Imagine Our World if We Taught It How to Eat
Melissa Walton-Shirley
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In
my office, I have a copy of the Mediterranean diet pyramid at checkout
for every new patient. Many established patients who suffer from
metabolic syndrome, coronary artery disease, or obesity receive a second
or even a third copy. I spend hours teaching the simple mechanics of
nutrition. I stress that it's more impactful on longevity than any metal
scaffold electively deployed into a coronary artery. I found a kindred
spirit in Dr Simon Poole. His salient points came rapid fire, finding
their mark and leaving quite an impression.
"If patients with
coronary artery disease came out of the office of a practicing physician
or cardiologist not on a statin, you could argue that's a negligent
practice, but I'd argue that most have no advice on diet. I lay down the
gauntlet. We as physicians need to emphasize diet," he began. He then
lauded Dr Stender by saying, "Steen has done remarkably well with his
government. Our secretary of state wanted to make an impact. We were
shuffled into a room to discuss how to decrease mortality in 2.5 years.
We emphasized "brave legislation" (hinting at labeling, reduction in
trans-fat content, and education). The reply was a terse, "Well, we
don't do social engineering." Someone in the group argued, "If you look
at eye-level in a market at the packaging of chocolates for children . .
. if that isn't social engineering, I don't know what is."
He
made the salient points that simple things like irrigation of olives
decreases the antioxidant content of olive oil, which can ruin even good
foods. When UV light replaces natural sunlight, it can be impactful.
Furthermore, he consumes up to 50 cc of olive oil per day and recommends
frying fish in it and pouring it on pasta. He doesn't count calories.
I
quickly asked the expert if anything about my usual dietary
recommendations could be improved. I told him that I advocate for
cutting in half the consumption of bread, sweets, potatoes, pasta, and
rice and to eat five servings of fruits and vegetables per day. I
recommend a maximum of four eggs per week and no more than one serving
of red meat per month.
Dr Poole
replied, "I don't discourage consuming pasta if they drizzle olive oil
on it because it lowers the glycemic load. I'd die without having red
meat once per week but the portion is very, very small," he said,
pointing to a small portion of the palm of his hand. "It's always grass
fed," he added and quipped, "I always know what my food ate." Further
critiquing my recommendations, he added, "I would go for more than five
portions of fruit and vegetables per day. Butternut squash, for
instance, and cucumbers are fruits of sorts. As for eggs, they are back
on the menu."
His friend Dr Aseem Malhotra (Frimley Health NHS
Foundation Trust, Camberley, UK), who was standing nearby, added,
"Following an MI, for mortality lowering, a high-fat Mediterranean diet
is more effective than aspirin, statins, and coronary stents." It was a
statement thrown like a fastball toward home plate, its implication
staggering and dead on target.
Dr Poole concluded his presentation
today by stating, "We need broader professional leadership and access
to resources. Education is key. We need to take responsibility."
I hope someday you'll join us
Dr
Neil Thomas emphasized the importance of respecting the many randomized
controlled trials assessing the effectiveness of the Mediterranean and
DASH diets to reduce all cause mortality. The impact of uneven
recommendations and the impact of the media's influence cannot be
underestimated. He cautions against supplements, stating that, "The
media regularly reports on omega-3 fatty acids for prevention and
treatment of CV disease, but there are no interventional studies that
demonstrate a reduction in mortality. The US Preventive Services Task
Force found no evidence of a positive effect of any nutritional
supplement. Although there was a 7% reduction in all-cause mortality in
one study that included vitamin D, those studies included simultaneous
calcium supplementation. Those with vitamin D alone are all negative,"
he said, then added, "There are two larger trials upcoming that will be
definitive regarding whether it's beneficial." He concluded by saying,
"With regard to beta carotene, as soon as you start giving it in
interventional trials it actually increased the risk of death."
Dr
Thomas Larsen is studying multiple dietary combinations like high- or
low-glycemic-index diets combined with higher or lower fatty- and
protein-content diets. According to the DIOGENES
trial, he noted, patients who followed a low-protein and high-glycemic
index diet were more likely to gain weight. He then added, "High-protein
diets, not low-glycemic-index diets, are the most promising
for regulation of fat mass and abdominal height." He concluded that
based on the Diogenes diet and
others, "a high-protein, low-glycemic-index diet may have additive
effects to improve body-weight regulation, is more successfully
maintained, and may be more likely to lower CVD risk factors if followed
long term."
And the world will be as one
I
challenge you take this information into your exam rooms tomorrow. Bring
along a copy of the Mediterranean diet pyramid. Talk to patients about
how adding extra virgin olive oil blunts the glycemic index of
whole-wheat pasta. Advocate against unfounded claims for dietary
supplements. Strike up a conversation with your local congressional
representatives. Imagine how we as clinicians and practitioners can
change the world one conversation at a time, one politician at a time,
and one act of legislation at a time. If you can see the future, you can
make it happen. Imagine how the world would eat and live if we all did
that tomorrow. Just imagine.
