Barriers to Heart Disease Prevention

Image Credit: Williams / Flickr. This image has been modified.

Why Don’t More Doctors Practice Prevention?

Why don’t more doctors practice preventive cardiology? Time availability is a reason frequently cited by physicians, but if you probe a little deeper, the number one reason given was their perception that patients fear being deprived of all the junk they’re eating. Can you imagine a doctor saying, “I’d like to tell my patients to stop smoking, but I know how much they love it”?

Changes in diet to reduce cholesterol levels are often assumed to result in reductions in quality of life. Do we get to live longer or is it just going to feel longer? Contrary to popular belief, studies have found  no apparent reduction, but rather an improvement, in some measures of quality of life and patient satisfaction using  nutrition therapy as opposed to drugs for high cholesterol. Whereas people taking cholesterol-lowering drugs don’t feel any different, studies have found that those using dietary changes reported significantly better health and satisfaction, and better life in general. More positive feelings and fewer negative. In the Family Heart Study, for example, those placed on a cholesterol lowering diet showed significantly greater improvements in depression as well as a reduction in aggressive hostility.

Another barrier to preventive cardiology is that doctors don’t realize how powerful dietary changes can be. The importance of diet for patients’ health remains underestimated by doctors. Even the new drug-centered cholesterol guidelines emphasize that lifestyle modification should be the foundation for the reduction of atherosclerotic cardiovascular disease risk. Despite this, more than half of physicians may skip over lifestyle change completely and jump straight to their prescription pad, doubting that cholesterol goals can be reached with lifestyle changes alone.

According to the Director of the famous Framingham Heart Study (highlighted in my video, Barriers to Heart Disease Prevention), the best way to manage coronary artery disease is to lower patients’ LDL cholesterol and other atherosclerosis-causing particles. “You can achieve this with diet plus drugs, but if you can do it with a vegetarian diet, it works even better.” In the Framingham Heart Study, those running in the Boston Marathon achieved the goal of getting their total to good cholesterol ratio under four, but the vegetarians did even better.

And if you go all out, putting people on a very high fiber, whole-food vegetable, fruit, and nut diet, you can get a 25 percent drop in the bad to good cholesterol ratio within one week and a 33 percent drop in LDL. That’s the cholesterol-reduction equivalent to a therapeutic dose of a cholesterol-lowering statin drug.

Dr. Ornish talks about how diet can be more sustainable than drugs, since compliance is more based on love-of-life rather than fear-of-death. See his editorial in Convergence of Evidence.

More on how lifestyle medicine is not only safer, and cheaper, but more effective:

Many physicians just weren’t taught the power of diet:

But there have been cases of the medical profession actively seeking to limit further nutrition training. See my series about a bill in California:

Why not take drugs every day for the rest of our lives instead of using dietary change? That’s the question I ask in my video Fast Food: Do You Want Fries With That Lipitor? Plus, drugs may not be effective as we think. Check out: Why Prevention is Worth a Ton of Cure. Not only is that not treating the root cause, but there are potentially serious drug side-effects. See, for example, Statin Muscle Toxicity and Statin Cholesterol Drugs and Invasive Breast Cancer.

In health,
Michael Greger, M.D.

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


Michael Greger M.D., FACLM

Michael Greger, M.D. FACLM, is a physician, New York Times bestselling author, and internationally recognized professional speaker on a number of important public health issues. Dr. Greger has lectured at the Conference on World Affairs, the National Institutes of Health, and the International Bird Flu Summit, testified before Congress, appeared on The Dr. Oz Show and The Colbert Report, and was invited as an expert witness in defense of Oprah Winfrey at the infamous "meat defamation" trial.

100 responses to “Why Don’t More Doctors Practice Prevention?

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  1. Hmm, right above the box where I’m typing, there’s an ad, and it’s for “skinny pills” supposedly hawked by Dr. Oz, what’s going on on my favorite dot org?

      1. Is that how it would work? I have never seen any ads on NutrtiionFacts before todayand I come here almost daily for years. I don’t believe I’ve opened any suspicious emails. I browse exclusively from my Android tablet, which its my understanding doesn’t get viruses.. Other people, are you seeing these ads? Have you seen them before?

