Dr. Tim Says....

What I (Un)Learned in Medical School

It was about 15 years ago, but as amazing as it may seem, I actually had a professor say, "I don't care about my diet, I'll just take Zocor or another cholesterol lowering medication and keep eating my thick, juicy steaks." This was in response to a Grand Rounds lecturer speaking about the importance of diet in preventing heart disease.

The professor was quite an important researcher and made the argument that taking a pill like Zocor to lower cholesterol was just as good as eating healthy. The most interesting thing is that no one in the auditorium argued with him (he was, after all, a very prominent physician).

While we have a great deal of research showing the power that change in diet and lifestyle can have on our health, many have been smaller studies. A very large study of about 43,000 men who participated in the Healthy Professionals Follow-up Study (Circulation 2006; 114: 160-167) shows just how important such changes can be. (Ironic that the study participants are predominantly physicians.)

In the dietary section of the study, the researchers assigned a rating scale for consumption of those foods known to reduce the risk of heart disease. These included seven categories: percent energy from trans fat; ratio of polyunsaturated to saturated fat; amount of chicken eaten; the ratio of fish to red meat eaten; daily servings of fruit; amount of vegetable protein, such as legumes and soy products; and the number of grams of cereal fiber eaten. Each category varied in the points assigned but the total score could range from 2.5 points (worst) to 77.5 points (best).

Those study participants with diet scores over 42.4 had a 25% reduction in risk of heart disease. As scores decreased below 31.6 the risk increased by close to 60%.

The research looked at other lifestyle modifications as well, including Body Mass Index (BMI), smoking, exercise and alcohol use. When these were taken into account, those men who adhered to healthier lifestyles had a much lower risk of heart disease. In fact, the change in risk was dramatic and the researchers estimate that 62% of all coronary (heart) events may have been avoided had all of the health professionals eaten well, kept their BMI under 25, exercised and did not smoke (yep, there are health professionals that smoke!).

But what of my professor (the one who just wants to take his Zocor)? When those in the study taking medication for hypertension or high cholesterol were looked at, the ones who followed all five lifestyle recommendations had a 57% lower risk of heart problems.

Many people have high cholesterol and hypertension for both lifestyle and genetic reasons. Either way, medication is not the complete answer. Eating great healthy food, along with other lifestyle changes, does prevent heart attack.

August 21, 2006

Last updated: 08/21/06