AHA: Doctors don't have time for prevention

3. November 2006 William Davis (0)
Doctors "don't have enough time to educate their patients and to stop and think about what measures the patient really needs," says Dr. Raymond Gibbons, new head of the American Heart Association.

Dr. Gibbons highlighted how the system reimburses generously for performing procedures, but reimburses relatively little (often just a few dollars) for providing preventive counseling. He claims to have several ideas for solutions.

Good for Dr. Gibbons. There's no doubt that the lack of truly effective preventive information and counseling is a systemic, built-in flaw in the current medical environment. It is especially true in heart disease.

Another problem: "If a doctor didn't say it, it must not be true." That's the attitude of many of my colleagues. Despite their broad and systematic failure to provide preventive counseling, most physicians (my colleagues the cardiologists especially) pooh-pooh information that comes from other sources. Yet, it's my prediction that much of healthcare will go the way of optometry--direct access to care, often delivered in non-healthcare settings like a store or mall. People are hungry for truly self-empowering health information. Too many physicians can't or won't provide it. You've got to turn elsewhere for it.

That's one of the main reasons I set up the Track Your Plaque program. It's direct access to self-empowering information. A flaw: You still require the assistance of a physician to obtain lab values, lipoproteins, and to monitor certain treatments (e.g., niacin at higher doses). If I knew of a way around this, I'd tell you. But right now I don't. We remain constrained by legal and moral obligations.

Nonetheless, phenomena like CT heart scanning and the Track Your Plaque program are just a taste of things to come.
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Everything has omega-3

Everything has omega-3

8. November 2007 William Davis (5)
Walking the supermarket aisles, you may have lately noticed that numerous new products are appearing sporting "omega-3s" on the label.

Some products simply contain alpha-linolenic acid, a tiny amount of which is converted to the biologically active omega-3s, EPA and DHA. Natural Ovens' Brainy Bagel, for instance, carries a claim of "620 omega-3."



I find this confusing and misleading, since people will often interpret such a claim to mean that it contains 620 of EPA and DHA, similar to two capsules of standard fish oil (1000 mg capsules). Of course, it does NOT. I find this especially troublesome when people will actually stop or reduce their fish oil, since they've been misled into thinking that products like this bread contain active omega-3 fatty acids that yield all the benefits of the "real stuff."


Other products actually contain the omega-3, DHA, though usually in small quantities. Breyer's Smart with DHA is an example, with 32 mg DHA per container.


I find products with actual DHA (from algae) a more credible claim. However, the Center for Science in the Public Interest (CSPI) has looked at the actual contents of DHA in some of these products and found some discrepancies, including amounts of DHA less than the labeled amount and claims of omega-3 wihtout specifying DHA vs. linolenic acid. (It's probably linolenic acid, if it's not specified.)

All in all, the addition of DHA to food products is a nice way to boost your intake of this healthy omega-3. However, keep in mind that these are processed, often highly processed, foods and you will likely pay a premium for the little boost. For now, stick to fish oil, the real thing.

For a brief summary of the CSPI report and a link to the Nutrition Action Newsletter, see Omega-3 Madness: Fish Oil or Snake Oil.
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Comments (5) -

  • ethyl d

    11/8/2007 5:38:00 PM |

    I get really annoyed sometimes when grocery shopping by all the food manufacturers trying to manipulate us into buying their product by trumpeting whatever health angle they can get away with. "Only 100 calories!" "Good source of fiber!" "Low-fat!" Only 1g carb per serving!" "25% less sugar!" They sniff the air for whatever the latest health trend is and see how they can get their product modified a little while still remaining junk to cash in on the trend. They don't care about our health, they just want our money.

  • Michael

    11/8/2007 7:00:00 PM |

    There is one thing I am unsure about regarding all of the 'omega-3' products -- is it even healthy for men to use omega-3 products derived from non-fish (flax)? ALA has been shown to raise the risk of prostate cancer, although some studies also show other aspects of flax decreases the risk (making it all nice and confusing). I've also read, that for some people, who can't convert ALA to omega very well in their bodies,  flax can also raise inflammation levels.

    Should men even bother taking flax or products with  flax omega, at all? My own cardiologist pushes flax on me, oddly enough, even though I guzzle down plenty of fish oil. When I mention possible problems from flax, she basically drops the subject, leaving me in the dark as to why she suggested it in the first place.

  • Cindy Moore

    11/9/2007 4:21:00 AM |

    I saw a commercial for baby food with added DHA being marketed at helping your baby's brain development.

