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Scientific Basis for "Heart-healthy" Advice
Sorry, Doctor Kirksey,
I am not a doctor. I am a patient who can read and think critically and I have come to some conclusions. If you were my cardiologist, I would tell you this:
1. I don't subscribe to the "lipid hypothesis". No dietary regimen has ever been shown to have an effect on heart disease. See the French paradox. Half of all heart attacks take place in people with normal cholesterol.
2. Anyone is capable of a weight loss "stunt", losing weight in the short term, but virtually everyone - I repeat, everyone - gains all the weight back and more, including the highest-motivated patients who have been provided with substantial clinical and nutritional support. Even those who, it has been shown, do not increase their calorie intake following the initial weight loss.
Since the net result of the standard medical advice to "lose weight" is essentially always - repeat, always - yoyo weight loss and regain with additional weight added, resulting in a worsened clinical situation, I have to ask how this advice conforms to the "first do no harm" clause of the Hippocratic oath.
No diet and exercise regimen - not moderate calorie restriction, semi-starvation, or fasting - has ever been shown to be effective in long-term weight loss. None. We have a genetically-determined set point, and our weight can vary fifteen pounds or so up or down from that set point, and that's it.
3. You say the "ideal BMI" is 23. I am 5' 10", and I understand the "ideal height" is six feet two inches. Should I try to achieve that, too, because that is altogether just as realistic as trying to achieve the "ideal" BMI. I guess if I can't achieve it, I "don't really want it".
4. In my opinion, calcium scans are an obscene waste of limited health care resources and the equivalent of 250 unnecessary chest X-rays. Shall we have calcium scans for everyone over 45 and no preventive care for 47,000,000?. Tell me exactly, what valuable information does a calcium score add to a standard EKG and nuclear stress test?
5. A patient can have all of the "right" lab numbers and still die of sudden cardiac arrest, so why am I even seeing you?
This discussion is related to Exerecise and Cardiac Health.
I am not a doctor. I am a patient who can read and think critically and I have come to some conclusions. If you were my cardiologist, I would tell you this:
1. I don't subscribe to the "lipid hypothesis". No dietary regimen has ever been shown to have an effect on heart disease. See the French paradox. Half of all heart attacks take place in people with normal cholesterol.
2. Anyone is capable of a weight loss "stunt", losing weight in the short term, but virtually everyone - I repeat, everyone - gains all the weight back and more, including the highest-motivated patients who have been provided with substantial clinical and nutritional support. Even those who, it has been shown, do not increase their calorie intake following the initial weight loss.
Since the net result of the standard medical advice to "lose weight" is essentially always - repeat, always - yoyo weight loss and regain with additional weight added, resulting in a worsened clinical situation, I have to ask how this advice conforms to the "first do no harm" clause of the Hippocratic oath.
No diet and exercise regimen - not moderate calorie restriction, semi-starvation, or fasting - has ever been shown to be effective in long-term weight loss. None. We have a genetically-determined set point, and our weight can vary fifteen pounds or so up or down from that set point, and that's it.
3. You say the "ideal BMI" is 23. I am 5' 10", and I understand the "ideal height" is six feet two inches. Should I try to achieve that, too, because that is altogether just as realistic as trying to achieve the "ideal" BMI. I guess if I can't achieve it, I "don't really want it".
4. In my opinion, calcium scans are an obscene waste of limited health care resources and the equivalent of 250 unnecessary chest X-rays. Shall we have calcium scans for everyone over 45 and no preventive care for 47,000,000?. Tell me exactly, what valuable information does a calcium score add to a standard EKG and nuclear stress test?
5. A patient can have all of the "right" lab numbers and still die of sudden cardiac arrest, so why am I even seeing you?
This discussion is related to Exerecise and Cardiac Health.
You have made some interesting points. However, time for a counterpoint...
Obviously, genetics play a big role in our size, shape and tendencies for diabetes, heart disease. However, I'm betting I'm much older than you. I got out my high school yearbook, and reviewed my classmates, and very few of us were overweight. In the 1950's, we ate meat that wasn't so high in fat, a fast food restaurant was a really fast cook and faster server. Most of us couldn't afford a car in high school so bikes and legs got us there. That's not the story today, young people are much fatter than we were. That's just the way it is.
My mother got quite heavy. She was 5' 1" tall, and weighed about 180 when she was 45 years old. She went on a diet, and for the next 48 years she probably weighed no more than 110 pounds. That's one person. I'm 6'2", your ideal height model, and I've lost 44 pounds since my heart attack in 1999, and have a BMI of 24.9. That's two....
I believe we can't use a broad paintbrush when it comes to health issues. Even someone as long in the tooth as I'm getting sees that.
You have made some interesting points, I question the calcium theory also, but the only thing I know for sure is that I don't know anything for sure.
Obviously, genetics play a big role in our size, shape and tendencies for diabetes, heart disease. However, I'm betting I'm much older than you. I got out my high school yearbook, and reviewed my classmates, and very few of us were overweight. In the 1950's, we ate meat that wasn't so high in fat, a fast food restaurant was a really fast cook and faster server. Most of us couldn't afford a car in high school so bikes and legs got us there. That's not the story today, young people are much fatter than we were. That's just the way it is.
My mother got quite heavy. She was 5' 1" tall, and weighed about 180 when she was 45 years old. She went on a diet, and for the next 48 years she probably weighed no more than 110 pounds. That's one person. I'm 6'2", your ideal height model, and I've lost 44 pounds since my heart attack in 1999, and have a BMI of 24.9. That's two....
