Thursday, August 8, 2013

The popular media. misinformation, and heart disease.

During a routine physical, former President George W. Bush discovered he had a blocked artery in his heart earlier this week.  The following day, he had a stent placed in the artery to open the blockage.  Watching the NBC Nightly News' description of the event, I found myself to be dumbfounded.  Below is a list of key points from the news broadcast.

  • President Bush is an avid exerciser
  • He exercises 5 times a week for at least 30 minutes
  • His cholesterol is normal
  • Eating a low fat, "heart healthy" diet is your best protection


 What you believe about nutrition could be wrong

The medical correspondent, Nancy Snyderman, MD, as well as host Lester Holt bantered about how even someone living a seemingly healthy lifestyle is not immune to the ravages of heart disease.  What struck me as strange is that the notion that the recommendations for heart health are pretty much bogus never entered anybody's mind.  Of course there is a huge genetic factor involved here as well as the stress involved with leading the free world for 8 years.  After all, his father has heart disease and held the same job for 4 years.  I have no problem with this fact.  However, I do take issue with the recommendations being untouchable, especially if someone can pretty much follow them word by word and still get a blockage.

Exercise-Not the cat's meow

For one, exercise is great and is something everyone should do for a multitude of reasons.  As for reducing your risk for heart disease, reducing the amount of time spent being sedentary is far more important than exercising.  This should be common sense, but to put some numbers behind it, 30 minutes of exercise performed 5 days a week is 2.5 hours out of a total of 168 hours in the week.  That's 1.4% of the week, it doesn't even seem plausible that this amount of time could counteract being a slouch on the couch for the other 98.6%.

High cholesterol is an overrated risk factor

The fact that his cholesterol is normal is also interesting for most people, but isn't very surprising.  Approximately 50% of heart attacks occur in people with normal or low cholesterol.  That didn't prevent Dr. Snyderman from referring to the blockage as a cholesterol blockage.  I wonder why they don't refer to them as calcifications since the plaques that form the blockages are 50% calcium and only 3% cholesterol.

This certainly adds to the confusion I get when I tell people they don't really need to concern themselves with the amount of cholesterol they eat unless they have a genetic condition called familial hypercholesterolemia.  Familial hypercholesterolemia is found in 1 out of every 500 people so it is certainly not a common condition.  It will also be interesting to see whether or not the former President is put on statins, despite having normal cholesterol levels.  People with familial hypercholesterolemia and people with a previous heart attack are the only people I would recommend take a statin, but that's just what the research shows and I'm not a doctor.  That makes the point moot.


Low fat does not mean low risk

The notion that the low fat heart healthy diet isn't actually healthy to the heart has been unraveling over the course of the last 5 years.  Not only has it been determined that saturated fat and cholesterol are not that bad for you, replacing these foods with processed, low fat foods high in carbohydrate is worse.  This has been the de facto dietary advice for a healthy heart for more than 40 years.  Talk about digging yourself deeper in to a hole.

Science works best when done properly

All of this brings up an excellent point that most people need to understand about science.  Science doesn't make truths, it identifies them.  When funding for science primarily comes from companies with financial interests in the outcomes of that science, you cannot expect to get unbiased results.  A recent article looked at the likelihood of finding positive outcomes in both industry funded and government funded studies, specifically with the pharmaceutical industry.  Oddly enough, government funded studies tend to get positive outcomes around 50% of the time while industry funded studies tend to find positive results around 85% of the time.  Part of this problem is certainly due to the fact that industry is not required to report results from all of their studies, so they just don't report the negative ones.  This is more of a pharmaceutical industry problem, but who do you think is pushing the low fat, low cholesterol BS?  I'd go with the folks making the anti-cholesterol drugs.

A more common problem with dietary research isn't with how the research is conducted so much as the way it is reported.  The popular media loves to report results from epidemiological research as fact.  These types of studies cannot prove cause and effect, they can only identify relationships that can be further studied with better research.  The primary problem lies within the fact that most people get their information from the popular news media and not from peer reviewed journals.  When the media reports this stuff, it sticks because everyone has heard it and it becomes established fact even though it has never been proven scientifically.  Then, physicians get on television and keep the BS rolling.  Is it any wonder how we are so misinformed on diet?