Paradigm Shifts in Medicine–Can Lifestyle Change Cure?

Modern medicine is scientific, evidence based, and very conservative.  Doctors like to treat patients with medicine and procedures that offer the best known odds for success.  No doctor wants to try out something new only to discover it kills their patients.

Patients on the other hand are fearful folk.  They usually know little of their newly diagnosed conditions and they are afraid of suffering or dying.  They are quick to take any cure they are offered.  If they have faith in their doctor and she says  take these pills and have this surgery, they will comply.  However, many people are afraid of pills and surgery.  They hate to suffer, but they are afraid of the cures offered them.  If they hear about alternative medical treatments that are less scary they will chase after them.

I’ve recently discovered I have clogged arteries, but won’t know how bad until next Thursday when I get a heart catheterization.  This is the kind of personal experience where I get to explore very concrete details of reality.  I have choices to make.  If I decide wrong I could die.  If I decide right I get restored health.

The conservative medical solution is to put in a stint and have me take Plavix for a year.

The alternative is a proposed paradigm shift that claims if I eat a radically different diet, I can reverse the buildup in my arteries.  My doctor says there’s not enough research to support this conclusion.  Books by Dr. Ornish and Dr. Fuhrman claim otherwise.  My doctor replies that those doctor’s claims are meant to sell books, and are unproven.

Here’s my problem.  I can’t handle drugs.  My doctors usually pooh-pooh my fear of drugs.  But here’s what topical steroids did to me.

steroid-reaction

And that photo was after I healed considerably.  It took a year for my face to clear up.

I’ve taken other medicines that filled my mouth and throat with sores.  I often take medicine that tears up my stomach.  I’ve taken medicine that gave me sores under my eyelids.  I’ve taken medicines that gave me pains in my intestines.  I’ve taken medicines that distorted my sense of time.  Taking penicillin once sent me to the emergency room.  And statins really did a number on my body.  I have a hard time taking a 81mg “baby aspirin.”  I even had to give up caffeine.

So the idea of getting a stint and then having to take a powerful drug for a year is pretty scary.  If it was just a stint, I’d say great.  When I had a heart arrhythmia they eventually fixed it by zapping something inside my heart.  That was after years of torturing myself with various heart drugs.  They had offered me the ablation when they offered me the drugs, but I believed I could control my heart arrhythmia with beta blockers, diet and exercise.  I did for years, but ultimately I couldn’t.  Letting them zap my heart was great.

Once again, I’m back toying with the idea of curing myself by diet and exercise.  However, this time, there’s more evidence, supported by real doctors, to suggest that the lifestyle change is a possible cure.

I’ve already shifted towards the new diet, but it’s hard.  Even though I’ve been a vegetarian since 1969, I’m a very poor eater who is addicted to junk food.  Food I found comfortable for my stomach was slowly attacking my heart.  Now switching to healthy food sometimes tears up my stomach like some medicines.  Yet, I do feel better, and I believe if I learn to eat the healthy, and especially if I learn to cook it and make it an easy routine, I could switch my lifestyle.

I do have a proven record of changing.  I did go vegetarian at 16.  And in recent years I’ve control my back and leg pain with physical therapy exercises.  I gave up pain pills and anti-inflammatory meds.

One reason I think conservative doctors are against lifestyle cures is they know few people can change their way of living.  My dad died at 49 after three heart attacks and a stroke.  He never gave up his Camels, Seagram 7, or steaks.  Nor did he try to exercise.  I was in my teens at the time, and I wondered why he wouldn’t change.  Now I know how hard it is to change.  Sometimes I think I’ve lived 12 years longer than my dad because I became a vegetarian.  It also helps that I didn’t follow in his footsteps of smoking and drinking.  What choices can I make to live another 12 years, and maybe 12 more after that?

One reason I believe lifestyle change might work is because bad lifestyle habits clogged my arteries in the first place.  The other bit of logic is if I got a stint and continued to eat and live like I did, wouldn’t I just clog up other arteries?  Isn’t clogged arteries a sign that I’m doing something wrong and should stop?

