Saturated Fat is Back
I think we are at the point that we need to rethink everything. Since the 1970s, it has been drilled into us that saturated fat is bad. As a doctor I have been proselytizing about this more than anyone. And yet people have been getting fatter and fatter with more and more neolithic disease. What if we were wrong? I know, sounds crazy, that something so politically driven by McGovern back then could be wrong but it is possible. Read this article in the LA Times and this commentary in the British Medical Journal (if you want to dig deeper). The amount of push back on this is amazing and I am not sure why. We hold onto our beliefs to the point we are identified with them and so it gets personal. I know, I am the same way. I was a vegetarian for over 20 years before I decided to rethink what I was doing (as I was getting fatter and fatter). I await your response to this but if you think the LA Times and the cardiologist who wrote the BMJ piece are wrong or alternative or new age then please read this article and see this video by Peter Attia MD. You want the real story and the real science, he lays it out for you. Saturated fat is not the issue, people. It blew me away but we WERE WRONG! Now it is time to retool our recommendations to patients so that we can truly help them instead of harming them.
Bravo!!
Statins were – seriously – one of the reasons I left private clinic practice. Here were a class of drugs, heavily marketed, with tons of studies to back them up, that brought with them the real possibility of rhabdomyolysis, liver dysfunction, physical discomfort, (even) more risk of medication interaction, and significant expense. All of organized medicine, these new “best” practices and core measures, and this little storm cloud on the horizon called P4P said I needed to prescribe them. And of course I knew that any patient – like my asymptomatic 62 year-old gentleman, in-shape, thin, daily runner, with a slight family history, who dropped dead after his customary morning jog – any patient suffering any ‘adverse event’ better damn sure have been on a statin lest the helpful attorney come calling. Yep, there were a whole bunch of reasons to prescribe statins. the drug companies were even starting to produce studies suggesting that some be started as early as age 18 on statins. How far off the mark have we go tent when we believe that the majority of the population is “abnormal”?
While I was spouting the collective line to patients and dutifully checking their cholesterol panels, and trying to tweak all of that to perfection, I couldn’t get them to drop weight or increase exercise, and only rarely could I get the smokes away from them. You smoke and you’re 40 pounds too fat, but HOORAY!, we got your LDL’s down. And see you in six weeks for an LFT check.
But what always bugged me about statins was that I was never willing to take them myself. So maybe I was right?
But where I, and any physician, is wrong is when we recommend under collective pressure, against our own best judgement, treatments that we would never select for ourselves. I’m at least glad I don’t do that any more. Regular, vigorous exercise, moderate alcohol, no smoking ever, and make my steak medium rare. Risk of death at some point, albeit with a smile, is certain.
Who would have thought to call Woody Allen “prescient”?
http://www.youtube.com/watch?v=gs4b3Fm5ymI