I believe we can't use a broad paintbrush when it comes to health issues. Even someone as long in the tooth as I'm getting sees that.
You have made some interesting points, I question the calcium theory also, but the only thing I know for sure is that I don't know anything for sure.
COMMUNITY LEADER
Thanks, weight loss was not near as tough as I thought, this was my first try. If a wimp like me can do it........................
FYI, the car will be in a Corvette ride through the mountains this weekend with a couple dozen others, can't wait!
Jon
FYI, the car will be in a Corvette ride through the mountains this weekend with a couple dozen others, can't wait!
Jon
Kudos to you on your weight loss and lifestyle management!!
It's gonna be a nice weekend to take the car for a spin : )
Take care Jon
It's gonna be a nice weekend to take the car for a spin : )
Take care Jon
Gotta go with Jon on this one!!
Dr. Kirksey has contributed a number of great articles to the forums. His professional opinions and suggestions are supported by mega studies and years of practicing medicine.
Take the time to read through his posts (Cardio Prevention Forum) and his journal entries. His points are valid, current and reflective of a doctor who adheres strongly to the Hippocratic Oath....
Bob, the choices are yours....You are certainly free to bypass tests, medications, advice, etc. But, literature and studies support the doctor's suggestions.
Be well.
connie
Dr. Kirksey has contributed a number of great articles to the forums. His professional opinions and suggestions are supported by mega studies and years of practicing medicine.
Take the time to read through his posts (Cardio Prevention Forum) and his journal entries. His points are valid, current and reflective of a doctor who adheres strongly to the Hippocratic Oath....
Bob, the choices are yours....You are certainly free to bypass tests, medications, advice, etc. But, literature and studies support the doctor's suggestions.
Be well.
connie
COMMUNITY LEADER
Wow, a little stored up anger there? You would probably stand a better chance of getting to Dr. Kirksey if you pried open your wallet and spent the $20 to post on his forum.
I actually agree with your 4th point, I've never been sold on the calcium score scans. I'll wait until they have a litlle more data on their accuracy and usefulness. Here's a thought, don't like them, don't have one.
I don't agree with the rest of you points though. Personally, I decided to loose weight on January 1st, 2007, yes a New Years resolution. I have lost around 70 pounds by doing it right, no fad diets, no stop and go exercise routine but through a proper diet and daily exercise. I have lost weigh at a slow and steady rate and have yet to put the first pound back on. I think it is a more fair statement to say that some people have more difficulty loosing weight than others, but it could be their methods. Are you really saying that all of us that HAVE lost serious weight through proper diet and exercise are wasting our time or are you just not happy with the results of your efforts? I know what the ideal BMI is and I have that as my goal. To say EVERYONE has a predisposed weight they can never alter is either an excuse or just plain backwards thinking.
Also, I guess what you're saying is I'm just as well of with a total cholesterol of 300 plus as I am with my current TC of 151, how can that possibly make any sense to anyone? Plaque is made up of what..... you can say it... we all know.... it's LDL, why would it not make sense to have less of it?
I also understand that people can die with good numbers, happens all the time. But remember that there are other causes of cardiac death than high cholesterol and other lipids. You have not even accounted for those that die of heart disease not realted to CAD, things like electrical issues as well as structural issues with the heart itself. It is true, we all have some plaque in our arteries and one can rupture and cause a heart attack, even in someone with good numbers but I'm pretty sure you'll find more plaque in people with high lipids which will only increase their risk. Seems like a no brainer to me.
I guess what I don't understand is why you would want to come on and bash a doctor who is volunteering his time to reach out and help people. You can certainly disagree with him, but why discredit him on the forum?
Oh well, you have a right to express you opinion, this is mine.
Jon
I actually agree with your 4th point, I've never been sold on the calcium score scans. I'll wait until they have a litlle more data on their accuracy and usefulness. Here's a thought, don't like them, don't have one.
I don't agree with the rest of you points though. Personally, I decided to loose weight on January 1st, 2007, yes a New Years resolution. I have lost around 70 pounds by doing it right, no fad diets, no stop and go exercise routine but through a proper diet and daily exercise. I have lost weigh at a slow and steady rate and have yet to put the first pound back on. I think it is a more fair statement to say that some people have more difficulty loosing weight than others, but it could be their methods. Are you really saying that all of us that HAVE lost serious weight through proper diet and exercise are wasting our time or are you just not happy with the results of your efforts? I know what the ideal BMI is and I have that as my goal. To say EVERYONE has a predisposed weight they can never alter is either an excuse or just plain backwards thinking.
Also, I guess what you're saying is I'm just as well of with a total cholesterol of 300 plus as I am with my current TC of 151, how can that possibly make any sense to anyone? Plaque is made up of what..... you can say it... we all know.... it's LDL, why would it not make sense to have less of it?
I also understand that people can die with good numbers, happens all the time. But remember that there are other causes of cardiac death than high cholesterol and other lipids. You have not even accounted for those that die of heart disease not realted to CAD, things like electrical issues as well as structural issues with the heart itself. It is true, we all have some plaque in our arteries and one can rupture and cause a heart attack, even in someone with good numbers but I'm pretty sure you'll find more plaque in people with high lipids which will only increase their risk. Seems like a no brainer to me.
I guess what I don't understand is why you would want to come on and bash a doctor who is volunteering his time to reach out and help people. You can certainly disagree with him, but why discredit him on the forum?
Oh well, you have a right to express you opinion, this is mine.
Jon
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