  • Carl

    11/10/2007 9:02:00 PM |

    I found this little article to contain very useful advice.  

    How to Eat - in Seven Words

    "Eat food," said Michael Pollan. "Not too much. Mostly plants."

    Seven words - short ones, no less, totaling eight syllables. Easy to spell, translate, or jot on a sticky note. But really, is that all that needs to be said?

    Pollan - a journalism professor at the University of California at Berkeley and author of the bestselling book The Omnivore's Dilemma - admits that boiling down advice on how human beings should eat to a mere seven words is dicey. A great deal, for example, depends on how one defines "food."

    But in a rousing presentation to a packed room of health professionals at the Fourth Annual Nutrition and Science Conference in San Diego, Calif., on May 2, 2007, Pollan argued that Americans have gone astray when it comes to thinking about food. While other cultures define food in terms of pleasure, sociability, religion or history, Americans are uniquely mesmerized by its scientific aspect.

    We are followers, Pollan said, of "nutritionism."

    "It is an ideology, a way of organizing experience," he said. "Like other 'isms' it rests on a simple set of assumptions, though we don't realize it." The connection between food, science, and health is "a real linkage," he said, "but it has overwhelmed all of the other linkages in our culture."

    Only in America, Pollan said, do people care more about food components - cholesterol, saturated fat, omega 3 oils, fiber and so on - than the foods themselves. And only in America can a low-fat craze grip the country, as it did from 1977 until 2002, to be displaced within a few months by a low-carb craze.

    The problem with nutritionism, Pollan said, is that it gives processed foods a huge advantage over whole foods. "A banana or potato cannot significantly change its structure. But any processed food can be changed overnight to correspond with food fads. You can even rejigger bread along Atkins lines." So the "loudest foods in the market" he said, are processed foods, touting their nutritional virtues via a $42 billion marketing industry, while "these poor whole foods just sit there silently."

    Thus, the irony: Americans are "a people obsessed with eating healthily, yet they are nonetheless very unhealthy."

    Nutrition science has value, Pollan said, but unbridled "nutritionism," pushed by processed food marketers has simply left people confused. In an attempt to simplify food, he came up with his seven-word, three-sentence manifesto, though he concedes that each sentence needs amplification:

    Eat food. The key term here, of course, is "food." We need to make hard distinctions between real food and "food-like products," Pollan said. Some guidelines:

    Don't eat food with more than five ingredients, or with ingredients you can't pronounce, or that contain high-fructose corn syrup (which serves as a 'marker' indicating that the food is highly processed).

    Eat only food that you have cooked, or could cook.

    Eat only food that your great, great grandmother would recognize as food.

    Not too much. The chief harm of nutritionism, Pollan said, is that processed food companies seize on "good nutrients" and "push us to eat more of them." The result is a tendency for Americans to eat more generally, which is one reason why we are consuming 300 calories more daily than in 1985. In the mass of verbiage surrounding food in America, plain overeating is "the elephant in the room." Pollan's advice to reverse the trend:

    Don't eat alone.

    Don't eat in front of the TV.

    Don't eat seconds.

    Perhaps most importantly, pay more and eat less. "I believe that the better quality food you eat, the less you need to feel satisfied."

    Mostly plants. "It's not that meat will kill you," he said. "I eat meat. Small amounts of meat have much to recommend them in terms of vitamins, minerals and taste. Most traditional diets - whether Mediterranean, Asian, Indian or Mexican, use meat sparingly, as a flavoring. I think that's an important lesson."

    By Brad Lemley
    DrWeil.com News

    http://www.drweil.com/drw/u/id/ART02840

  • Dr. Davis

    11/10/2007 11:20:00 PM |

    For anyone who has not read Michael Pollen's book, I would strongly urge you to read this logical and entertaining discussion that attempts to re-introduce rational thinking back into diet.

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"It must have been the statin"

"It must have been the statin"

13. December 2006 William Davis (0)
After four years of trying, Randy finally reduced her heart scan score. It not only dropped, it plummeted. After four previous scans that showed 25% or more increases, she'd finally dropped her score 23%. (I Blogged about Randy's case a few weeks ago.)

Randy also works for a cardiologist. When she told him that she had reversed her coronary plaque and reduced her heart scan score by 23%, he said, "It must have been the statin agent."

