According to the Director of the famous Framingham Heart Study, the best way to manage cholesterol and heart disease risk is with a more plant-based diet. Why then, don’t more doctors advise their patients to change their diets?
Barriers to Heart Disease Prevention
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Why don’t more doctors practice preventive cardiology? Available time is a reason frequently cited by physicians, but if you probe a little deeper, yes they complain about not having enough time to give their patients dietary advice, but 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, “Yeah, 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, but do we get to live longer or is it just going to feel longer? But contrary to popular belief, this study found no apparent reduction but rather an improvement in some measures of quality of life and patient satisfaction using medical nutrition therapy as opposed to drugs for high cholesterol. Whereas people taking cholesterol-lowering drugs don’t feel any different, this study 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 remained underestimated by doctors. Even in the new drug-centered cholesterol guidelines emphasize that lifestyle modification should be the foundation for the reduction for atherosclerotic cardiovascular disease risk, yet 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, 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 4, 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% drop in the bad to good cholesterol ratio within one week. A 33% drop in LDL. That’s the cholesterol reduction equivalent to a therapeutic dose of a cholesterol-lowering statin drug.
To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by veganmontreal.
Please consider volunteering to help out on the site.
- E Bruckert, D Pouchain, S Auboiron, C Mulet. Cross-analysis of dietary prescriptions and adherence in 356 hypercholesterolaemic patients. Arch Cardiovasc Dis 2012 105(11):557 – 565.
- L M Delahanty, D Hayden, A Ammerman, D M Nathan. Medical nutrition therapy for hypercholesterolemia positively affects patient satisfaction and quality of life outcomes. Ann Behav Med. 2002 Fall;24(4):269-78.
- G Weidner, SL Connor, JF Hollis, WE Connor. Improvements in hostility and depression in relation to dietary change and cholesterol lowering. The Family Heart Study. Ann Intern Med. 1992 Nov 15;117(10):820-3.
- N J Stone, J Robinson, A H Lichtenstein, N B Merz, C B Blum, R H Eckel, A C Goldberg, D Gordon, D Levy, D M Lloyd-Jones, P McBride, J S Schwartz, S T Shero, S C Smith, K Watson, P W F Wilson. ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013.
- L R Erhardt, F D R. Hobbs. A global survey of physicians' perceptions on cholesterol management: The From The Heart study. Int. J. Clin. Pract. 2007 61(7):1078 – 1085.
- D J Jenkins, C W Kendall, D G Popovich, E Vidgen, C C Mehling, V Vuksan, T P Ransom, A V Rao, R Rosenberg-Zand, N Tariq, P Corey, P J. Jones, M Raeini, J A Story, E J Furumoto, D R Illingworth, A S Pappu, P W Connelly. Effect of a very-high-fiber vegetable, fruit, and nut diet on serum lipids and colonic function. Metab. Clin. Exp. 2001 50(4):494 – 503.
- W P Castelli. The new pathophysiology of coronary artery disease. Am J Cardiol 1998 82(10):60 – 65.
- T E Kottke, H Blackburn, M L Brekke, L I Solberg. The systematic practice of preventive cardiology. Am J Cardiol 1987 59(6):690 – 694.
Why don’t more doctors practice preventive cardiology? Available time is a reason frequently cited by physicians, but if you probe a little deeper, yes they complain about not having enough time to give their patients dietary advice, but 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, “Yeah, 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, but do we get to live longer or is it just going to feel longer? But contrary to popular belief, this study found no apparent reduction but rather an improvement in some measures of quality of life and patient satisfaction using medical nutrition therapy as opposed to drugs for high cholesterol. Whereas people taking cholesterol-lowering drugs don’t feel any different, this study 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 remained underestimated by doctors. Even in the new drug-centered cholesterol guidelines emphasize that lifestyle modification should be the foundation for the reduction for atherosclerotic cardiovascular disease risk, yet 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, 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 4, 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% drop in the bad to good cholesterol ratio within one week. A 33% drop in LDL. That’s the cholesterol reduction equivalent to a therapeutic dose of a cholesterol-lowering statin drug.
To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by veganmontreal.
Please consider volunteering to help out on the site.
- E Bruckert, D Pouchain, S Auboiron, C Mulet. Cross-analysis of dietary prescriptions and adherence in 356 hypercholesterolaemic patients. Arch Cardiovasc Dis 2012 105(11):557 – 565.
- L M Delahanty, D Hayden, A Ammerman, D M Nathan. Medical nutrition therapy for hypercholesterolemia positively affects patient satisfaction and quality of life outcomes. Ann Behav Med. 2002 Fall;24(4):269-78.
- G Weidner, SL Connor, JF Hollis, WE Connor. Improvements in hostility and depression in relation to dietary change and cholesterol lowering. The Family Heart Study. Ann Intern Med. 1992 Nov 15;117(10):820-3.
- N J Stone, J Robinson, A H Lichtenstein, N B Merz, C B Blum, R H Eckel, A C Goldberg, D Gordon, D Levy, D M Lloyd-Jones, P McBride, J S Schwartz, S T Shero, S C Smith, K Watson, P W F Wilson. ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013.
- L R Erhardt, F D R. Hobbs. A global survey of physicians' perceptions on cholesterol management: The From The Heart study. Int. J. Clin. Pract. 2007 61(7):1078 – 1085.
- D J Jenkins, C W Kendall, D G Popovich, E Vidgen, C C Mehling, V Vuksan, T P Ransom, A V Rao, R Rosenberg-Zand, N Tariq, P Corey, P J. Jones, M Raeini, J A Story, E J Furumoto, D R Illingworth, A S Pappu, P W Connelly. Effect of a very-high-fiber vegetable, fruit, and nut diet on serum lipids and colonic function. Metab. Clin. Exp. 2001 50(4):494 – 503.
- W P Castelli. The new pathophysiology of coronary artery disease. Am J Cardiol 1998 82(10):60 – 65.
- T E Kottke, H Blackburn, M L Brekke, L I Solberg. The systematic practice of preventive cardiology. Am J Cardiol 1987 59(6):690 – 694.
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Barriers to Heart Disease Prevention
LicenseCreative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)
Content URLDoctor's Note
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:
- Lifestyle Medicine: Treating the Causes of Disease
- Convincing Doctors to Embrace Lifestyle Medicine
- Fully Consensual Heart Disease Treatment
- What Diet Should Physicians Recommend?
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:
- Nutrition Education Mandate Introduced For Doctors
- Medical Associations Oppose Bill to Mandate Nutrition Training
- California Medical Association Tries to Kill Nutrition Bill
- Nutrition Bill Doctored in the California Senate
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? Not only is that not treating the root cause, but there are potentially serious drug side-effects. See, for example, Statin Cholesterol Drugs and Invasive Breast Cancer
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