    1. The ads were a problem with Disqus and should be gone now. Thank you all for telling us what was going on!! Please let us know if you ever see something fishy on NutritionFacts and we will look into it right away. Keeping a clean, ad-free site- and one that is open to respectful discussion and debate- is a top priority!

    2. Are you watching on youtube or one of the other video sites where videos are posted? There are no ads on, and NF has no control over what google or other site owenrs allow for ads.

    3. Back before I divorced myself from Microsoft I got malware ads, even on my Chromebook, which doesn’t get viruses. My virus software had gone old and I never used that computer any more, so I got a cloud ready printer, unplugged my old laptop, and bwalah! No more Microsoft! No more malware ads! Sweet…

  2. Off topic, but for anyone interested in how America cooks up its national food policy, this article in Politico by Marion Nestle on US farm bill politics lifts the flap: Spoiler alert: It’s like sausage-making, but worse–and the results just about as healthy for the body and the body politic.

    1. Her book Food Politics is really good. Another book along those lines is Appetite for Profit by Michele Simon. Really good and goes behind the scenes of food policy.

  3. I so agree! I am shocked about the ad and super sad. was my little haven, the honest place to go to and now ads of the worst kind. So disapointing.

      1. Dr. Dave: It is a disqus problem that is coming and going. The ads are a mistake from disqus and NF staff are working on it. NF staff says: “Regarding ads on the site, we should *NEVER* have ads on the site… Our web developer is fighting with Disqus for their third ‘accidental’ advertising stint on the site in a week.”

    1. Regina: The ads are a mistake from disqus and NF staff are working on it. NF staff says: “Regarding ads on the site, we should *NEVER* have ads on the site… Our web developer is fighting with Disqus for their third ‘accidental’ advertising stint on the site in a week.”

    1. This is something that Disqus is doing, not I have gotten so good at ignoring ads like this that I didn’t even see it until I read your comment.

      1. Well, they were never there before.But that makes sense that it might be coming from Disqus, tho there are no ads on the Disqus site that I can see. Well, this is not good for, and that’s what I care about, if Disqus is doing this, there must be a way to do without Disqus. It makes NutrtionFacts look bad.

        1. This is the third day I see an ad and the second day in a row.. must be paying Disque for their services, so should be able to choose between ads or no ads.

          1. George: : The ads are a mistake from disqus and NF staff are working on it. NF staff says: “Regarding ads on the site, we should *NEVER* have ads on the site… Our web developer is fighting with Disqus for their third ‘accidental’ advertising stint on the site in a week.”

    2. Konakci: : The ads are a mistake from disqus and NF staff are working on it. NF staff says: “Regarding ads on the site, we should *NEVER* have ads on the site… Our web developer is fighting with Disqus for their third ‘accidental’ advertising stint on the site in a week.”

  4. Speaking of preventive cardiologists… I’m reading “The Whole Heart Solution” by vegan cardiologist Dr. Joel Kahn. This well written book is loaded with tips on living a healthful lifestyle. I think this would be an excellent “how to get started” guide for someone new to plant based eating and healthy living.

    1. I read Prevent and Reverse Heart Disease by Dr. Caldwell Esselstyn who was one of the doctors with Bill Clinton’s change to plant-based-diet. He was on Forks Over Knives and his story of starting the heart program at Cleveland Clinic and the resistance with the powers that be at CC is fascinating. I’ve been doing the plant based lifestyle since the day after The China Study was released. Was strict vegan for a few years before that and vegetarian since college so don’t have any health problems except genetic thyroid disease but read Esselstyn’s book just for the preventive material. It’s a great read. He and Dr. Campbell are buddies.

  5. Hi everyone,

    Thanks so much for your concern and comments about the ads. You are all correct that there are NOT supposed to be ads on NutritionFacts. This is a problem we have had once before with Disqus and we are actively working on it right now.

    Thanks again for all your help keeping our website clean! Please let us know anytime you see something of concern.

