacemaker!  Installed supposedly for bradycardia (keep my heart rate from dropping below 60) but the new cardiologist questioned the diagnosis (shaking his head all the while)!  I'll tell ya why -- $65,000.  I have a nice computer installed in me!  

    On my last visit to the previous cardiologist he did not know how my pacemaker worked -- incredible as it may seem!  He said that it was set to prevent my heart rate from dropping below 60 AND going above 130.  I told him that I often achieved heart rates higher than 130 during exercise.  To clarify I asked him three times.  He said I must be mistaken because it was not possible.  Huh?  He had an assistant call me the next day to explain how the pacemaker worked.  Yup.  He was mistaken.  Unbelievable.  I never returned.

    It was shortly thereafter that I discovered the Track Your Plaque program!!  Thank the Good Lord!

    slimjohn

  • Anonymous

    6/21/2008 12:16:00 AM |

    Dr. Davis, thank you for the heads up on this unconscionable trend in cardiology.

    I shudder to think of the numbers of patients who either through ignorance, or timidity, may undergo life-altering procedures. Every surgery has an inherent risk, does it not?  We don't live in a "Marcus Welby" world anymore, so why are people still so uninformed, and so intimidated by doctors?  This just mystifies me...

    I bought two additional copies of _Track Your Plaque_ again today.  At least I will have them on hand to give to people I know who find themselves on the slippery slope of cardiology (which seems to happen all too frequently these days).

    Yes, I know, it's like trying to put Starbucks out of business... one cup at a time!  [laugh!]  Anyway, I can at least be personally responsible for educating a few people I care about on their alternatives, and especially on the TYP alternative to invasive cardiology nostrums.

    Thank you!

    Terri
    madcook
    in Houston, TX

  • Anonymous

    6/21/2008 11:15:00 AM |

    I can still remember when my grandfather had a "heart attack" all those years ago.  And yet today with what I've learned here I'm not sure if he did have a heart attack.    

    10 years ago, one morning before work grandma calls to say that granddad has collapsed, will I run over?  I suspected what had occurred, granddad was a life long pipe smoker and he loved his steak and potatoes.  When I got there, granddad had recovered, he was awake, sitting up rubbing a sore head from the fall.  He wasn't having breathing problems but I said to him I'm calling 911.  I didn't want to take a chance of loosing him like we had Stan.  A year before an employee at the company named Stan had died of a sudden heart attack while preparing Christmas decorations at home.  

    The ambulance comes, I followed behind in my car, we get to the emergency room, and a nurse begins a series of tests.  I remember when the testing was over the nurse said in what I thought was a sarcastic tone, "yeah your granddad had a heart attack, it's a good thing you called." I thought that was strange.  

    At the time I was working in the health food industry.  And while there I used to receive many magazines and news letters about health care.  I always have loved reading and pretty much read what ever health magazine that came my way.  There was one doctors news letter in particular, Dr. Julian Whitaker (sp), that constantly wrote about the dangers of cardiac care in America.  He wrote about the unnecessary procedures that were going on, lack of preventive care in cardiology, etc.  I didn't know what to make of Whitaker's news letter, he was the only one I knew writing such things about doctors and hospitals. Was he saying such things to sell his vitamin line?  At the time I suspected that might be the case.  

    Basically though I knew that for my grandfather's sake it would be best to be on my guard - not to be taken if I could avoid it.  

    Granddad was wheeled up to a room upstairs to await a visit from a Cardiologist.  While there I meet with the new nurse looking after him.  I don't remember the exact words she said, but remember she seemed to be indicating that she didn't think granddad needed to be there.  She didn't come out and say that, but that was my impression.  More strangeness. She ended our talk with "I should keep my mouth shut."  Wow, I thought, OK.  

    By this time granddad was scared.  He had been hooked up to a heart rate monitor and he had been told that when ever his heart rate was too high an alarm bell would go off and a nurse would check on him.  And it was a loud alarm bell - I heard it and nurses came running in a panic when it went off.  At the time I was a jogger, and I got to looking at the alarm setting and saw that the alarm went off at 10 beats higher than his resting heart rate.  It doesn't take much effort to raise the heart rate 10 beats higher.  Just rolling over in bed should do it I imagine.  Was the heart rate monitor alarm and panicked nurses for show, I thought?    

    Later that afternoon a cardiologist stopped by, along with the nurse that seemed to have doubts.  He immediately recommends bypass surgery, scheduled for the next day.  I spoke up and said I have some questions for the doctor.  The nurse next to him seemed to perk up, smiled.  I didn't know enough of what to ask, other than the basic of "are you sure granddad needs bypass surgery?"  "are there alternative treatments, granddad is in his late 70s?"  I remember asking a few more questions, the last one being can the surgery be done with the heart still beating so that loss of blood to the brain does not occur?  I had read about what Fanatic Cook wrote about our former President a week ago in one of Whitaker's news letters.  The nurse by this point seemed to loose interest.  The doctor was smooth and reassuring in his answers.  Granddad spoke up and said he wanted the surgery, he was concerned.  And that sealed the deal.  

    He didn't get any rest all night as the heart rate alarm bell kept going off.  After the surgery there were no alarm bells.

  • Dr. William Davis

    6/21/2008 12:10:00 PM |

    Thank you for your sad story, though wonderfully told.

    Please clarify something: Where did the heart catheterization fit into this? This is always performed before any conversation about bypass surgery can proceed.

    If no catheterization was performed and bypass was recommended, then we've got a full-fledged scam on our hands, one worth investigating further.

  • Anonymous

    6/21/2008 12:30:00 PM |

    Events are fuzzy after 10 years, but I believe one of the tests done was catherization.  I remember a dye test was done to look for blockages.

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