Panaceia or Hygeia

immunize yourself against the pandemic of lifestyle diseases

Posts Tagged ‘exercise’

Effectively treating atherosclerosis without angioplasty or bypass

Posted by Colin Rose on September 17, 2008

Below is a example of the issues involved in treating chronic coronary atherosclerosis presented by an intelligent patient who asked questions about treatment and did not accept the mainstream opinion without good evidence.

The vast majority of patients with chronic coronary artery atherosclerosis can be treated as the patient described here. Most cardiologists still believe the profitable myth that heart attacks can be prevented by “treating” those blockages seen on a coronary angiogram. We now have good evidence that such blockages are composed of older, harder plaques that are less likely to rupture and cause a sudden total blockage and a heart attack. Angioplasty, stent or not, and coronary bypass are PALLIATIVE procedures indicated only for intractable symptoms related to decreased coronary blood flow reserve.

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From ProCor

From the patient’s perspective: Effectively treating heart disease through diet, exercise, lifestyle and medication

In the late 1960s, Professor G. S. H. Lock was engaged in the development of the artificial heart to address cardiac conditions for which other alternatives were not available. Forty years later he writes, “Today it is difficult to argue that technological intervention on such a scale is really necessary on a routine basis. Even intervention through angioplasty and the insertion of a stent may offer little more than temporary relief.”

In this article, adapted from a longer feature in The Lown Forum, Professor Lock shares his experiences as a cardiac patient and his observations on the use of medical technology in cardiovascular care. The Lown Forum is a publication of the Lown Cardiovascular Research Foundation; ProCor is one of its programs.

Vikas Saini
President, Lown Cardiovascular Research Foundation
 
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From the patient’s perspective: Effectively treating heart disease through diet, exercise, lifestyle and medication

G.S.H. Lock, Professor Emeritus and former Dean of Interdisciplinary Studies, University of Alberta, Edmonton, Alberta, Canada

My story begins, as it often does, with the onset of mysterious chest pains. My family physician immediately diagnosed it as angina, meriting further investigation. After numerous tests on treadmills and in machines whose operations are still a mystery to me, I was confirmed as a high-risk patient with a plumbing problem, usually described as coronary arterial occlusion. An angiogram was recommended and scheduled within two weeks. However, this seemingly routine procedure created a special problem for me because three of my colleagues had failed to recover from that very procedure. With apprehension, I listened to the consulting physician explain that the risk of complication was minimal (about 1%). I asked if there was an alternative. I shall never forget his answer: “Death.”

Needless to say, I was not reassured by this response from a very able doctor who was obviously bound by prescribed procedure. Even though he was careful enough to prescribe appropriate medication while I waited for the angiogram procedure, I sought a second opinion, at another hospital. This proved to be an equal waste of time. The physician simply described the use of angiography as a “no brainer” because he viewed it as the natural prelude to intervention. No other possibility was even considered.

These experiences led me to conduct my own extensive research on heart disease, its diagnosis, and treatment. The majority of cardiologists seem to favor intervention, with all of the technology that accompanies, if not drives, it. I, however, could not support such an approach except in emergencies or when surgery was clearly the only means by which a patient’s life could be improved if not saved. Through the Lown Cardiovascular Center I was able to confirm that a healthy minority of cardiologists are not interventionists, but believe instead that in the majority of cases, heart disease may be treated more effectively using medical therapy with its four components: diet, exercise, lifestyle, and medication.

At first glance, I thought that each of these would prove to be distasteful – something that would destroy the quality of life – but I found instead the very opposite.

Luckily for me, my wife is an excellent cook – dare I say chef? – and has developed the standard Mediterranean diet into such a variety of dishes that I eat better now than I did two years ago. This alone took my cholesterol level down well below the established safe limit.

Exercise, too, has improved my quality of life. My cardiologist at the Lown Center, Dr. Vinch, is himself and athlete and he reminded me that the heart is a muscle that needs to be nourished and exercised like any other muscle. Under his guidance, I began various walking exercises. At first, using a nitroglycerine spray to decrease the resistance of the peripheral vascular system, I took my daily walks in the river valley where I live. Gradually, the walks became longer and steeper. Today, I can briskly walk up and out of the river valley and then jog up 12 flights of stairs without any angina, and without using the nitroglycerine. 

Clinical Encounter 
Date Posted: 9 April 2008

Posted in atherosclerosis, cardiology, coronary artery disease, diet, drugs, professionalism, surgery | Tagged: , , , , , , , , , | Leave a Comment »

DIRECT. More obese liars.

Posted by Colin Rose on July 16, 2008

We have already commented on a similar diet study, A to Z. Again with DIRECT (DIetary RandomizEd Controlled Trial) we have another attempt to prove the Atkins diet is better but is really another demonstration of lying by most overweight and obese people. Any study on diet and energy balance that cannot first demonstrate that the First Law of Thermodynamics is obeyed from self-reported data is totally unreliable and unreproducible and should never be published.