  6. Despite the presence of the American College of Lifestyle Medicine and the Institute of Lifestyle Medicine, lifestyle medicine as a specialty seems out of reach for patients. Try Googling “lifestyle medicine” in your area and your are likely to come up dry. The American College of Lifestyle Medicine has a “find a doc” service. For the entire metro Denver/Boulder Colorado area, there were only four listings: one a $69 medication-free sleep audio tape (free shipping), one an ob-gyn who has retired, one in an occupational medicine practice and one in a family medicine practice whose website has no mention of lifestyle medicine.

    Is there anybody who has some guidance on how to find a doc who practices lifestyle medicine?

    1. Am kind of curious why those of us who know about the power of lifestyle medicine even need doctors, though, at least in so far as with making such changes to our lifestyle. Surely we can look into these things and make changes on our own, no doctor required. Or am I missing something?

      If you’re thinking more for other people’s sake, that everyone going to any doctor (especially for issues pertaining to heart disease, diabetes, etc.) should be told about lifestyle medicine, then I agree; we have a big problem here. Most patients are going to the hospital and trusting that their doctors are giving them the best information available, and this is not the case.

      1. Kim, I mean for me. And I’m a trained nutritionist and long-time vegan. I’d put myself near the top in understanding and practicing healthy vegan eating. But I am not immune to illness and injury. Lifestyle medicine not the same as healthy eating or healthy living. I want a doctor who coaches and looks to lifestyle and natural remedies first, but understands modern medicine. If I acquired one of those flesh-eating infections, the last person I would go to is a nutritionist. But I would expect my doc to attend to my gut flora as they blasted the bad bugs.

      2. There really needs to be a balance between lifestyle and traditional medicine. If lifestyle changes were to happen earlier in one’s life, the likelihood of needing a doctor would certainly be decreased, see Dr. Greger video from a few years ago, An apple a day. In

        Dr. Esselstyn’s study

        , his patients remained on cholesterol lowering medications. However, I don’t believe the medical community at large, is aware of the power of food as medicine and lifestyle medicine. I would guess, the few physicians that practice lifestyle medicine are sought out by patients who already believe in the power of lifestyle medicine. I think there are more and more physicians becoming aware of lifestyle medicine. I have been a dietitian for 20 years and I am slowly starting to see more physicians open to lifestyle medicine. Hopefully this trend will continue.

    2. I have tried as well along with a couple of friends and we’ve all come up empty. The closest for me is at the True North Center in Santa Rosa but that’s over an hour away and they don’t take medical insurance. One friend lies in NYC and her closest is an hour by train then cab ride. So we just rely on books Dr. Greger and the internet eating healthy for preventive medicine.

    3. Hi Steve, great question. I would check with the Institute for Functional Medicine. They have a robust training program that I personally have completed which focuses exclusively on lifestyle medicine. They have a “find a practitioner” button on the home page. Depending on where you are there may be many in your area or not so many but more and more practitioners are getting on board every day. I would always give this disclaimer: as with a search for any healthcare provider you should do your due diligence in terms of understanding if a particular practitioner can and will meet your needs. In order to be listed on their website you must complete their training which took me 2 years to complete. However what a practitioner does once they complete the program is up to them so make sure you ask questions.

  7. The one thing wfpb diet can’t cure is severe cystic acne. Trust me, you can’t just say “don’t eat overt fats” or “food sensitivity” or “Nina and Randa tho”. For people like me with horrible acne, accutane is the only answer. Maybe it could be prevented through diet, but certainly not treated for people like me. Some people want to bash modern medicine, but for people like me, accutane was a LIFE SAVER.

    1. Zac, it isn’t the use of drugs per se, but the overuse, some might say abuse of them, as the first line of treatment before trying other safer options or actually getting to the cause. There are exceptions to everything, but trying to find the solution to the problem instead of treating the symptoms is the goal. As you make clear, that isn’t always possible, but no one has a shortage of accutane, there is something else going on. We do what we can, but it’s the overall mentality of a pill for every symptom that cheats people from fixing the underlying issues, and stunts investigations into the causes. Of course the pharmaceutical model is much more profitable, so unlikely to happen anytime soon!

