From the Archives: A Second Opinion
Tuesday, February 24, 2009 at 12:00PM 
My father’s cardiologist needs to have his face forcibly rearranged. I’m not one to bang heads, but I’d love to walk into that guy’s office and knock him around a little bit.
Two weeks ago, Dad had a massive coronary. Three stents and a stay in the ICU later, he received the worst piece of advice I’ve ever heard, courtesy of a man who should know better. With no hint of irony, the cardiologist told him to limit his fat intake.
The last thing my favorite four-heart-attack survivor needs is to stop eating fat. Quite the contrary, he needs to swerve his runaway diet directly toward lipids. A few fat calories would serve to displace a portion of his rampant carbohydrate consumption, regulating his blood sugar levels and mitigating his fortress-like insulin resistance.
Unfortunately, there was no mention of carbohydrates in their discussion. My dad will avoid fat like the plague, continuing his steady diet of egg noodles, bread, potatoes, and skim milk. He’ll be eating the very stuff that’s been killing him for the last sixty years.
Even worse, his highly educated, stethoscope-toting Specialist will sleep well at night, thinking he did everything he could to save Dad’s life. In reality, he put him on track for heart attack number five, albeit with a bit more metal in his chest and a newfound appreciation for the freedom of hospital apparel.
Perhaps a little less textbook and a bit more common sense would’ve done the trick. A simple lifestyle examination shows that my father’s diet is carbohydrate-based, his protein consumption is deficient, and the sum total of his daily exercise consists of getting in and out of his truck. Furthermore, his stress levels are off the charts.
These behavioral patterns haven’t changed a lick during the twenty-seven years I’ve had the pleasure of being my father’s son. Given the long duration of this lifestyle and the very unpleasant result, you would think that Captain Cardiologist’s advice would’ve turned Dad’s daily routine on its head. It didn’t. It just politely asked him to consume 80% less hamburger.
After I finish the Doctor’s impromptu facelift, I’m going to sit down with Dad. We’re going to cut the sugar from his diet, replace those calories with lean protein and unsaturated fats, and then we’re going to exercise with as much intensity as we can without blowing his ticker. If he has a fifth heart attack, it’ll be during a PR attempt.
I’ll be damned if he’s going to go while eating a grilled cheese sandwich made with low-fat cheddar and a dollop of “I Can’t Believe It’s Not Butter”, staring vacantly at the ceiling while his no-fat diet drops him into an early grave.
Picture courtesy of dartmed.dartmouth.edu, the fine Ivy-League Institution responsible for my father's care.
Reader Comments (12)
Since this article is "From the Archives", I'm not sure how your situation is these days with your pops. I share your frustration though. A little more common sense goes a long way. Keep up the GREAT work, and my prayers go for you and your pops.
"If he has a fifth heart attack, it’ll be during a PR attempt. " -> my favorite...
Yeah, unfortunately, this is the very same situation here, in Europe with my father and his cardiologist... It's a conspiracy or something :)
How can these well educated people be SO ignorate?! If my 21 year old daughter can figure this out with absolutely NO formal training......Just don't get it. It must be a conspiracy. I guess if we were all healthy and ate like we were suppose to, these docs would all be out of a job.
So how's your Dad doing John?
How did he juggle your advice versus the MD's?
Please consult the research and literature--the scientific, founded, and published literature--not your personal or popular opinion. Heart disease is the result of plaque build up, which is the result of an excessively fatty diet...sorry. Fat will not do your father any good, it will only further his risk for a future heart attack, stroke, or whatever CVD you please. Your fathers MD is correct--it's what he went to school for for more than 13 years, plus however long he's practiced, it's no conspiracy, it's education. Granted, he likely should have discussed the need for increased plant based foods, and decreased consumption of animal products e.g. meat, eggs, butter, fatty milk, etc as those all have saturated and/or trans fats (the sources that causes your liver to make excess cholesterol) and sodium but it's likely that your father has a history of chronic hypertension(high BP) and hyperlipidemia. Exercising regularly and increasing plant based foods, i.e. anything green and w/ fiber, oats, flax, etc can help combat cardiovascular disease--not more fat. While I support a lot of the workout approach that Crossfit offers, on too many of your affiliate sites I am seeing incorrect and misleading "health/nutritional education" information. Most of it I brush off because I know better, but you need to be careful what you are saying because some people will believe, and create a problem for themselves, which may create a problem for you all.
Oh...and PS yes, I believe fat to be an important part of the diet--it's in fact a necessity for many of the supportive functions of our body's--ESPECIALLY if you are female! But consuming a diet of trans and/or saturated--or just greater than 30% of fats in general is dangerous, bottom line. If you eat whole grain carbs and enough fiber--that's at least 30 grams/ day you can effectively reduce your risk for heart disease, diabetes etc. And at the end of the day, if you don't eat the carbs, your liver will convert your fats and proteins to glucose anyway. With respect to portion, maybe we're saying the same thing: yes, American's are over fed and under-exercising as a whole. I guess I'm just saying I don't think it's the fat to carb ratio that's the issue, rather it's the types of carbs (refined vs. unrefined) lack of fiber, and types of fat (sat. vs mono/polyunsaturated) and of course, lack of exercise that is...I don't mean for this to be argumentative--but I am good with discussion--I just don't an increase in CVD because people are being misinformed, or underinformed
Jessica,
Arterial plaque builds up only when LDL cholesterol oxidizes in the presence of uncontrolled blood sugar, precipitated by excessive carbohydrate consumption.
