It’s a new age.
Nutrition has been put on the back burner for years… until now. Medical providers around the nation are starting to incorporate nutritional concepts into their plan of care. For example, the other day a client informed me that her cardiologist recommended she start a plant based diet to reduce cholesterol!
Go back 10 years ago and this was blasphemy! A doctor or advanced practice provider may have raised her nose to the idea. But as the research continues to support the benefits of a plant based diet, it is getting harder and harder for medical professionals to ignore the scientific evidence. Research is showing us, if young people are following a mainly plant based or whole food lifestyle, they are extending not only their life expectancy… but improving their quality of life.
Quality of life is a very important concept. Who wants to live a life of low quality, or suffering?
For example, autoimmune disease worsen when eating an unhealthy diet, and with diabetes we are at risk of losing limbs, eye sight, and skin sensation. If you have hypertension you are at risk of stroke, vision changes, chronic headaches, and dementia. And of course cholesterol elevations have been associated with heart disease (& heart attacks), stroke, and dementia.
“Who wants to live a life of low quality, or suffering?”
US Leading Causes of Death
More on cholesterol…
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 the LDL. He also observed a reduced level of HDL (Gofman et al., 1954b). By 2020 Gofman’s discoveries have been replicated many times. The correlation between high LDL levels, low HDL levels, and heart attacks is one of the most profound epidemiologic 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 epidemiologic 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 build up 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 in order to reverse the affects of artery stiffening.
“…adults will have to follow strict cholesterol lowering diets in order to reverse the affects of artery stiffening“
What are the current guidelines medical professionals follow when treating high cholesterol?
To keep it simple there are two main guidelines…
1. To emphasize a healthy lifestyle to prevent elevated cholesterol levels.
2. 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 do not understand nutrition, and nutrition is the only alternative to statin medication. Because of this, the first guideline of prevention via lifestyle changes is difficult to implement. It is much easier to treat with medications once the cholesterol crosses the 110-120 mark. But unfortunately providers are also letting cholesterol remain high due to a lack of urgency. There’s so much confusion around cholesterol that providers avoid treatment all together.
But it is not their fault…
Medical providers are hesitant to discuss nutrition because they are not taught to. And they are hesitant to attack cholesterol because they have never understood the true cause of heart attacks. The AMA requires little to no nutrition education in medical schools and the AAPA requires the same minimum in Physician Assistant education. Along with a lack of nutrition education there is a lack of direct correlation between food intake, cholesterol and heart attacks. For example, while undergoing training many medical providers are told a cholesterol level of 120 is not urgent and they rarely correlate cholesterol with animal products. Because of the laxity and lack of nutrition education, it is difficult for providers to implement these unclear concepts into practice.
This is why patients who tend to listen to the guidance from their PCP on cholesterol management still have a high risk of heart attack.
Since medical providers aren’t trained on these important concepts, it is important to recognize the providers who are implementing them. Those who are implementing nutrition into their practice are doing so all on their own and are trying to guide other PCPs to do the same.
If you find a medical provider who is willing to discuss nutrition and lifestyle changes with you, you have found a hidden gem.
For a list of medical doctors leading the fight against food, take a look at this inspiring list of professionals and their stories: New Age Doctors
Why do we lead this fight?
Because although medicine prolongs life, it does not prolong quality of life. Many who continue to eat unhealthy while taking medications, will suffer as other diseases take over their body.
Medicine is like a bandaid that falls off over time, and as we increase dosages (adding a new band aid to the wound) the patient continues their unhealthy diet. But although a new band aid is placed, a new diagnosis tends to be found and now a new medication will be started. It’s a cycle we are trying to stop.
Eating healthy foods MOST OF THE TIME, not only reduces heart attack risk but can reduce risk of cancer, heart failure, stroke, dementia, and worsening autoimmune diseases!
As a primary care PA-C, health coach, and nutritionist myself I have helped my share of clients and patients improve their quality of life.
It takes a deep found empathy to fight this battle. But I think we all should have the goal to learn how to fight this battle, in order to prevent this cycle in our children…. who are our future generation.
The new generation of medical providers are paving the way to a happier and healthier future. If you are a medical provider now is the time to jump on board.
Mariah Campoy, PA-C, CHC, Nutritionist