While the data as presented are hard to interpret in terms of detailed energy balance because daily energy intake and expenditure is not reported, as it should have been, the subjects claimed to be doing more exercise and eating less but only lost 10 pounds in two years. The prescribed diets contained 1800kcal for men and 1500kcal for women. These values are close to the basal metabolic rates of these mostly obese people. They should have lost weight continuously and markedly during the trial. Let’s see how much they should have lost if they were reporting accurately. They claimed to be eating about 500 kcal less than baseline per day on all diets. Even doing the same amount of exercise they should have lost about a pound per week (one pound of fat is about 3500 kcal) or about 50 pounds per year or 100 pounds in 2 years. Since they claimed to be doing more exercise they should have lost even more. If they had been telling the truth, most participants should have starved to death well before the end of the study! Ergo, most overweight and obese people lie about food intake and exercise; they tell investigators what the investigators want to hear.

Obesity is and always has been caused by junk food addiction. Until we deal with that, the pandemic of obesity and its terrible consequences will only worsen. Unlike most infectious diseases, there is no vaccine against  addictions. We all must make the right choices as to what we put into our bodies. In developed capitalist democracies resisting the self-destructive temptation to consume all manner of cheap addictive substances or to adopt addictive behaviours readily supplied by highly profitable enterprises is the hardest task we have. And how to deal with it is not taught in medical school.

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That obese people lie about food intake was proven beyond doubt by a study using doubly-labeled water to measure true energy expenditure. About 65% of these subjects were overweight or obese. They claimed to be eating only about 1500 kcal/day, about 40% less than they actually ate, but were burning 2500. So, they should have had a deficit of 1000 kcal/day and be losing weight dramatically but their weights were stable. Ergo they were “misreporting”, a euphemism for lying.

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Disney World

Is she on a low-fat or low-carb diet?

Posted in diet, obesity | Tagged: , , , , , , , , , , , , , | 25 Comments »

Child obesity and trans fat, a politically correct scapegoat

Posted by Colin Rose on March 28, 2007

Here is a classic example of politicians trying to deflect responsibility for a problem away from the average voter, whom they are loath to antagonize, to a politically powerless scapegoat. You will never hear a politician say that eating TOO MANY CALORIES because of food addiction is the cause of pandemic obesity. That would upset the whole food supply industry and rural voters whose votes are worth twice a much as city dwellers. So, politicians blame trans fat and recommend building more gyms, changes that will make ABSOLUTELY NO difference but will not injure an delicate voter sensibilities.

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Child obesity an epidemic, Ottawa told

25% OVERWEIGHT: COMMONS COMMITTEE For first time, Canada’s younger generations are expected to live shorter lives than parents

OTTAWA – More Canadian children are overweight and for the first time the country’s younger generations are expected to live shorter lives than their parents because of obesity, says a new Commons committee report made public yesterday.

Committee MPs said they were “shocked” to learn about the increase in overweight children, from 12 per cent to 18 per cent, and obese children, from three per cent to eight per cent, between 1978 and 2004.

That makes about one in four Canadian children overweight or obese.

The report said parents must be in denial, as a Canadian Medical Association survey found only nine per cent report they have a child who is at least somewhat overweight.

The health committee called yesterday for aggressive measures to halt child obesity, and said they share fears of experts that “today’s children will be the first generation for some time to have poorer health outcomes and a shorter life expectancy than their parents.”

Highlights of recommendations are a ban on trans fats as advised by a federal task force; use of a mandatory, simplified, standardized food labelling system; and designation of federal funds to build or replace aging playgrounds, sidewalks, rinks, pools and other community exercise spots across the country.

The report said most Canadian children spend too much time in front of TV and computer screens; don’t get the expert-recommended 90 minutes a day of exercise; eat too much fat and junk food; consume too many sugary drinks and don’t eat the recommended five daily servings of fruit and vegetables.

The committee also reported the “distressing” and “most alarming” number of 55 per cent of First Nations children living on reserves, and 41 per cent off reserves, are overweight or obese.

There is so much poverty among First Nation and Inuit people that many people cannot afford nutritious food, especially in remote northern communities, the report said.

And of more than 500 First Nations schools, only half have a gym.

The health committee proposed Canadians take up a national challenge to halt a 30-year rise in overweight children in just three years – by the 2010 Olympic games in Vancouver. Then targets to reverse the trend could kick in.

“It is ambitious but it is doable,” committee chairperson Rob Merrifield, an Alberta Conservative MP, told a news conference.

“For the first time in recorded history, our younger generations are expected to live shorter lives than their parents due to obesity,” he said in a prepared statement.

“New and aggressive action is required to address this complex and, ultimately, very costly problem.”

The report was welcomed by the Heart and Stroke Foundation, which has long warned “fat is the new tobacco,” and by the Canadian Medical Association.

Foundation chief Sally Brown said overweight children are on “a fast track” to developing hypertension, heart disease and stroke.

