If Sid Were Nina Teciholz’s Father, Would She Prepare Him a Steak Soaked in Butter?
I have so many cardiology patients similar to Sid but he is one of my favorites. He had coronary artery bypass surgery 18 years ago and he had a stent to one of his bypass grafts 3 years ago. He gets occasional angina for which he takes a nitro pill. He has struggled to follow a lifestyle program to support his health. “Moderation in everything” was his mantra but his wife reported that it was more like excess in everything except exercise. Late last year he began to focus on the wedding of one of his granddaughters planned in 2018. He realized that he had to take more responsibility for his health. He qualified for the Pritikin Intensive Cardiac Rehabilitation program in the area and his Medicare insurance covered this advanced training in exercise, stress management, and nutrition centered on plant based meals. He cut out most dairy, red meats and cheeses. He learned to like bean stews, vegetable soups, oatmeal and salads. He reported increased energy and had not needed a nitro pill for months.
All was well until this morning when Sid emailed me. He was surfing the internet and came across a report in the LA Times by journalist Nina Teicholz that appeared to contradict all that he had learned in the last year. He read that the American Heart Association (AHA) was not to be trusted and that there was much hidden evidence that led to the conclusion that “butter, steak and coconut oil weren’t likely to kill you”. Sid emailed me asking if it was true that he could resume eating butter and steak, foods he had learned to omit and substitute for in the last 12 months since cardiac rehabilitation.
Sid’s dilemma is real not hypothetical. He wrote to me that he would like to return to his former pattern of eating if it really was “OK” now. Sid did not recognize that his former meat-centric diet was the very diet that contributed to his early heart disease. So what should Sid do? Should he abandon the new diet he learned at a program covered by Medicare after they considered for years whether there was enough data to reimburse it (which they did in 2010) or should he follow the “new science” that teaches that we were all misled by the AHA and other groups leading us down a path that led the country to get fatter and sicker? As has been pointed out by David Katz, M.D. of the Yale University School of Medicine, heart disease is not hypothetical and decisions like this may be of huge importance to the wellbeing of individual patients.
Headlines and blogs provide an opportunity for diverse opinions to be voiced but they are quite different than the process of submitting original medical research to a “peer-reviewed” medical journal where the data can be criticized, rejected, or requested to be revised. Sid had adopted a dietary program, as developed at the Pritikin Center, that was based on many peer-reviewed articles in addition to the review by CMS and Medicare before approval. The Op-Ed piece in the LA Times this morning that advised him to ditch all that he had learned underwent none of that process. It was the opinion of one journalist.
While the Presidential Advisory of the American Heart Association that recommended decreasing foods rich in saturated fats has created a media frenzy, it is not alone in its analysis of the science. Earlier this year in the journal of the American College of Cardiology (a large organization of cardiologists separate from the AHA) a lengthy article was published on nutrition for heart patients. It came to similar conclusions as the AHA advisory in terms of reducing meats, eggs, and coconut oil. For some reason, this peer-reviewed paper did not incite the same fervor that the AHA article did despite similar findings. If Sid were to read this scientific report he would want to stay focused on his plant-based diet without meat, butter, eggs or coconut oil. Even more recently the Canadian government released an announcement about new dietary guidelines under development favoring plant-based diets and particularly legumes while eliminating a milk pattern. If Sid read this carefully prepared document he also would be inclined to stay on track with his diet.
Why is it that Ms. Teicholz and other journalists like Gary Taubes, both promoting diets rich in meats, cheeses, dairy, and coconut oil, get enormous space and headlines in newspapers such as the New York Times, the Wall Street Journal and now the LA Times? It is curious why this has been a pattern repeated over and over in the last few years. Allegations of funding and influence have swirled around Teicholz and others promoting this “new” saturated fat nutrition that conflicts with both major cardiology organizations.
The problem gets back to Sid and his email to me about 12 hour ago. The shock headline in the LA Times today was read by real people who have real medical conditions. The advice by Teicholz regarding the apparent safety of eating butter, steak and coconut oil was delivered without consideration as to the impact it has on Sid and thousands of others like him who might be harmed by disregarding recommended limits on foods rich in saturated fats. I truly wonder if Teicholz herself had loved ones with advanced atherosclerotic heart disease if she would serve them grilled steaks in butter sauce? Or would she decide not to risk it and serve plant-based meals naturally low in saturated fat that have been developed from clinical trials published in peer-reviewed journals? Fortunately Sid reached out to me and is sticking with his Pritikin diet but I anticipate more calls and emails from confused patients when my office opens up tomorrow.