Randy was indeed on a statin drug at a low dose. But she also had taken great efforts in exercise, food choices, fish oil, and vitamin D. In fact, her score had progressed dramatically while she was taking the drug. Put simply, it was not the statin.

But that is the mindset of the conventionally thinking cardiologist. Stent, bypass, or statin drug--what else is there? Even with crystal clear evidence for coronary plaque regression, they refuse to acknowledge that tools that are not in their everyday consciousness could have achieved so spectacular a result.

Given a choice, 9 out of 10 cardiologists would rather put a stent in and walk away $2000 richer for an hour of work. Don't allow them to have this choice. Take control now.
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Heart scan curiosities 3

Heart scan curiosities 3

28. December 2006 William Davis (0)

Note the shape of the chest in this 64-year old man. The front of his chest (upper portion of scan) is concave. In other words, if you were looking at this man (shirtless, of course) face to face, his chest would bow inward, rather than the usual outward configuration. The official name for this is "pectus excavatum".





Compare this to the normal chest in the second image, in which the chest is convex. Face to face, the chest would bow slightly outward.















What does it matter? The pectus excavatum in and of itself has no importance, just a curiousity. (I personally find this surprising, given the fact that the heart actually appears squashed by the sternum, or chest wall.) However, it is commonly associated with a "floppy" mitral valve (also called mitral valve prolapse), a common congenital disorder of the mitral valve often accompanied by a slender build, loose joints, and even a nervous disposition. Occasionally, in its more severe forms, the aorta is also enlarged. (This man's aorta is not enlarged.)

So, while we can't actually visualize the mitral valve by a CT heart scan, we can surmise that he likely has a floppy mitral valve, is slender, is probably a nervous sort, and has long limbs with loose joints. He probably required braces as a child, since many people have a phenemenon of "crowded teeth". The roof of his mouth, or hard palate, probably unusually high up in the mouth. He probably has a "weak chin", meaning a less prominent protuberance of his chin. His fingers and toes are likely unusually long and slender.

It could mean that some attention and exploration of how floppy his mitral valve might be could be useful, e.g., an ultrasound or echocardiogram. He might even require oral antibiotics at the time of any oral or some gastrointestinal procedures, since floppy valve are more susceptible to blood infections when potentially "dirty" orifices are instrumented.

All that from a heart scan!
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The powerful forces preserving the status quo

The powerful forces preserving the status quo

31. January 2007 William Davis (1)

An interesting quote from the book, Critical Condition: How health care in American became big business--and bad medicine:


Politics and Profits

To protect its interests and expand its influence, the health care industrial complex has done what all successful special interests do: It's become a big donor and a high-powered lobby in Washington. In the last fifteen years, HMOs, insurers, pharmacuetical companies, hospital corporations, physicians, and other segments of the industry contributed $479 million to political campaigns--more than the energy industry ($315 million), commercial banks ($133 million), and big tobacco ($52 million). More telling is how much the health care industry spends on lobbying. It invests more than any other industry except one, according to the nonpartiisan Center for Responsive Politics. From 1997 to 2000, the most recent year for which complete data is available, the industry spent $734 million lobbying Congress and the executive branch. Only the finance, insurance, and real estate lobby exceeded that amount in the same period, with a ttoal of $823 million. In contrast, the defense industry spent $211 million--less than one-third of the health care expenditure.


These telling statistics indicate just how vigorously profit-seeking forces in heart care are trying to preserve the status quo. Hospitals want to protect their valuable procedure-driven enterprise, the pharmaceutical industry wants to protect its enormous though little-known niche of procedure-based medications (like $1200 a dose ReoPro), and the medical device industry wants to maintain the multi-billion dollar-generating machine aided and abetted by the FDA's 501k rule (that makes entry to market a breeze).

The current procedure based formula for heart disease profits so many and they are desperate to preserve it. Resistance to the deep-pocketed efforts of industry and hospitals will come from people like you and me, trying to propagate a better way.

Remember: hospital procedures for coronary disease represent the failure of prevention. They are not--any longer--successes in and of themselves.

Read a scathing insight into some of these practices by reading investigative journalists' Donald Barlett and James Steele's book, Critical Condition. I found their descriptions painfully accurate. (But don't get too angry! Remember: only optimists reverse their plaque! We need to turn the conversation in a positive direction, not just in this Blog or the Track Your Plaque website, but nationwide.)