    2. I thought my problem was wheat, but a WFPBNO diet seems to be working for me. Whenever I “slip” and eat something fatty, the problem returns….

    3. I did a lot of reading on leaky gut in order to clear mine up. I had cystic acne for years even after changing to a WFPB diet. If anything, eating plant based made it worse. Turns out that both nightshade vegetables and wheat give me terrible acne as well as seasonal allergies and sinus pain. I cut them both out for a whole year in order to heal my gut and then I slowly reintroduced them. They still cause me issues if I eat them in excess but nothing like what it used to be. I’m not sure what your Acutane experience has been like but in the event that you wanted to try getting off it, I’d HIGHLY suggest an elimination diet. I’m not saying that this is for sure your issue and perhaps you have already tried doing one, but I just thought I’d throw it out there. Although I’m not a fan of and would not ordinarily promote mono-diets, eating nothing but one non-triggering food like rice or bananas or sweet potatoes for a few days or so is an excellent tool to verify that your issue is diet-related. If your acne begins to diminish, you know it’s being caused by something in your diet and you can slowly reintroduce foods until you find the trigger. If you see no difference, you know it’s not your diet and you can move on and look elsewhere for solutions.

  8. My doctor recently suggested I start taking statins. I said no, how about low dose aspirin. He said no, low dose aspirin doesn’t provide the same benefits as statins. Then he said, the only thing that provides the same benefits as statins is the Dean Ornish diet. And I’m thinking, why didn’t you suggest the Dean Ornish diet in the first place.

  9. I recall very limited nutrition training in medical school. I actually spent the next 40 years learning about nutrition based upon my own recognition of its importance, but the learning curve was steep especially with the amount of misinformation promulgated by the various food councils and drug companies, as well as the extremely poor quality of food presented in the hospitals in which I worked: essentially, I would not eat hospital food but the patients are stuck. No matter how much education the nutritionists and I provided for inpatients much of our work was being undone by the hospital kitchens and their own families who brought in junk food. The television image of health care also does not help with most shows fixing people with medicine or surgery with no hard work expected from patients and they families. Extreme diets and fad foods as well as fad supplements also cause much harm. A healthful diet does not require a “colon cleanse” which is just another way of ripping off the public. I am really thankful to Dr Greger and staff for this site and Dr Greger’s book How Not to Die.

    1. Hi Robert,

      I also received little nutrition training in medical school and I’m so grateful for Dr. Greger and this website. I do think (hope!) that change is coming, although at a painfully slow rate. Hospitals, at least in my area, have banned sugary drinks including soda, energy drinks and sweetened tea and coffee and have gotten rid of their deep fryers. Not exactly cutting edge nutritional ideas, but still progress! They were certainly selling a lot of these items, so being willing to take a financial hit to promote nutrition is laudable. I just hope that we can all encourage more change in this direction!

      1. I am just amazed that hospitals have been so slow to change, but hopefully, more individual physicians, like yourself, will initiate change themselves and be good role models for their own patients.

        1. When I was working in a hospital about 20 years ago, there was a demand for “healthier meals”. So we added a lean cuisine option to the cafeteria line up. You can imagine what happened. The lean cuisine option was placed side by side to the chicken fingers and fries. Guess what people chose? (the chicken finger and fries). However, I spent some time in the hospital recently and when I visited the cafeteria, I was pleasantly surprised at the number of plant based options there were. I think change is coming.. albeit slow… I think it is slowly moving in the right direction.

          1. That’s great. People staying or visiting the hospital are a captured audience, and hospitals need to set an example by providing only healthful food, showing that junk is not an option. Furthermore, considering that the cost of daily room & board in a hospital costs more than many 5 star hotels, the food should reflect 5 star quality.

  10. I have been a healthcare professional for over 40 years. My experience is as you identified, physicians obtain information about the research regarding diet and do not integrate it into their practice for a whole range of reasons. I would argue our current healthcare system does not support integration of diet and lifestyle change into physician practice. The culture is one of get the patient in and out, give a Rx, and go it alone. We need a culture change that encourages physicians to take time with patients more than 10 mins, use Rx as last intervention not the first, and pay for lifestyle education by other healthcare professionals.

