Just one anecdote on that point. I'm pre-med and I recently shadowed the director of cardiac research (a cardiac surgeon) at the big hospital/medical school in this area. He was asked point-blank by a patient, "I've been reading that with diet and exercise I might be able to reverse my heart disease. What do you think?"
The doctor's answer was, "Absolutely not."
This is one data point, so it's hardly conclusive, but coming from a doctor who (a) teaches doctors and therefore plants seeds for the next generation and (b) should be an expert on new medical treatments with his position as the director of research, it's troubling.
Meanwhile, there is a growing minority of doctors who take patients through an eating "bootcamp" where they help them take out processed foods/white-flour/high-fructose corn syrup from their diet, teach them how to shop and cook plant-based foods, etc. I saw a documentary on it, "Forks Over Knives" I believe. Fascinating stuff.
In the documentary, they take a man with advanced heart disease, cut out all meat/dairy/processed foods from his diet, and take before-and-after blood readings (cholesterol, blood pressure, etc.). It was surprising how quickly the intervention reversed his numbers.
There are other pioneers working in this area. There's Dr. Terry Wahls, an MD who reversed her multiple sclerosis by eating what some would call a "paleo" diet (only vegetables, fruits, nuts, meat). Here's her TED talk if you're interested: http://www.youtube.com/watch?v=KLjgBLwH3Wc She's currently working on human clinical trials to test this diet-intervention in other patients.
To your point, "all doctors say eat better, etc." I have two thoughts.
1. I'm glad you have doctors who have mentioned that but I've never had that experience.
2. A doctor who says, "You really need to eat better," is not quite what we need. For reversible conditions like heart disease, diabetes, (MS?) etc we need doctors who say, "Your next appointment will be with a food specialist/nutritionist. He will help you completely change your eating habits, go shopping with you to get new staple-foods, and you will stick to this new lifestyle for x months. Here's a list of foods you must not eat and here are x great-tasting recipes that are easy to make. Come back in 6 weeks and we'll do another round of blood-tests to see how it's working. If you're not willing to do this I can give you [statins, etc. fill-in-the-drug] but they won't actually treat the disease and may not make you feel better. They will keep you alive though. It's totally up to you and I'll support you in either decision."
Just my 2 cents. I think medicine will eventually look more and more like this, but it will take time to change the culture and the traditions of western medicine.
Depends on why he was seeing a cardiac surgeon (who usually sees patients that have had or need surgery), and what his heart disease is. I don't think you have enough medical knowledge to assume the cardiac surgeon was, in fact, wrong. The question could easily have been interpreted as:
"Will diet and exercise reverse my [multiple 95% blocked coronary arteries before I die from a massive heart attack]"
or
"Will diet and exercise reverse my [dead heart tissue from my heart attack]"
Both answers are reasonably close to "absolutely not".
You seem to equate 'heart disease' to high cholesterol levels, and blood pressure readings. It is not. And if he "just" had high cholesterol and high blood pressure, he would not be seeing a cardiac surgeon.
Meanwhile, the answer to "Will diet and exercise reverse my [high cholesterol and high blood pressure]" The answer to that is sure, definitely possible.
You're right. Surgery is the only option in some cases. The question to the surgeon was about heart disease in general, or hardening of the arteries.
The doctor and I had a chat about it after the patient left. He said, "There are some researchers whose studies show that you can reverse heart disease with lifestyle changes, but when you look more closely at their data you can't tell which interventions actually help. The bottom line is that most people need the drugs and surgery to help them."
To me, it seemed like the doctor had a bias against non-drug or non-surgery options, and he didn't want to explore it with an open mind. Makes sense for him. His entire practice was based on surgery and drugs. If I were in his shoes I'd want to believe that drugs and surgery were the best option.
I think it's fair to say that I'm biased against drugs, yes.
To your second set of questions, it totally depends on the situation (patient's willingness to change, type of disease, science of drug-based vs non-drug-based interventions, whether the illness is acute or chronic, etc). It's really impossible to make blanket statements about which interventions are most appropriate.
By the time a patient is seeing a cardiac surgeon, it's extraordinarily unlikely that it would be remotely responsible to advise a patient to try to treat their condition by using diet and exercise without medication.
I think that's mainly because of tradition and the difficulty involved in getting people to make a wholesale change in their diet, not because of the superiority of the medication in reversing the condition.
Your link shows a study comparing diet to placebo. In contrast, your comment talks about diet vs medication. A nuanced but important difference. To the best of my knowledge, diet-vs-medication has not been tested systematically in a high quality trial.
Another study that you might like, and which is potentially more relevant by the point you're talking with a cardiac surgeon, is the Lyon Heart Study, which actually looks at secondary prevention:
Heart disease can be plaque, which, theoretically, might be removable with some diet change. It can also, however, be hardening of the arteries, which is a loss of elasticity of the artery walls. We don't know how to reverse tissue loss of elasticity do we? So when he said it could not be reversed with diet, that seems to be correct to me.