One of the new missions for the www.cureality.com website is to help you understand just how powerful, insidious, shrewd, and pervasive the efforts to maintain the current system truly are.
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Comments (1) -

  • Anonymous

    2/6/2007 5:09:00 PM |

    I agree that the system is a mess. I am happy to see that you are not angry at the system, that serves no purpose and in my mind makes your position even more credible

    Don Howard

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The Paleo approach to meal frequency

The Paleo approach to meal frequency

24. November 2009 William Davis (12)
Furthering our discussion of postprandial (after-eating) phenomenona, including chylomicron and triglyceride "stacking" (Grazing is for cattle and Triglyceride and chylomicron stacking), here's a comment from the recent Palet Diet Newsletter on the closely related issue, meal timing and frequency:


We are currently in the process of compiling meal times and patterns in the worlds historically studied hunter-gatherers. If any single picture is beginning to emerge, it clearly is not three meals per day plus snacking ala the typical U.S. grazing pattern. Here are a few examples:

--The Ingalik Hunter Gatherers of Interior Alaska: 'As has been made clear, the principal meal and sometimes the only one of the day is eaten in the evening.'
--The Guayaki (Ache) Hunter Gatherers of Paraguay: 'It seems, however, that the evening meal is the most consistent of the day. This is understandable, since the day is generally spent hunting for food that will be eaten in the evening."
--The Kung Hunter Gatherers of Botswana. "Members move out of camp each day individually or in small groups to work through the surrounding range and return in the evening to pool the collected resources for the evening meal."
--Hawaiians, Tahitians, Fijians and other Oceanic peoples (pre-westernization). 'Typically, meals, as defined by Westerners, were consumed once or twice a day. . . Oliver (1989) described the main meal, usually freshly cooked, as generally eaten in the late afternoon after the day’s work was over."

The most consistent daily eating pattern that is beginning to emerge from the ethnographic literature in hunter-gatherers is that of a large single meal which was consumed in the late afternoon or evening. A midday meal or lunch was rarely or never consumed and a small breakfast (consisting of the remainders of the previous evening meal) was sometimes eaten. Some snacking may have occurred during daily gathering, however the bulk of the daily calories were taken in the late afternoon or evening. This pattern of eating could be described as intermittent fasting relative to the typical Western pattern, particularly when daily gathering or hunting were unsuccessful or marginal. There is wisdom in the ways of our hunter gatherer ancestors, and perhaps it is time to re-think three squares a day.


In other words, the notion of "grazing," or eating small meals or snacks throughout the day, is an unnatural situation. It is directly contrary to the evolutionarily more appropriate large meal followed by periods of no eating or small occasional meals.

I stress this point because I see that the notion of grazing has seized hold of many people's thinking. In my view, grazing is a destructive practice that is self-indulgent, unnecessary, and simply fulfills the perverse non-stop hunger impulse fueled by modern carbohydrate foods.

Eliminate wheat, cornstarch, and sugars and you will find that grazing is a repulsive impulse that equates with gorging.


The full-text of the Paleo Diet Newsletter can be obtained through www.ThePaleoDiet.com. You can also read and/or subscribe to the new Paleo Diet Blog, just launched in November, 2009.
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Comments (12) -

  • Kevin

    11/24/2009 3:18:05 PM |

    I can't rememeber exactly when but several years ago a melting glacier uncovered a 5000 year old man in the Pyranees area. He was dubbed 'Oetzi'.  Since he carried a bow and arrow and kit with seeds he was certainly a hunter-gatherer.   It's logical that he was hunting and carried seeds to sustain him during the day.  But he died of an arrow attack so possibly he was killed for the game he had found, or perhaps by a tribe mate wanting to move up the social ladder.  Who knows.  

    kevin

  • Adolfo David

    11/24/2009 4:10:24 PM |

    And what about 3-4 small high fat (Omega 6 free) low carbs (no glycemic) meals during the day? Its for example my case

  • KENNY10021

    11/24/2009 5:23:26 PM |

    Plus grazing would result in higher levels of digestive acid present in the stomach more often. More acid, more often.......This too is unhealthy...is it not?

  • Richard Nikoley

    11/24/2009 7:58:11 PM |

    Excellent data, doc.

    I rarely eat anything big during the day, and almost never before 10am. It's now 12:00 noon and I'll be headed for an intense workout at 12:30 lasting for 30 minutes and will include a lot of pushing weight around. I may eat a bit in the afternoon, but most probably will have a large meal this evening.

    This approach has worked wonders in terms of body comp and especially, hunger. I'm just almost never ravenous as I was with all the junk, which I think is the root cause of the grazing dysfunction.