    1. Robin, in my experience my colleagues don’t even bother reading the diet research and remain ignorant on the subject. I agree with your assessment completely!

  11. A lot of people don’t want to change their diet even when faced with serious health issues. You can show them clear evidence that changing their diet & lifestyle works better than drugs and they’ll just look at you and say “Isn’t there just a pill I can take?”.

  12. Hi Dr. Greger,
    I’m an active 53 year old, weigh 118 lbs., workout 5 days a week and have been committed to changing my life for the past 2-1/2 years. I’ve concentrated on my diet eating a Dr. Perlmutter diet (I’m reading your book now)
    Is it possible for me to reverse Hashimotos disease/vitiligo and my thyroid disease by going to a plant base diet? I take synthroid and lyothyroinine everyday, I wish I did not have to!! Thank you for any help and advice you can give to me.

    1. Hashimotos and vitiligo are both autoimmune diseases. Much of conventional medicine treats these diseases as an “over active” immune system. In integrative/lifestyle medicine we usually attribute it to increased intestinal permeability also known as “leaky gut”. Essentially the cells of intestinal lining break down due to injury or inflammation and large proteins from foods that would not normally pass through the gut wall are able to get through. Once the proteins get through they are exposed to the immune system. The immune system views those proteins as foreign and forms antibodies against them. There are cases where the foreign protein looks structurally similar to the patients own native proteins and through a process known as molecular mimicry the immune system begins to “mistakenly” attack the persons own tissue. In my experience healing the gut is helpful in preventing the process from continuing and having the person go on to develop other autoimmune diseases. But reversing the damage that’s already been done can be difficult since the immune system has already made antibodies and has started damaging thyroid tissue. I have treated many Hashimotos patients and even after getting their antibody levels down, have only had one patient that no longer needed thyroid hormone replacement. No matter what eating a more healthy diet can’t hurt and definitely can help repair a damaged gut lining. Here is a video where Dr G touches on the subject of fruits and vegetables helping to keep the gut lining healthy. Hope that helps.

    2. I am sorry you have to deal with Hashimoto’s! I commend you for taking your health into your own hands!! Dr. Perlmutter deals mainly with gluten, which looks like it may have a role in

      gluten sensitivity and inflammation. However, the best diet for

      inflammation is a plant based diet, as it is high in antioxidants, which protects against inflammation. Many autoimmune conditions,

      rheumatoid arthritis, lupus,

      IGA neprhopathy, an many more, have been treated with WFPB diet. Reversing the disease is questionable, but treating it and keeping flares to a minimum is possible with a diet rich in antioxidants and anti-inflammatory foods. Hope this helps!

  13. all this theory is based mainly on one good forgotten book of Arnold Ehret – mucusless diet healing system? with good and detailed explonations.

    1. No, it’s based on one well researched and documented book, “The China Study” by Dr. Colin Campbell. As a result of his work and the work of many physicians and researchers we know that animal products are bad for us.

  14. My cholesterol was 297 before going vegan, even though I was thin and just ate things like salmon, dairy, veggies, bread and fruit! My latest reading was 207! It had crept back up to 243 even on a vegan diet. But surprisingly, limiting saturated fat to just 1 tablespoon of flax per day and 1 tablespoon of nut butter (most days) did it!

      1. Thanks so much! I was surprised that cutting back on nuts and seeds actually helped, but I was really going overboard on them and it turned out, adding in whole grains like oatmeal and quinoa (and more beans) was better than going nuts over nuts!

  15. I am tremendous fan of Dr. Greger’s excellent nutrition facts and I among the few MD’s who practice preventive medicine. While a plant based diet has tremendous benefits, depending on diet alone has a significant failure rate, almost regardless of which diet one chooses. Most of my long term successes have been from diet supported by appetite suppression (resulting from better exercise, better sleep, and education about food substitution – and medications ).

  16. EEE — I believe that doctors generally get a bum rap. They probably know quite a bit about nutrition, learned as we have learned over the years, but are responsive to the “demand for a cure” from patients who simply don’t want to hear about steps they need to take to improve their lives and overall well being. And, of course, the whole medical establishment responds to this “free market” approach — “Here’s a pill to cure your malady.” Love your work!