New Democratic Party MP Penny Priddy said by chronicling links between poverty, poor diet and lack of exercise, the report busts a myth that overweight children all sit around playing on computers and watching TV. She cited the example of children in poor families being fed Kraft Dinner instead of going to bed hungry.

Kraft Dinner is a brand of macaroni and cheese, an inexpensive food.

Expressing concern that the committee would get into trouble with the Kraft corporation, Merrifield said “I love Kraft Dinner.”

The report said on average, adolescents in Canada spend almost 35 hours a week in front of a TV or computer screen – more time than in the classroom over the course of a year. Studies had shown the less time in front of a screen and the more activity, the less weight.

The committee also postponed a decision on a possible ban on food advertising to children, saying it would assess the impact of self-regulation in Quebec, Sweden and other jurisdictions in a year before deciding on the issue.

Bloc Québécois MPs issued a dissenting report, saying the Quebec government already has a well-defined strategy to deal with juvenile obesity and that the federal government should stick to its own jurisdiction in health, which is confined to First Nations and Inuit people.

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According to studies conducted at the University of Guelph, Canadians consume an average of eight to 10 grams of trans fats per day. At 9 kcal/gm for fat, trans fat account for at most 90 kcal/day. This is the cause of the obestiy pandemic? One pound of fat is about 3500 kcal, so it would take about 40 days to gain or lose one pound of fat if one adds the trans fat or eliminates it respectively. But that trans fat is always REPLACED with another form of fat with the same calories. A gram of trans fat has the same caloric value as a gram of oil or other fat. So one has to reduce the TOTAL FAT and TOTAL CALORIE intake to make any difference.

Here is what is often used to replace trans fat. No cholesterol, no trans fat, omega-3. These slogans are now used by food manufacturers to market even more junk calories. I predict the pandemic will only worsen. Nobody wants to deal with the fundamental problem, food addiction. See my photo essay on food addiction.

Health Food in Costco

Posted in children, obesity | Tagged: , , , , , , , , , | 1 Comment »

A TO Z trial. Atkins tops?

Posted by Colin Rose on March 12, 2007

The recent publication of the results of the A TO Z trial of four weight-loss “diets” made headlines around the world: “ATKINS DIET TOPS”. The group on the Atkins diet lost about 10 pounds, a few more pounds than the others, after one year of “dieting”.

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Did anyone, including the paper’s reviewers, actually look at the numbers behind this conclusion? Table 1 shows the baseline parameters.

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Note that the average BMI was about 32. One is considered to be obese above a BMI of 30. So most were obese. Note also the weights. About 85 kg. Now look at the results in Table 2 (below). Remember that these numbers are derived by SELF REPORTING of food consumption and exercise. The subject could tell the investigators anything. There was no check on what they said. They were paid, so the subjects had an incentive to the investigators what the subjects thought the investigators wanted to hear. The subjects claimed to be eating about 1900 kcal/day at the outset of the trial. Any adult who eats only 1900 kcal/day is UNLIKELY TO GET OBESE in the first place. During the trial they claimed to be eating only about 1500 kcal/day. So even if they hadn’t increased exercise they should have had a deficit of 400 kcal/day, 2800 kcal/wk. One pound of fat is about 3500 kcal. So, if we are to believe what they reported, they should have lost at least 3 pounds per month or 36 pounds per year. But even the Atkins group only lost 10 pounds. It gets worse. They reported total energy expenditure of about 35 kcal/kg/day. Multiply by their weight and you get about 3000 kcal/day. But they claimed to be eating only 1500 kcal/day. So they should have lost two to three pounds per week, at least 100 pounds per year. Also note that total calorie intake remained about the same in all groups in spite or a wide range of percentages of protein, fat and carbohydrate and by the end of the trial these percentages tended towards the same fraction in all groups. The First Law of Thermodynamics says energy cannot be created or destroyed. Any study of energy flows that cannot first show that energy is conserved should never be published. The methods employed by the study are fatally flawed. No conclusion can be drawn from this data. Many interpretations are possible. So, if all groups ate the same REPORTED calories on the average and burnt the same REPORTED calories on average, why did the Atkins group lose a little more weight? Maybe the Atkins group did a little more exercise. Who knows? They were lying about everything. Or, maybe, for some reason those presumably following the Atkins diet were slightly less proficient liars as the others.

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That obese people lie about food intake was proven beyond doubt by a study using doubly-labeled water to measure true energy expenditure. About 65% of these subjects were overweight or obese. They claimed to be eating only about 1500 kcal/day but were burning 2500. So, they should have had a deficit of 1000 kcal/day and be losing weight dramatically but their weights were stable. Ergo they were “misreporting”, a euphemism for lying.

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The real cause of obesity is food addiction. Like alcoholics food addicts will deny they consume too much and/or exercise too little. See my photo essay on the topic. Which diet is this lady on?

Food Addiction

Is she on a low-fat or low-carb diet?

Posted in cholesterol, diet, exercise | Tagged: , , , , , , , , , , , , , , , | Leave a Comment »