    Also, note that it's probably far easier for them to keep their minds off food when they're busy hunting and gathering it.

  • UofMWolverine81

    11/24/2009 9:54:10 PM |

    ting caught up on what meal frequency or timing is "best" and shift the focus toward ensuring an adequate micro and macronutrient intake that supports your goals and lifestyle?

    If I am highly active and making quality food choices that fall in line with that activity level, it seems like there wouldn't be anything inherently wrong with eating 4-6 small meals/snacks per day .  That's not to say that 1 or 2 relatively larger meals wouldn't work as well, but I can't see there being much overall difference provided overall daily intake is roughly equivalent (if not the same) and and the focus is on undamaged fat sources, lean protein sources, plenty of vegetables, and a modest intake of fruit (especially things like berries).

    Some folks find that various styles of intermittent fasting work best for them when it comes to controlling intake, and others have found that a higher number of smaller feedings work better. So while I do not dispute the wisdom in observing patterns from various hunter-gatherers, I don't feel that mirroring their patterns is something that fits my lifestyle and individual tendencies.

    Of course I could be living with my head in the sand and the joke is on me, but I figured I'd just offer up my general thoughts.  I am far from being an expert on these issues.

    In any event, thank you for sharing this post, Dr. Davis.

  • Helen

    11/25/2009 12:21:24 AM |

    I'm against grazing (especially since it's usually crap that people graze on), but I do have a question about this.  I recently read that the rate of strokes increases during Ramadan, which mirrors this pattern - a large evening meal every day.  

    http://www.thaindian.com/newsportal/world-news/does-ramadan-fasting-increase-risk-of-stroke_10038409.html

    My father used to just eat one big meal a day at night.  He had a massive heart attack in his 50s.  He ate a lot of meat, butter, eggs, and bacon grease.  I doubt that all of that caused it - I think the primary cause was his two-pack-a-day unfiltered Camels habit.  But all of that didn't prevent it, either.

  • The Mick Solomons Experiment

    11/25/2009 1:59:47 AM |

    I've found going down to 2 main meals a day, and only eating between 11am and 6pm that my body fat has dropped considerably.  

    I was stuck on about 70kgs for 12 months after starting a high fat, low carb diet, since I've started IF I've dropped nearly a kg of body fat a week for the past 6 weeks (you can see photos on my blog) And I know its body fat because I'm maintaining and even increasing the amount of weight i'm lifting at the gym.

    I also feel great too Smile

  • Kathryn

    11/25/2009 2:44:44 AM |

    Then, why the insistence, heard over & over that breakfast is so important?  My body just doesn't seem to want something early in the day, & i've been trying to trust instinct.  But then i wonder if it is just a habit i've gotten into?  

    I'm not eating a lot of calories & i eat no wheat (on rare occasion i break this, but have been 95% gluten-free for about 4 years or more).  But no weight loss.  I sometimes wonder if it is because i'm resistant to having breakfast.  

    I really don't understand.

  • PERKDOUG

    11/25/2009 4:18:43 PM |

    I borrow here from the Diabetes community. Blood sugar spikes may be the root cause of or a major contributor to Type 2 diabetes. The bigger the meal the bigger the spike. Most of us that have endured the SAD for most of our lives are well on our way to Type 2 (in my opinion) even after taking to the Low Carb WOE. Thus we are damaged goods and probably would be well advised that if we eat fewer meals per day, we should test the effects on our blood sugar. I do this. Blood meters are dirt cheap. Low carbing no doubt helps but does not assure "no spikes".

  • Methuselah

    12/3/2009 2:16:43 PM |

    Kathryn, the answer to your question "then why the insistence" is because the people who are doing the insisting are basing their advice on little or no real evidence, just pseudo science and old-wivery. Don't confuse exposure with validity. Bad ideas very often get more air time than good ones and the world of medicine and nutrition is rich with examples.

  • buy jeans

    11/3/2010 6:40:00 PM |

    I stress this point because I see that the notion of grazing has seized hold of many people's thinking. In my view, grazing is a destructive practice that is self-indulgent, unnecessary, and simply fulfills the perverse non-stop hunger impulse fueled by modern carbohydrate foods.

  • mike

    5/29/2012 7:35:12 PM |

    If the typical hunter-gatherer tribe eats only once a day and if humans can only absorb around 35g of protein at one time, this would mean that even H-Gs eating very high protein diets would ACTUALLY be on very low protein diets. This is huge no?

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