Such logic can be deceptive.  I’m reading Thinking Fast and Slow by Daniel Kahneman who details all the ways our own brain tricks us.  He chronicles a long list of deceptive psychological mechanisms our brains use to convince us that wrong things are right.  So, how do I know if my cardiologist is right, or Dr. Ornish and Dr. Fuhrman?  Decades ago some researchers suggested that stomach ulcers might be caused by the helicobacter pylori bacteria.  Most doctors said that was insane.  But over time there’s been a paradigm shift.

Are we at the beginning of a paradigm shift with chronic diseases and diet?  We know that the western diet has led to the increase in various chronic diseases, so logically it would seem if we gave up that diet, we might reverse course?

It doesn’t matter what I think.  I know my brain tricks me.  What’s important is what science learns.  My doctor is right to be skeptical of any idea that’s not well backed by lots of scientific studies with huge numbers of participants.  Ornish and Fehrman claim the science is there.  I need to find it.

JWH – 5/3/12

9 Responses

  1. Physicians and medicine is a strange science. The foundation of medicine is science, including physiology and pathology and pharmacology. When we put it together to treat patients, we perform clinical trials to compare one treatment for a disease or codition, say a new surgery and compare it to a standard, or usual care, say a drug. In the end, we analyze the data, compare the results, and declare a winner. easy, right. No. Some times it is very difficult.
    There are numerous reasons why clinical trials don’t work or are flawed or give us the wrong information. And in addidition, medicine is slow to change. We cling to old ideas and old tretaments because we know them or because “I had this patient once, and she …”. It gets complicated.
    The reality is there are no easy answers. Well, there are, such as if you have coronary aretery disease and take an aspirin, then you are less likely to have a heart attack. If you have high blood pressure, and treat it and get to a pretermined goal number, then you are less likely to have a heart stroke.
    Are stating effective for reducing cardiovascular events? Yes, some of them are, but compared to no drug.
    In this case, and in the (hopefully) near future, patients will both demand and need to help control their own destiny. Not every disease has a pill or potion to cure the disease. And with the exception of antibiotics, most drugs change risk, control or manage disease and do not cure them.
    So, here are my 2 cents worth. In the situation, have a test to determine the extent and severity of the disease and illness. Then make a concerted effort, vegan diet, to alter the underlying pathology, in this case high cholesterol levels. In 2 months, reassess the cholesterol levels. If they are better, then you are on the right track. Will the placque regress in 2 months? No. Will it start to regress in 12 months? Absolutely.
    We all have a right to be treated how we think we will be the most successful and comfortable.
    Try healthier living.

    • Bob, there are definitely no easy answers. But I wonder if we could change that? What if scientific research was more public? What if they used artificial intelligence, like IBM’s Watson, to meta-analyze research? In the Dr. Ornish book I’m currently reading, The Spectrum, he covers studies about the benefits of Omega-3 supplements. What they found is for most people the supplements are probably helpful, but they also found a class of people, those with certain stages of heart disease, where they could be harmful. What’s needed are more studies that show, if you are this kind of person, with these traits, or even with these genetic markers, then these medicines will work for you, but if you’re this kind of person, you’ll need to take a different approach.

      What science is discovering by mapping the genome that we’re all slightly different, and we all need customized medical solutions. That’s very encouraging. We’re not there yet, but we’re getting closer.

      What I’m curious to know is how many studies have been made on the impact of the vegan diet and it’s ability to reverse heart disease. Is it 5 small studies, or 10 huge studies, and 20 small studies, or so on. How many participants are required to make a valid study? Say it’s 10,000 people. Are there 10,000 people with clogged arteries even willing to go vegan? And how many different types of people are there? I’m talking gene combinations that influence this kind of heart disease?

  2. Well, Jim, I tend to agree with your doctor, but then, I would, wouldn’t I? Of course, I know I wouldn’t stick with a restrictive diet. But I also have to wonder why, if that will work for you, you haven’t done it already. You’ve been talking about changing your diet for a long time now.

    Doctors tend to be “conservative” about adopting treatment when there’s no good evidence backing it up. There’s been a paradigm shift about stomach ulcers because the evidence backed that up. There was a similar paradigm shift about prions and Mad Cow Disease, for the exact same reason – because the evidence was there.

    But there are a million things that authors – even when they’re doctors themselves – claim in books. The vast majority of them are wrong. So why believe ANY of them until there’s enough evidence to change the scientific consensus?

