It’s a new age. Nutrition, long relegated to the back burner, is now taking center stage. Medical providers across the nation are beginning to incorporate nutritional concepts into their care plans. For instance, a client recently informed me that her cardiologist recommended she start a plant-based diet to reduce cholesterol.
A decade ago, this recommendation would have been considered blasphemous. Back then, doctors or advanced practice providers might have dismissed the idea outright. However, as research continues to support the benefits of a plant-based diet, it is becoming increasingly difficult for medical professionals to ignore the scientific evidence. Studies show that young people who follow a predominantly plant-based or whole-food lifestyle not only extend their life expectancy but also significantly improve their quality of life.
“Studies show that young people who follow a predominantly plant-based or whole-food lifestyle not only extend their life expectancy but also significantly improve their quality of life.”
For example, autoimmune diseases worsen with an unhealthy diet, and diabetes increases the risk of losing limbs, eyesight, and skin sensation. Hypertension raises the risk of stroke, vision changes, chronic headaches, and dementia. Elevated cholesterol levels are associated with heart disease, heart attacks, stroke, and dementia.
The shift towards recognizing the importance of nutrition in medical care is a promising development. Medical providers are increasingly acknowledging that dietary choices can profoundly impact chronic diseases and overall well-being. As we continue to embrace this approach, we pave the way for a healthier future, free from the limitations of poor quality of life and unnecessary suffering.
“Who wants to live a life of low quality, or suffering?”
US Leading Causes of Death
(Source: https://www.cdc.gov/nchs/products/databriefs/db328.htm)
Cholesterol was discovered fairly recently.
The era of LDL began in 1955 when John Gofman separated cholesterol components and identified low-density lipoproteins (LDL) and high-density lipoproteins (HDL). When he studied plasma from heart attack patients, Gofman found a major increase in LDL and a reduced level of HDL (Gofman et al., 1954b). By 2020, Gofman’s discoveries had been replicated many times. The correlation between high LDL levels, low HDL levels, and heart attacks is one of the most profound epidemiological correlations in all of medicine.
“The correlation between high LDL levels, low HDL levels, and heart attacks (heart disease) is one of the most profound epidemiological correlations in all of medicine.”
All other things being equal, the higher the LDL, the faster the plaques evolve. However, all other things are not equal. At any given level of LDL, plaque formation is accelerated by risk factors that include obesity, smoking, high blood pressure, and diabetes. In addition, poorly understood genetic factors affect atherosclerosis, possibly by changing the susceptibility of the endothelium to become damaged. Unless the LDL level is extraordinarily high or low, it is difficult to predict accurately whether any individual will suffer a heart attack.
“At any given level of LDL, plaque formation is accelerated by risk factors that include obesity, smoking, high blood pressure, and diabetes. In addition, poorly understood genetic factors affect atherosclerosis, possibly by changing the susceptibility of the endothelium to become damaged.”
In 1987, Merck’s Mevacor became the first statin approved for human use (Brody, 1987; Byrne, 1987). The FDA approved Mevacor based on studies showing that it lowers plasma LDL and is well tolerated. At the time of approval, there was no evidence that a statin could reduce heart attacks. This evidence came in 1994 when Merck (Scandinavian Simvastatin Survival Study Group, 1994) demonstrated that simvastatin not only reduced heart attacks but actually prolonged life in middle-aged people at high risk of a coronary event.
Statin therapy has saved many lives. Patients with severe genetic mutations have to be treated from childhood. Observational studies in these children show that lifelong LDL reductions are much more effective than late LDL reductions in preventing coronary events. Therefore, the earlier we prevent plaque buildup, the less risk we have of heart disease.
Most adults find they are suffering from high cholesterol as young adults despite having normal levels as children. This is because the cause is usually environmental, from years of cholesterol ingestion. By the time of diagnosis, adults will have to follow strict cholesterol-lowering diets to reverse the effects of artery stiffening.
“…adults will have to follow strict cholesterol lowering diets in order to reverse the effects of artery stiffening.”
What are the current guidelines medical professionals follow when treating high cholesterol?
- Emphasize a healthy lifestyle to prevent elevated cholesterol levels.
- If the LDL cholesterol is above 100 mg/dl. start statin medication to reduce risk of heart disease.
But there is a “therapeutic option” for providers to treat to under 70 mg/dL to maximize patient benefit.
Although research has shown levels above 70 are still increasing your risk of chronic diseases providers are content with an LDL ranging between 90-120.
For the very high-risk there is still an option to use drug therapy to reach less than 70 to reduce their risk of heart attack. But again this is only an option…
As odd as it is, there are still many primary care providers who do not follow these guidelines. Research has found that many heart attack patient’s were told their cholesterol was of no concern being that it was slightly over 100 or slightly below.
(Source: Guidelines Made Simple)
Why is this a big deal?
Because medical professionals often lack a comprehensive understanding of nutrition, it becomes challenging to implement the first guideline of prevention via lifestyle changes. Nutrition is the only alternative to statin medication, yet it is much easier to treat with medications once cholesterol levels exceed the 110-120 mark. Unfortunately, providers often allow cholesterol to remain high due to a lack of urgency and confusion surrounding cholesterol, leading many to avoid treatment altogether.
However, this is not entirely their fault.
Medical providers are hesitant to discuss nutrition because they are not adequately taught to do so. They are also reluctant to address cholesterol aggressively because they may not fully understand the true cause of heart attacks. The AMA requires minimal nutrition education in medical schools, and the AAPA mandates the same minimum in Physician Assistant programs. This lack of nutrition education results in a poor understanding of the direct correlation between food intake, cholesterol, and heart attacks. For example, during training, many medical providers are taught that a cholesterol level of 120 is not urgent, and they rarely connect cholesterol with animal products. This laxity and lack of education make it difficult for providers to implement these concepts into practice.
Consequently, patients who follow the guidance of their primary care providers (PCPs) on cholesterol management still face a high risk of heart attack.
Given that many medical providers are not trained in these critical concepts, it is essential to recognize those who are implementing them independently and encouraging other PCPs to do the same.
If you find a medical provider willing to discuss nutrition and lifestyle changes with you, you have discovered a hidden gem.
Why do we lead this fight?
While medicine can prolong life, it does not necessarily improve the quality of life. Many people who continue to eat unhealthily while taking medications suffer as other diseases take hold of their bodies.
Medicine is like a band-aid that eventually falls off. As we increase dosages (adding a new band-aid to the wound), the patient often continues their unhealthy diet. Although a new band-aid is applied, a new diagnosis typically follows, necessitating yet another medication. This is a cycle we are striving to break.
Eating healthy foods most of the time not only reduces the risk of heart attacks but also lowers the risk of cancer, heart failure, stroke, dementia, and worsening autoimmune diseases.
As a primary care PA-C, health coach, and nutritionist, I have helped many clients and patients improve their quality of life. It takes deep empathy to fight this battle, but we all should strive to learn how to prevent this cycle in our children, who are our future generation.
The new generation of medical providers is paving the way for a happier and healthier future. If you are a medical provider, now is the time to join this movement.
For a list of medical doctors leading the fight against poor nutrition, take a look at this inspiring list of professionals and their stories: New Age Doctors
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4525717/