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Related Drugs & Diseases
I attended a session yesterday at the European Society of Cardiology (ESC) 2015 Congress
entitled, "What should you eat to live a heart-healthy life?" By all
accounts, accolades, and high-fives following the presentation, it was
life-changing. Dr Neil Thomas (University of Birmingham, UK), Dr Steen
Stender (University of Copenhagen, Hellerup, Denmark), Dr Simon Poole
(Cambridge, UK), and Prof T Meinert Larsen (University of Copenhagen,
Frederiksberg, Denmark)—all nutrition gurus and scientists—spent 67
minutes teaching us how to save the world. It was probably the most
important series of the entire ESC 2015 meeting because they advocated
for nutrients whose side effects are nil (for most) and are readily
available for mass consumption (in most places). They demonstrated how a
population of unsuspecting individuals could be sickened when a
government allows a food supply to become tainted by commerce and
ignored by politicians. They proselytized with proof and enthusiasm that
we need to educate and legislate on the topic of nutrition to save
millions upon millions of lives and dollars.
You may say I'm a dreamer
Dr
Steen Stender dreams of a world without trans fat. He knows why it has
been favored by the food industry: it's cheap, can hold its shape as a
semisolid at room temp, has an ultralong shelf life, and stands up to
repeated heating. Dr Stender also understands why the 2006 Nurses'
Health Study published in the New England Journal of Medicine
demonstrated a 33% increase in the incidence of coronary heart disease
when 5 g or more of trans fat per day is consumed. Its ability to
increase LDL and decrease HDL levels is a negative double-whammy in the
lipid arena.
Because Dr Stender stood up to big commerce, he is
now a superhero in the world of trans-fat legislation. As chair of the
Danish Nutrition Council's subgroup dealing with trans fats and health,
he convinced the country of Denmark to approve a ban there effective
January 1, 2004. It is now illegal for any food to contain more than 2%
trans fats, and offenders face hefty fines and even incarceration. Proof
of the downside of taking a hard stand on trans fat is the fact that he
was sued after he outed the content of a favorite snack wafer. He
likened the public's risk of consuming it to that of smoking 10
cigarettes per day. Sales plummeted, and the company sued him for $1
million. Then, in a stunning turnaround, in 3 months, it dropped the
suit and removed 100% of the trans fat in its product.
The number
of Danes who died from cardiovascular disease fell by 70% between 1985
and 2009. No EU member state has recorded a greater decline in
mortality. Could the ban on trans fats in 2003 be the cause? Indeed, it
seems that Dr Stender's dream for Denmark may have already come true.
But I'm not the only one
entitled, "What should you eat to live a heart-healthy life?" By all
accounts, accolades, and high-fives following the presentation, it was
life-changing. Dr Neil Thomas (University of Birmingham, UK), Dr Steen
Stender (University of Copenhagen, Hellerup, Denmark), Dr Simon Poole
(Cambridge, UK), and Prof T Meinert Larsen (University of Copenhagen,
Frederiksberg, Denmark)—all nutrition gurus and scientists—spent 67
minutes teaching us how to save the world. It was probably the most
important series of the entire ESC 2015 meeting because they advocated
for nutrients whose side effects are nil (for most) and are readily
available for mass consumption (in most places). They demonstrated how a
population of unsuspecting individuals could be sickened when a
government allows a food supply to become tainted by commerce and
ignored by politicians. They proselytized with proof and enthusiasm that
we need to educate and legislate on the topic of nutrition to save
millions upon millions of lives and dollars.
You may say I'm a dreamer
Dr
Steen Stender dreams of a world without trans fat. He knows why it has
been favored by the food industry: it's cheap, can hold its shape as a
semisolid at room temp, has an ultralong shelf life, and stands up to
repeated heating. Dr Stender also understands why the 2006 Nurses'
Health Study published in the New England Journal of Medicine
demonstrated a 33% increase in the incidence of coronary heart disease
when 5 g or more of trans fat per day is consumed. Its ability to
increase LDL and decrease HDL levels is a negative double-whammy in the
lipid arena.
Because Dr Stender stood up to big commerce, he is
now a superhero in the world of trans-fat legislation. As chair of the
Danish Nutrition Council's subgroup dealing with trans fats and health,
he convinced the country of Denmark to approve a ban there effective
January 1, 2004. It is now illegal for any food to contain more than 2%
trans fats, and offenders face hefty fines and even incarceration. Proof
of the downside of taking a hard stand on trans fat is the fact that he
was sued after he outed the content of a favorite snack wafer. He
likened the public's risk of consuming it to that of smoking 10
cigarettes per day. Sales plummeted, and the company sued him for $1
million. Then, in a stunning turnaround, in 3 months, it dropped the
suit and removed 100% of the trans fat in its product.
The number
of Danes who died from cardiovascular disease fell by 70% between 1985
and 2009. No EU member state has recorded a greater decline in
mortality. Could the ban on trans fats in 2003 be the cause? Indeed, it
seems that Dr Stender's dream for Denmark may have already come true.