    1. No, as a doctor I can assure you we know almost nothing about medical nutrition. Prior to my stumbling upon a WFPBD I was eating a very “healthy” American diet with at least 40% of my calories coming from low fat dairy! My family was sick and I could not help them despite all my years of medical training. Changed the whole family to WFPBD and viola! no one has had any significant illness in 6 years! (kidney stones, familial colon polyps, recurrent ear infections and chest pains just a few of the cured family ailments)

      When I treated patients using pills and surgery by the thousands each year I was touted as the best doctor in the area. Now that I preach diet and lifestyle change as the first step, I have been called a wacko and fraud by some. Indeed, most of my regular patients do not want to hear about any changes needing to be made. Slowly I am building a reputation as a lifestyle doctor and those patients that come in are such a pleasure to treat. Most I only have to see once or twice and often they call back months later to say the improvement in total health has been miraculous! Let food be thy medicine!

  17. I have a great passion for cars, especially Mustangs. I spend considerable time on a Shelby GT350 forum, a vehicle which I was fortunate enough to have recently acquired. A few days ago the topic of comfort came up, specifically with regard to the Recaro seats. Several members complained that the seats are too confining and in some cases painful. I, on the other hand, find them extremely comfortable. As the discussion proceeded I began calculating the BMI’s of those who complained. They ranged from 28 to 40. I identified myself as a physician, BMI 21.5, and suggested maybe the fact that they are not comfortable in a world-class sports car they just paid $65,000 for might serve as a wakeup call to institute some lifestyle changes. Well, suffice to say my unsolicited suggestion was not warmly received. Several said such a comment was offensive. I won’t make that mistake again.

    1. Haha. Good on ya. People do not like being told it’s their fault. It’s the same when I was speaking to some friends and family about veganism; the implication that they are not compassionate or not animal loving etc did not go down well. And when I said that their argument is not with me but with themselves, regarding the enslavement, commodification and murder of sentient being purely to satisfy their tastes, well, all hell broke loose. People either get it or they don’t. I didn’t get it for years, even when I no longer consumed animal products. We can only control ourselves. And simply try to help those we love… even if they don’t want to hear it. This applies to both nutrition and animal rights.

  18. So when a patient tells their overweight cardiologist they are eating a plant based diet and the doctor says that is too extreme, we know we have a big problem. Doctors not recommend to patients anything they are not willing to do themselves. If only we could get them to at least be supportive of patients with more advanced understanding of food as medicine.

  19. Kaiser Permanente did a study and they found physicians are more likely to talk to their patients about a healthy lifestyle if they themselves were living one! Sometimes MD are reluctant to tell people to do what they aren’t doing!

    1. So true! I certainly talk more about nutrition and diet with my patients now than I did before I changed to a WFPB diet. It’s always easier to talk about something you have personal experience with. Especially when patients have questions, and good ones!, about diet change- “How could I make a dessert without eggs?? What if my friends are getting pizza? But what do you actually EAT???” It’s so much easier to answer these type of questions if you have actually made such changes yourself.

      Hopefully more physicians will see the power of plants in their own lives and then share their experience with others!

  20. I voraciously read How Not to Die and immediately converted to a WFPB diet. For a variety of reasons I was ready for a change. I always considered myself healthy (although after reading I knew that was a misconception), but my cholesterol had slowly been elevating to finally a 237 at my last test.

    I was just re-tested as part of an annual physical. My dr. was very excited about my lifestyle change, but forewarned me that while I likely won’t see big results in just 7 weeks, we could test it again in 6 mos and will very likely see an impact.

    I just received my results after only 7 weeks and my total cholesterol dropped from 237 to 147! I am AMAZED! Both my LDLs and triglycerides, which had previously been elevated, are totally now in healthy range.

    Tomorrow is my 2-month anniversary of converting to this diet. I also just turned 43. I have never felt happier and healthier in my life. I’m just thrilled with my results and so grateful for Dr. Greger’s passion and commitment to sharing this information with the world, and me. Thank you, thank you, thank you!

