Interesting story. I wonder if you have any thoughts about Steven Gundry's program in California. Very popular in my area and I'm not sure how to advise patients.
Scary - will try and get back to fresh food, Mediterranean-ish, and reduce sugary stuff, and alcohol except a tiny bit of red wine (I am not really sure whether alcohol is sugary, or has the sugar been reduced by the fermentation). And will get a blood test to check cholesterol level - I was recommended that but have put it off as I didn’t want to be taking statins forever.
Esselstyn works with the patient’s doctors and does not interfere with the medical Rx. His job is not medical Rx. I have seen a case where the lipids and blood pressure fell so drastically with the whole plant based diet that the cardiologist paradoxically wanted the patient to stop the diet and continue the meds! To a cardiologist or a hammer everything is a nail
The old paradigms for treatment of CAD are still persistent in the private practice community.
The only recent studies we have compare CABG to PCI for left main for example. This is because studies in the 1980s showed CABG was superior to optimal medical therapy at that time. Since then OMT has dramatically improved, including better treatments for heart failure and CAD .
Dr. Mandrola has been advocating a trial of CABG versus current day OMT for several years ("For the record, I think the next trial in left main coronary disease ought to be revascularization vs optimal medical therapy. Recall that CABG beat medicines in the 1980s. And medical therapy has improved quite a lot since then")
Your apt statement "Esselstyn should make it more clear that people like this need all the help they can get including aggressive medical treatment. He needs to support rather than compete against medication like statins that have robust overwhelming data in reducing myocardial infarction’s, both primary and secondary as well as cardiovascular death"
could be applied to many other dietary evangelists on both the very low carb and very low fat end of the spectrum.
Interesting article and commentary thanks for that!
As a primary care doc I also see the fad diets come and go, and try to recommend Mediterranean diet concepts for most. I think there is good evidence to stay away from sugar, refined carbs, middle of the grocery store type stuff. Fast food is consumed more frequently than we would think, and has all sorts of bad features, even including PFAS in the wrappers.
For a relatively young man in his mid 40’s, with almost unstable angina and multiple vessel disease >80%... I feel like the cardiologists in my area would have recommended CABG. I leave that sort of decision up to you guys, and since it’s not my call I don’t know the exact criteria for CABG vs PTCI, but most studies do show superiority long term with CABG.
Again, thanks for the food for thought. Cringe pun not intended but I’ll leave it there 😊
It is important to note that reduced meat intake translates into reduced arachidonic acid intake. (Google Michael Greger arachidonic acid)
Vegans and vegetarians would likely have dramatically lower rates of vascular disease if they didn't consume more polyunsaturated fatty acids than omnivores. Unfortunately, plant-based enthusiasts have been persuaded that saturated fats clog arteries because they raise cholesterol levels. It doesn't work that way. Saturated fats are not bioactive molecules. Polyunsaturated fatty acids are. (Google the saturated fat–unsaturated oil dilemma)
Thank you for posting this article. Like the author, I have also struggled with the incredible amount of information and dietary advice to be found on the web. I am a 74-year-old woman, had one NSTEMI in 2020, two stents, on statins, diagnosed with coronary spasm. Would you have any other advice for managing coronary spasm?
Dead wrong about lEsselstyn diet, his LDL plunged to 60, BP corrected itself and with loss of weight his beta cell function would have improved.
We don't know his Lp (a) so hard to comment. Esselstyn leaves the meds to the patient’s doctors. He has never advocated against statin. Metoprolol protection is time limited, at least after MI.
No. there are more causes than lipids and diet for atherosclerosis, otherwise there would be no residual cases. Cardiologists need to accept a knowledge gap
I do have thoughts on Gundry.
https://theskepticalcardiologist.com/2018/07/14/why-you-should-ignore-the-plant-paradox-by-steven-gundry/
Dr. P
Interesting story. I wonder if you have any thoughts about Steven Gundry's program in California. Very popular in my area and I'm not sure how to advise patients.
Scary - will try and get back to fresh food, Mediterranean-ish, and reduce sugary stuff, and alcohol except a tiny bit of red wine (I am not really sure whether alcohol is sugary, or has the sugar been reduced by the fermentation). And will get a blood test to check cholesterol level - I was recommended that but have put it off as I didn’t want to be taking statins forever.
Esselstyn works with the patient’s doctors and does not interfere with the medical Rx. His job is not medical Rx. I have seen a case where the lipids and blood pressure fell so drastically with the whole plant based diet that the cardiologist paradoxically wanted the patient to stop the diet and continue the meds! To a cardiologist or a hammer everything is a nail
Ryan,
Thank you.
The old paradigms for treatment of CAD are still persistent in the private practice community.
The only recent studies we have compare CABG to PCI for left main for example. This is because studies in the 1980s showed CABG was superior to optimal medical therapy at that time. Since then OMT has dramatically improved, including better treatments for heart failure and CAD .
Dr. Mandrola has been advocating a trial of CABG versus current day OMT for several years ("For the record, I think the next trial in left main coronary disease ought to be revascularization vs optimal medical therapy. Recall that CABG beat medicines in the 1980s. And medical therapy has improved quite a lot since then")
Dr. P
Art,
Thanks for sharing your thoughts.
Your apt statement "Esselstyn should make it more clear that people like this need all the help they can get including aggressive medical treatment. He needs to support rather than compete against medication like statins that have robust overwhelming data in reducing myocardial infarction’s, both primary and secondary as well as cardiovascular death"
could be applied to many other dietary evangelists on both the very low carb and very low fat end of the spectrum.
Dr P
Interesting article and commentary thanks for that!
As a primary care doc I also see the fad diets come and go, and try to recommend Mediterranean diet concepts for most. I think there is good evidence to stay away from sugar, refined carbs, middle of the grocery store type stuff. Fast food is consumed more frequently than we would think, and has all sorts of bad features, even including PFAS in the wrappers.
For a relatively young man in his mid 40’s, with almost unstable angina and multiple vessel disease >80%... I feel like the cardiologists in my area would have recommended CABG. I leave that sort of decision up to you guys, and since it’s not my call I don’t know the exact criteria for CABG vs PTCI, but most studies do show superiority long term with CABG.
Again, thanks for the food for thought. Cringe pun not intended but I’ll leave it there 😊
It is important to note that reduced meat intake translates into reduced arachidonic acid intake. (Google Michael Greger arachidonic acid)
Vegans and vegetarians would likely have dramatically lower rates of vascular disease if they didn't consume more polyunsaturated fatty acids than omnivores. Unfortunately, plant-based enthusiasts have been persuaded that saturated fats clog arteries because they raise cholesterol levels. It doesn't work that way. Saturated fats are not bioactive molecules. Polyunsaturated fatty acids are. (Google the saturated fat–unsaturated oil dilemma)
Thank you for posting this article. Like the author, I have also struggled with the incredible amount of information and dietary advice to be found on the web. I am a 74-year-old woman, had one NSTEMI in 2020, two stents, on statins, diagnosed with coronary spasm. Would you have any other advice for managing coronary spasm?
Dead wrong about lEsselstyn diet, his LDL plunged to 60, BP corrected itself and with loss of weight his beta cell function would have improved.
We don't know his Lp (a) so hard to comment. Esselstyn leaves the meds to the patient’s doctors. He has never advocated against statin. Metoprolol protection is time limited, at least after MI.
No. there are more causes than lipids and diet for atherosclerosis, otherwise there would be no residual cases. Cardiologists need to accept a knowledge gap