But I'm not the only one
In
my office, I have a copy of the Mediterranean diet pyramid at checkout
for every new patient. Many established patients who suffer from
metabolic syndrome, coronary artery disease, or obesity receive a second
or even a third copy. I spend hours teaching the simple mechanics of
nutrition. I stress that it's more impactful on longevity than any metal
scaffold electively deployed into a coronary artery. I found a kindred
spirit in Dr Simon Poole. His salient points came rapid fire, finding
their mark and leaving quite an impression.
"If patients with
coronary artery disease came out of the office of a practicing physician
or cardiologist not on a statin, you could argue that's a negligent
practice, but I'd argue that most have no advice on diet. I lay down the
gauntlet. We as physicians need to emphasize diet," he began. He then
lauded Dr Stender by saying, "Steen has done remarkably well with his
government. Our secretary of state wanted to make an impact. We were
shuffled into a room to discuss how to decrease mortality in 2.5 years.
We emphasized "brave legislation" (hinting at labeling, reduction in
trans-fat content, and education). The reply was a terse, "Well, we
don't do social engineering." Someone in the group argued, "If you look
at eye-level in a market at the packaging of chocolates for children . .
. if that isn't social engineering, I don't know what is."
He
made the salient points that simple things like irrigation of olives
decreases the antioxidant content of olive oil, which can ruin even good
foods. When UV light replaces natural sunlight, it can be impactful.
Furthermore, he consumes up to 50 cc of olive oil per day and recommends
frying fish in it and pouring it on pasta. He doesn't count calories.
I
quickly asked the expert if anything about my usual dietary
recommendations could be improved. I told him that I advocate for
cutting in half the consumption of bread, sweets, potatoes, pasta, and
rice and to eat five servings of fruits and vegetables per day. I
recommend a maximum of four eggs per week and no more than one serving
of red meat per month.
Dr Poole
replied, "I don't discourage consuming pasta if they drizzle olive oil
on it because it lowers the glycemic load. I'd die without having red
meat once per week but the portion is very, very small," he said,
pointing to a small portion of the palm of his hand. "It's always grass
fed," he added and quipped, "I always know what my food ate." Further
critiquing my recommendations, he added, "I would go for more than five
portions of fruit and vegetables per day. Butternut squash, for
instance, and cucumbers are fruits of sorts. As for eggs, they are back
on the menu."
His friend Dr Aseem Malhotra (Frimley Health NHS
Foundation Trust, Camberley, UK), who was standing nearby, added,
"Following an MI, for mortality lowering, a high-fat Mediterranean diet
is more effective than aspirin, statins, and coronary stents." It was a
statement thrown like a fastball toward home plate, its implication
staggering and dead on target.
Dr Poole concluded his presentation
today by stating, "We need broader professional leadership and access
to resources. Education is key. We need to take responsibility."
I hope someday you'll join us
Dr
Neil Thomas emphasized the importance of respecting the many randomized
controlled trials assessing the effectiveness of the Mediterranean and
DASH diets to reduce all cause mortality. The impact of uneven
recommendations and the impact of the media's influence cannot be
underestimated. He cautions against supplements, stating that, "The
media regularly reports on omega-3 fatty acids for prevention and
treatment of CV disease, but there are no interventional studies that
demonstrate a reduction in mortality. The US Preventive Services Task
Force found no evidence of a positive effect of any nutritional
supplement. Although there was a 7% reduction in all-cause mortality in
one study that included vitamin D, those studies included simultaneous
calcium supplementation. Those with vitamin D alone are all negative,"
he said, then added, "There are two larger trials upcoming that will be
definitive regarding whether it's beneficial." He concluded by saying,
"With regard to beta carotene, as soon as you start giving it in
interventional trials it actually increased the risk of death."
Dr
Thomas Larsen is studying multiple dietary combinations like high- or
low-glycemic-index diets combined with higher or lower fatty- and
protein-content diets. According to the DIOGENES
trial, he noted, patients who followed a low-protein and high-glycemic
index diet were more likely to gain weight. He then added, "High-protein
diets, not low-glycemic-index diets, are the most promising
for regulation of fat mass and abdominal height." He concluded that
based on the Diogenes diet and
others, "a high-protein, low-glycemic-index diet may have additive
effects to improve body-weight regulation, is more successfully
maintained, and may be more likely to lower CVD risk factors if followed
long term."
And the world will be as one
I
challenge you take this information into your exam rooms tomorrow. Bring
along a copy of the Mediterranean diet pyramid. Talk to patients about
how adding extra virgin olive oil blunts the glycemic index of
whole-wheat pasta. Advocate against unfounded claims for dietary
supplements. Strike up a conversation with your local congressional
representatives. Imagine how we as clinicians and practitioners can
change the world one conversation at a time, one politician at a time,
and one act of legislation at a time. If you can see the future, you can
make it happen. Imagine how the world would eat and live if we all did
that tomorrow. Just imagine.
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