This is not my opinion. This is a fact.
We are NOT saying the same thing. The consumption of animal proteins and fats is essential to life, and their consumption can be nearly UNCHECKED in terms of volume as long as blood sugar is managed.
You are correct regarding the liver's conversion of protein to glucose. That does not substantiate your argument. Rather it shows that protein consumption supports major life processes.
I advocate a 40/30/30 diet, carbohydrates, protein, and fat. This is hardly low-carbohydrate or misleading, and CrossFit is not misinforming anyone. The health and performance markers of our athletes: triglycerides, resting heart rate, blood pressure, body fat, etc. are stellar, and they are universally brought about by the diet I describe (combined with high intensity exercise).
Input in, output out. My father ate the way he was told to eat for decades (high fiber, no fat, fucking blah blah blah) and it almost killed him. Portion is NOT the problem. Plants are NOT the answer.
Take your dime store nutrition degree and your Vegans Unite membership card, burn them, and try a real-world approach: does eating my way produce the health that the world needs?
Jessica-
You lay out a convincing argument...until we consider the facts. Heart disease was non-existent until the turn of the 19th century...we saw a slow increase in it's prevalence until a massive explosion with the advent of industrial scale food processing. That you mentioned Trans-fats is laudable...but so obvious as to be comical. This is on-par with "Uranium is harmful, it should be avoided." Ok, check.
Here are a few things I'd like you to consider:
The traditional diet of the Inuit is over 70% fat. They have NO HEART DISEASE until they start eating refined carbohydrate. You made the statement that some kind of "death percentage" exists in which if one eats "too much" fat, bad things happen. So, is there, or is there NOT a magical percentage of fat intake which confers certain doom? You made this statement with no small amount of huff and haughtiness...as if John's asertation to focus on dietary carbohydrate was irrational or misplaced. What gives? For further reading on THIS topic here is a good place to start:
http://discovermagazine.com/2004/oct/inuit-paradox
Saturated Fat;
You lump saturated fat in with trans fats...as a chemist I have some serious problems with this but that is outside the scope of this response. Suffice to say you are comparing something which has been a part of nature and living systems since the beginning of time (saturated fat) with something which came out of a laboratory about 75 years ago. I hope this fact alone opens your eyes to the shortcomings in your argument. This considered however, let's not play dueling banjos, lets looks at a real situation: The Kitavans. These islanders actually consume a fairly high amount of carbohydrate in the form of tubers in the traditional diet. Their main fat source? Saturated fat! their health? Virtually no cancer, diabetes or heart disease. Here is a link to the research:
http://www.staffanlindeberg.com/OurResearch.html
It is worth noting also, the 100 year old kitavan man pictured on that site is not uncommon for these pre-industrial cultures. Interestingly, a google search of the terms "vegan, centanarian" produces...nothing. Jessica, don't you find that interesting? I sure do.
So, at the end of the day this is not simply people bickering on the internet about nuances of health...this is our parents living or dying because of public health policy. Are you fully on board with that Jessica? If you are, are you 100% sure YOUR recommendations are based on the BEST science and understanding of human metabolism? Someone is going to live or die based on YOUR recommendations. What do YOU recommend?
Jessica I'm sorry but your on the wrong blog to be preaching mainstream health advice. Your argument would make sense if I haven't seen first hand what you're type of diet did to my mothers side of the family. They were told doctor after doctor to eat low fat high, carb avoiding red meat, cholesterol, yadda yadda. Meanwhile My grandfather and his side of the family (well some of them) have been on a Paleo type diet long before I can even remember. They are all in pristine health, They lived on a farm raising cattle and chicken, pigs etc. He had some apple trees but I never ate from them because I always thought It was nasty to pick apples from the trees and eat them when I was little. Anyway for some reason they didn't grow grains due to acre restriction or some type of BS. All they ate, well actually forced to eat, was what they had provided due to the fact that the nearest town was at least 50 miles away. None of them see doctors becasue they rarely get sick. My grandfather is 78 years old and still works his ass off at the farm. I studied up on this phenomenon and presented this information in a project to my class senior year of high school as the effects of location having on long term health.
H mm its weird but shouldn't it be the other way around? The doctors told my family what to eat, they got sick and weak. All my grandfathers family ate were meat, eggs, butter, fatty milk etc. I actually don't even know if they ate any plant life. I have respect for Doctors in the amount of schooling they go through, but if a doctor is fat and sick loading himself up with statins trying to give me health advice. Well I think Ill take his advice and SHOVE IT.