    1. Congratulations!!! That is an amazing change in such a short time. Keep us posted on how your plant-based journey goes. We’re here if you have questions or just want to share more of your success!

      1. Bravo on your lifestyle change. May you live a long, prosperous healthy life. I hand out at least 15 “daily dozen” summaries from How Not to Die each day to my patients and hope that they have the fortitude to convert. Keep up the good work!

  21. I wonder if some doctors want to push lifestyle changes but administrators or leaders within the practice don’t understand so won’t let them. IS an old guard in the medical community a problem with gaining acceptance of lifestyle medicine?

  22. of course a diet alone subscription for preventing cardiology problems is only one part of the solution. Many studies show that exercise combined with dietary changes can help significantly reduce the severity of heart disease and even reverse the damage to cardiac health. Yes its a good question why doctors then don’t subscribe exercise and diet changes more often to their patients? The thorny subject of pharma links to subscriptions might be a factor. Also often there is a limited window of time available to doctors on a patient visit and maybe a lack of confidence in the impact of non-drug based recommendations which may seem to have strayed from the traditional approach…However globally the levels of heart disease is on the up and exercise and dietary recommendations can only help improve peoples health.

  23. Not a lot of money to be made in prevention… Not saying doctors themselves (though there certainly are some bad ones out there) are the culprits, but just that they seem to be trained in working for big pharma, etc. The medical industry isn’t exactly with Hippocrates had in mind.

    1. It is not that doctors are withholding the “golden ticket”. They themselves do not know that truth. I was shocked to find the connection of diet and ENT problems 6 years ago, 14 years after graduating from medical school. I found it on my own through internet research. I felt I had been cheated in medical school and residency. But prevention is not a money maker so I think it will be a long time before the change is made. We should be teaching this in primary schools not waiting until the doctors office. It is late in the game once people have developed a palate for foods that cause disease as they are addictive and a hard habit for many to stop. Too many people are very happy with the status quo: big pharma, medical providers, and patients themselves. I tell my patients I will keep working until everyone is so healthy they no longer need me. To me, that would be the greatest day!

      1. I couldn’t agree more HeidiH! And absolutely, I realize it isn’t the doctors withholding this information. I have to say though, you sound like an incredible doctor!

  24. I have two friends who had similar comments about my plant based lifestyle. One said ‘I eat for enjoyment’ and the other ‘I enjoy food too much’. Their perception is that my way of eating is not enjoyable. I tell them it is enjoyable for me, but they don’t believe that it would be for them. I think that the Doctors have a valid argument, some people think they will be deprived if they switch to a plant based lifestyle. It is not so easy to convince some people.

  25. 1. Medical schools don’t teach prevention. Just ask my daughter relatively recently graduated.
    2. Drug companies hate prevention. $$$ loss.
    3. Fee for Service hates prevention, deprives them of $$$. Example Cleveland Clinic and Dr. Esselstyn who was let go because he was reducing the heart surgeons business, and they refused to join the bandwagon.
    4. Some people won’t quit no matter what, example smokers.
    5. Late results, if Doctors actually do advise people to lose weight, some do.
    6. My attitude, First Doctors should educate people on prevention example colon cancer, breast cancer, heart disease, diabetes, …
    7. Then Doctors should say if you don’t want to do prevention there are some Fee for Service procedures that might help, and some Drugs with side effects that might help.
    8. Total fly in the ointment, I think 90% (or more) of the nutrition programs are bunk. My opinion.
    9. We eased into healthy foods with “The China Study” by Cornell nutritional biochemist prof. T. Colin Campbell. That’s a history of his life’s scientific research which is fine for us technical types (engineer, programmer).
    So what small % of us eat primarily veggies, fruits, seeds (nuts, peas, beans, whole grains) like scientist Jane Goodall points out our digestive tracts are intended for? Do we really have teeth like a wolf? Short carnivore digestive tracts to get rid of the animal food before it putrefies? And no animal eats milk after they’re grown, especially from another species see “The Breast Cancer Prevention Program” by prof. Jane Plat (Amazon, etc.)