    Of course, you really, really want to believe them – and for good reason. But so does everyone who’s affected by whatever claim is made. And are you qualified to judge in this case? What about the people who reject modern medical care entirely and just pray for healing? They, too, think they have good reasons for that.

    Obviously, you’re going to want to change your lifestyle, too – if you can – even if you get that stent. So I guess I’d ask your doctor two things:

    (1) If Plavix causes you problems, are their alternatives? Would there be other drugs you could try, in that case? In a worst case situation, would you be able to skip the drugs entirely?

    (I have rather an atypical drug response, myself, and I tend to think that atypical responses might be the norm. I mean, everyone is a little different.)

    (2) You say you don’t know how bad it is, not yet, and that’s critical. If it’s bad, get the stent (and do the diet changes, too, of course). If you can afford to wait, then you can afford to give diet alone a try.

    Either way, listen to your doctor (although I’d advise a second opinion, as well). It’s funny, but I have little confidence in doctors, myself. I don’t think I’ve had a successful visit to a doctor since I was 13 and had my appendix removed. But as little as I expect from doctors, I expect far less from claims made in random books.

    Science depends on evidence convincing the experts. When that evidence is there, the consensus changes. When it’s not, it doesn’t. That may sound “conservative” to you, but the alternative is just believing what you want to believe.

    Still, an operation is not the “conservative” solution. There are real dangers in that, drugs or no drugs. So if you don’t need the stent right now, definitely try diet. But I’d listen to your doctor about whether you need it or not. There are real dangers in letting this continue, too!

    Good luck!

    • Bill, I don’t believe the books I am reading are making random claims. Both are by doctors are treating their patients with diets and have found consistent results. Dr. Ornish lists some of his research papers here:

      http://www.ornishspectrum.com/proven-program/the-research/

      And these articles are from major medical journals. One study from the American Journal of Cardiology shows a significant reduction in angina after being on a low-fat, plant based diet for 12 weeks.

      http://www.ornishspectrum.com/wp-content/uploads/Angina-Pectoris-and-Atherosclerotic-Risk-Factors-in-the-Multisite.pdf

      For the last two weeks I’ve gradually shifted to this low fat diet and have gotten adjusted to it. With my current incentive I believe I can stick to it. What I’m hoping is to get the chance to see if it works. I’ll know Thursday.

      What I wish is that it was easier for the average person to have access to scientific research. It would also be nice if there were trusted agencies that reviewed scientific research and annotated it. Scientific journals are peered reviewed, but it would be great to have review of reviewers. Something like a cross between Reader’s Digest and Consumer’s Reports.

      • The average person wouldn’t be able to understand scientific research, Jim, and wouldn’t understand the significance of it, if they could. That’s why we have science journalists and other interpreters in the media.

        Unfortunately, they don’t often do a very good job, in part because they need to emphasize the sensational in order to attract readers/viewers.

        In science, studies don’t mean much until they’re independently verified. And that’s not just a technicality, either. Many studies DON’T hold up upon further investigation.

        But I hope the problem isn’t too severe, so you can try something like this. If you’ve got the option, it’s certainly worth a try.

      • I didn’t expect the average person to be interested in scientific research. However, for those of us who are, I don’t think we should be barred by expensive journals or complicated databases. I believe all scientific research should be open, especially if it’s paid for with tax dollars. But more than that, I think it should be organized in a way that makes it more revealing. Knowledge shouldn’t be obscure. We now have tools to organize knowledge in ways to make it far more accessible to everyone.

      • For the most part, I agree with you, Jim, but I’m not talking about being interested in scientific research, but rather of understanding cutting edge research when you don’t have the background and the education necessary.

        Research papers are written for other scientists – and not just any scientists, but those within that field of expertise. Even science journalists frequently get it wrong when they try to explain them to the general public. Or, at least, that’s a complaint I frequently hear from scientists, anyway.

  3. That’s a very rational approach, I admire it. I think you’re right to be afraid of pills, though, if that’s what happened last time (the face thing). Is it partly about options and outcomes – like, what’s the worst that could happen if you try diet changing first, for instance?

  4. Ow !
    If my dog looked that bad, I’d shave his ass and make him walk backward.

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