Sorry guys, re-arrange the guys face who just saved your dads life??? Get real.
He's a cardiologist. Its gonna take a while before the whole high fat low carb thing becomes mainstream. Besides, there's newer stuff now about the ratio of Omega 6 vs Omega 3 in our diet that plays a big role in Cardiovascular health.
That cardiologist has been doing his thing for what, maybe ten, twenty years now?? You can't expect us to keep up with every new thing that pops up. It looks simple from your point of view but from here there are new stuff every week on risk reduction.
Is there a lower chance of an MI if your cholesterol is lower...YES. Will your cholesterol come down on a low fat diet ...YES. Has it been proven that a low fat diet and excercise will reduce the risk of heart diesease...YES. The PROBLEM is MOST people are eating too much anyway, so ANY reduction in fat/carbs is a GOOD thing. I'm sure in a few years everyone will be saying something like what you've been preaching.
That Cardiologist probably sees hundreds of people every week like your Dad. As a Doctor I can tell you it gets pretty darn depressing to try and tell every overweight, hypertensive, hypercholesterolemic, hyperglycemic,stressed, smoking patient to get on track or else.
Most don't.
Its called the Human factor, something you or I wont change.
Will one live to one hundred if you eat food(plants or meat) that is unrefined,natural, organic,not fed 100% grain. Yes of coarse.
I dont see Macdonalds selling raw almonds though.
I bet you that Centenarian is nice and skinny too. Why? Cause he doesnt eat much.
Its easy to criticize and forget about the fact that we're all trying to do our best.
And as for the argument about drugs:Statins MAKE PEOPLE LIVE LONGER. Thats a fact. There are enough double-blind placebo controlled trials to prove that. Can a really healthy diet and lifestyle modification reverse coronary vessel disease, yes. But try telling that to every high risk patient that walks into your practice for like, ten years and we'll see how you feel..
Are you going to get mainstream grass fed beef and low glycaemic bread anytime soon. I dont think so. Is your boss going to tell you to take an extra couple of hours a day off to relax/excercise cause its good for your heart?? I dont think so.
We're all trying to fix the problem. America's the fattest nation on earth and heart disease is an epidemic of massive proportions.
There's plenty of people alive today because of that little pill called lipitor.. And from experience, most people that age aren't suddenly going to ''get super duper fit''.
We're fixing the problem from both ends. Your Dads alive thanks to modern medicine.
In twenty years time there wont be Coke or grain fed beef of hormones or chemicals, right? Well, maybe we'll have more informed choices and MUCH less obesity, heart disease and death as a result of lifestyle and diet. We can all agree to that.
Kevin,
Perhaps you're right. Perhaps this is all a losing battle, and we should just give up.
Tell every patient that comes in to your office that statins are a grand cure, and fat kills them. Don't bother to ask them to exercise, because you know they won't do it. Don't ask for diet modification, because you know they won't do it. Just give them some Lipitor and send them on their way. After all, we can't expect you to "keep up with every little thing that comes along".
On the other hand, you might want to take the high road, and give it an honest effort. Of course, that would be more difficult than whipping out your prescription pad.
Perhaps I have a "simple view" because I subscribe to a simple model, the black box. If something doesn't work, it should not persist. The sewage that has been fed to my father as the "cure" for his problem, a low-fat diet and statins, has resulted in three subsequent heart attacks. In my overly simplistic view of the world, this means the "cure" doesn't work.
In your experience, people don't get "super-duper fit" because you DON'T TRY. You just give them a pill. In my experience, the decline in health due to poor diet and a sedentary lifestyle can be slowed and even reversed at virtually any age.
Of course, I haven't given up yet.
Best,
Jon
Kevin,
You actually think the recommendations of the doctor saved his dad's life?? This statement bothers me and I am very impressed that Jon's response was that professional. I want you to pick up one of your text books and do a quick search for me: Essestial fatty acids..check...essential amino acids..check...essential carbohydrates...won't find it! The evidence is substantial that a diet high in carbohydrate (especially refined) makes a mess of things. Just ask the Pima Indians.
It is not the amount of cholesterol but the density that matters, LDL can be both big and "fluffy" (good) or small and dense (bad) but the overall number is not an indicator. Not surprisingly a diet high in carbs with give you some nice small and dense VLDL.
So the doctor prescription of lower the fat while replacing it with carbohydrates is saving his life? How do you figure? Carbohydrates are NOT essential for life! You can get all the glucose you need from protein and fat. If carbs were essential for life we would all be dead by now becuase I know my ancestors weren't collecting plants/fruits/ grains during the winter, they were killing animals and living of protein and fat like we should be.
Statins and all the other bullshit drugs may keep people alive longer but they aren't making them healthier/improving quality of life. Modern medicine does nothing but cure symptoms not the case. Prescription drugs are one of the leading killers in the U.S, I wondery why?
I do agree with your stance on grass-fed beef as the fatty acid profile of a grain-fed cow is as good as a Mcdonalds burger. Unfortunately for us in Canada ALL chickens are grain-fed which is just disturbing.