Editor’s Note: This is the 53rd in a series on optimal diet and lifestyle to help prevent and treat disease. Any planned change in diet, exercise or treatment should be discussed with and approved by your personal physician before implementation. The help of a registered dietitian in the implementation of dietary changes is strongly recommended.
Medicines are a mainstay of American life and the healthcare system, not only because they are perceived to work by the individual taking them, but also because their benefit may be shown by the objective assessment of scientific study. Clinical research trials have shown that some of the medicines of Western science may reduce the risk of heart attacks, strokes and cardiovascular death, while others may reduce certain types of cancer.
In the first 52 installments of The Non-Medicated Life, informed diet and lifestyle have been shown to accomplish naturally for the majority of individuals, many, if not most of the benefits of medications in the treatment of chronic medical conditions. For those wishing to limit their use of medication or avoid unnecessary medication this is reassuring. What has not been adequately emphasized, however, are the limitations of modern medications and procedures, especially in the prevention of disease and how diet and lifestyle may be the more appropriate first choice.
Modern medicine utilizes a model of care which is based in fixing a problem rather than preventing a problem. For more acute medical problems this approach is very successful and dramatic. For example, in traumatic accidents Western medical science offers the means to stabilize the patient, prevent exsanguination (blood loss), replace blood volume, maintain blood pressure, and stabilize damaged blood vessels and organs, so that recovery may take place. In infections with noxious microorganisms, Western medical science offers the means to identify the organism and its growth requirements, and the pharmacological means to either stop the growth or kill the organism. Many lives have been saved as a result.
In the prevention of disease, Western medicine has had its greatest successes with immunizations, sanitation, and the correction of vitamin deficiencies. Diseases such as smallpox, polio, hepatitis B, measles, human papilloma virus (HPV), and pneumococcus have either been eradicated or controlled with immunizations resulting in tremendous reductions in both morbidity and mortality. The science of sanitation and clean, potable water, likewise, has prevented the spread of disease and dramatically improved human life. The identification of vitamin requirements and their treatment with appropriate diet has made diseases such as scurvy, beriberi, and pellagra a thing of the past.
Additionally, Western medical science has attempted to address the prevention of cardiovascular disease by identifying predisposing factors and modifying such factors to reduce or halt disease progression. Thus we have medications to reduce blood pressure and cholesterol, which reduce the formation of cholesterol plaque in the walls of arteries (atherosclerosis). Such medications have significantly reduced the rate of stroke and heart attack.
Nevertheless, there are limits to the Western medical science approach to prevention. Even with the use of potent pharmaceuticals and good control of blood pressure and cholesterol atherosclerosis progresses. For example, statins, the strongest cholesterol lowering drugs only reduce relative risk by 30 to 50 percent. In part this is because global risk is dependent on multiple factors, not just cholesterol. In part, this is because the disease is usually already fairly well advanced by the time it is recognized. In part, it is because cholesterol is many times not optimally controlled because diet and exercise are not included in the treatment armamentarium (resources available).
Likewise, Western medical science “preventive” procedures have limits as well. Coronary artery bypass graft (CABG) surgery “prevents” heart attacks and deaths as compared to medical therapy, only in a small number of individuals at highest risk with disease in the left main coronary artery, or severe disease in all three coronary arteries and only for a limited time. The procedure that helps reestablish adequate blood flow, and can thus reduce symptoms, does not address continuing atherosclerosis in both bypass vessels and native arteries. Thus, if blood has high cholesterol the bypass vessels themselves over time may become diseased and new disease appear in previously uninvolved portions of native arteries.
Indeed, within one-month to one-year after CABG with leg vein bypass vessels five to ten percent of those grafts have closed, and by the end of the fifth post-op year fully 35 percent of leg vein bypass grafts become diseased and stop working. Moreover, despite widespread acceptance and use, coronary artery stents in the majority of patients with symptomatically stable disease have not been definitively shown to prevent heart attacks and deaths compared to medical therapy. In large measure these procedures fail to prevent disease progression because they do not address the atherosclerotic process itself.
Additionally, CABG and stents are generally used only for those portions of the artery narrowed 85 to 99 percent. Yet plaque which narrows the artery a mere ten to 50 percent, and produces no warning symptoms or abnormalities on stress tests, accounts for the majority of heart attacks. The reason is felt to involve the different compositional makeup of smaller plaques, which makes them more vulnerable to disruption and subsequent heart attack.
Diet and healthy lifestyle changes are the original, natural approach to prevent cardiovascular disease and other diseases. Moreover, they are both very powerful when used consistently over time and very low risk. In parts of the world such as Okinawa and Crete, where an optimal cardiovascular diet is consumed, epidemiological data show heart disease to be a rare phenomenon.
In a randomized controlled clinical trial, the Lyon Diet Heart Study, a high omega-3 Mediterranean diet compared to a prudent Western diet reduced the risk of cardiovascular death by 70 percent in five years. Moreover, a healthy diet and lifestyle has no side effects – no muscle aches, no liver inflammation, no fatigue, and no sexual dysfunction. And the financial cost of a healthy diet and lifestyle is tiny compared to the cost of multiple medications and procedures.
Finally there is no scientific evidence that alternative approaches involving supplements, herbs, mega-vitamin therapy, or chelation therapy can prevent cardiovascular disease and take the place of a healthy diet and lifestyle. An assessment of risk and benefit suggests that a healthy diet and lifestyle should form the foundation for any approach to prevention of disease, and while it may be supplemented by the medications and procedures of Western medical science, it cannot be replaced by them.
In summary, there are definite limits to the ability of the medicines and procedures of Western medical science to prevent disease, especially cardiovascular disease. A healthy diet and lifestyle should serve as the basic strategy for disease prevention because the risk and cost is low and the benefit is proven and significant. This basic strategy is complementary to and helps address the limits of Western medical science.
Paul E. Lemanski, MD, MS, FACP is a board certified internist with a master’s degree in human nutrition. He is director of the Center for Preventive Medicine of Paul E Lemanski MD PLLC. Paul is an assistant clinical professor of medicine at Albany Medical College and a fellow of the American College of Physicians.
**Originally published in Adirondack life magazine.