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 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.

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