Here's one of the placebo-controlled studies that suggests lifestyle can reverse coronary artherosclerosis (hardening of the arteries):
http://www.ncbi.nlm.nih.gov/pubmed/1973470
And for something more digestible, here's Dr. Dean Ornish's TED talk discussing his research on the same:
In no way do I mean this as a personal attack, I simply find this comment fascinating, and it's a good example of something I see more and more of.
You basically say heart disease is either A or B. Because we don't know how diet effects A, and doctor says diet wouldn't help, doctor is right. (Notice the fallacies [false dichotomy, jump to conclusion, circular logic] become very clear when we simplify the wording.)
What I find interesting is the way we all seem to work to show that what we believe in must be right or that what we don't believe in must be wrong. Diet can't magically cure heart disease, and [logical fallacies], so diet doesn't cure heart disease. The Earth isn't warming, and [conspiracy theory], so the Earth isn't warming.
Again, I don't mean this as a personal attack (maybe your post was just had a few typos), but it's something that I see more and more frequently, even places like HN. Instead of being more like Feynman, our technology seems to be prodding us to be more like rush-hour talking heads.
I'm still trying to digest your argument, but my point was a simpler one.
I am very interested in whether or not we can restore elasticity in tissue, such as the lens of your eye, the skin on your face, or the walls of your arteries.
When a medical student, who doubtless has more knowledge than I do implies that heart disease can be reversed in any manner, diet or not, I'm interested and wanted to move the conversation forward in order to clarify.
> We don't know how to reverse tissue loss of elasticity do we?
Ok.
> So when he said it could not be reversed with diet, that seems to be correct to me.
Doesn't follow. If something has certain effects, that reality necessarily precedes our knowledge of it. Our discovery necessarily follows the reality.
When people talk about ischemic heart disease, they mean atherosclerosis. If they mean arteriosclerosis (e.g., Monckeberg's calcific sclerosis) they will call it out explicitly.
There's another reason that this general mindset exists: think drug interactions are poorly understood? Try researching nutrition and food interactions.
People eat thousands of chemicals daily, and we still haven't figured out if something as superficially simple as, e.g., the "food pyramid" is a good thing or not. What you eat is massively more complex than the drugs you are prescribed. The biggest difference there is that (most of) the chemicals have been around and in our diet for quite a long time, so they're evidently not (very) dangerous (to most. see also Celiac / Coeliac disease for an example of how long problems can exist)
Holistic approaches may be good; they may even be the best approach. But due to the insane amount of variables, they're also about the furthest from science as it's possible to get, and the least actionable in a specific sense. Everyone knows they should "eat better". Well... define "better". And be sure it applies to everyone, or be able to know who to apply what advice to.
"This is one data point, so it's hardly conclusive, but coming from a doctor who (a) teaches doctors and therefore plants seeds for the next generation and (b) should be an expert on new medical treatments with his position as the director of research, it's troubling."
Why should this be troubling? Why do you presume to know more as a pre-med than this director of cardiac research does?
The doctor's answer was, "Absolutely not."
This is one data point, so it's hardly conclusive, but coming from a doctor who (a) teaches doctors and therefore plants seeds for the next generation and (b) should be an expert on new medical treatments with his position as the director of research, it's troubling.
Meanwhile, there is a growing minority of doctors who take patients through an eating "bootcamp" where they help them take out processed foods/white-flour/high-fructose corn syrup from their diet, teach them how to shop and cook plant-based foods, etc. I saw a documentary on it, "Forks Over Knives" I believe. Fascinating stuff.
In the documentary, they take a man with advanced heart disease, cut out all meat/dairy/processed foods from his diet, and take before-and-after blood readings (cholesterol, blood pressure, etc.). It was surprising how quickly the intervention reversed his numbers.
There are other pioneers working in this area. There's Dr. Terry Wahls, an MD who reversed her multiple sclerosis by eating what some would call a "paleo" diet (only vegetables, fruits, nuts, meat). Here's her TED talk if you're interested: http://www.youtube.com/watch?v=KLjgBLwH3Wc She's currently working on human clinical trials to test this diet-intervention in other patients.
To your point, "all doctors say eat better, etc." I have two thoughts.
1. I'm glad you have doctors who have mentioned that but I've never had that experience.
2. A doctor who says, "You really need to eat better," is not quite what we need. For reversible conditions like heart disease, diabetes, (MS?) etc we need doctors who say, "Your next appointment will be with a food specialist/nutritionist. He will help you completely change your eating habits, go shopping with you to get new staple-foods, and you will stick to this new lifestyle for x months. Here's a list of foods you must not eat and here are x great-tasting recipes that are easy to make. Come back in 6 weeks and we'll do another round of blood-tests to see how it's working. If you're not willing to do this I can give you [statins, etc. fill-in-the-drug] but they won't actually treat the disease and may not make you feel better. They will keep you alive though. It's totally up to you and I'll support you in either decision."
Just my 2 cents. I think medicine will eventually look more and more like this, but it will take time to change the culture and the traditions of western medicine.