    1. Just follow the money.

      No truer words ever spoke.. . When I did not understand what was going on in the hospital I worked at, that motto usually gave me the answer..

      I think we should do what the ancient Chinese did.. PAY DOCTORS TO KEEP YOU HEALTY!! and STOP paying when you get sick… What a concept!!
      Change the money motivation from “sick care” (it’s not really healthcare, right?) to keeping people healthy…

  26. It’s interesting that we elevate these people that are referred as being medical doctors as if they have all the answers. The reality is that their life expectancy is significantly lower than our average population’s life expectancy. Their quality of life in regards to their health fares no better. Let’s face it…doctors know less about health than I would suspect most health novices that follow NutritionFacts,org. on a regular basis. I’m not speaking about medical terminology, drugs, medical technology, and all that which falls into field of medicine. I’m relating this to practical solutions for health problems with the heart, pancreas, liver, kidneys, etc. Let’s quit the lunacy of trying to persuade these doctors to become something that they aren’t and don’t want to be. If we do this, they will follow and perhaps actually become doctors we can trust.

  27. Re the comment in this article: “Can you imagine a doctor saying, “I’d like to tell my patients to stop smoking, but I know how much they love it”? I can easily imagine heart specialists saying this- I’ve had cardiac care in the last few months, and realized that these Doctors are devoted to love. The love concepts that we have, whether our bodis’ love for something, or our souls, are not dictated to nor neglected. These specialists are very open minded,and although it is also their work to suggest better intake than smoke, they don’t dismiss emotional needs.

  28. Re: Lipitor. I was told that there is a condition where a persons’ genetic makeup allows the liver to produce its own fat tissue. I have wondered where middle age spread came from, having been on a low cholesterol diet since age 28, and vegetarian longer than that. I asked for Lipitor a second time, to see whether it improved anything in that respect. Our Doctors don’t pill-push anymore and they (fortunately) are joyous bout well foods and lifestyle. It is inspiring.

  29. Anyone who has benefited from Dr. Greger’s work SHOULD help to spread his work by clicking on the FaceBook icon that will share his articles with all of your associates on FaceBook. We need to change the way this country and the rest of the world views health and food. The revolution can only start with us, “who know about foods for medicine”. Just one man, Dr Greger cannot do it by himself. If you ARE relying on Dr. Greger by himself to change the medical establishment and inform the American people, it will never happen. He needs an army of people like all of you who make comments in this section to SPREAD THE WORD. Times a wastin’….now go click away and spread these articles to your family and friends on the internet.

  30. I am a PA in a rural setting. I talk to my patients ALL the time about dietary changes to prevent/improve/reverse their diabetes, CVD, etc. I give them 3 months (sometimes longer if they are making an effort) to improve before medication–most don’t. That’s the truth. I am not afraid to discuss diet, but it seems to me that patients don’t want to initiate dietary changes.

    1. Thanks for all of your hard work, Molly. I know how frustrating it is when patients don’t seem to implement the advice we give. Keep up the good work!

    2. Bravo, Molly! I am an ENT physician and have also been talking to my patients about diet and lifestyle for 6 years. I agree that most do not want to make the change. I am not afraid to discuss diet either but the backlash has been tremendous. I had a recent online review that stated I am afraid to use medication, do not make my patients better and am no longer a doctor but a homeopath. I often ask myself what I am even still doing in this field! It seems that I am expected to be a disease care provider only and not a healthcare provider.

      I have sent our local primary cares literature from our Academy journal that miraculously had a study on ENT and GI complaints being dairy caused in more than half the subject (Food hypersensitivity and otolaryngologic conditions in young children. Paddack A, et al. Otolaryngol Head Neck Surg. 2012.), but still the pediatricians are furious when I take patients off dairy for a trial to see if ears and/or tonsils get better. One pediatrician has called me a wacko. Well, his patients get better in my care, so let the name-calling continue if it must.

      **Interesting side note. This article is not easy to find when Googled. You almost have to know it is out there to find it. And note that they did not use the word “dairy” in the title yet dairy was the only thing that was removed from the diet. Yes, we must never offend the food industry even when it is their product adding to sickness.

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