I've frequently written that medicine is hard work. It's work for the doctor, work for the patient, and work for the society as we make national decisions about health care. There are few shortcuts in the prevention and treatment of disease. It takes ongoing research at the bench and at the bedside, and then sorting through the chaos as the battle plan meets the enemy. Real people don't always behave as the textbooks suggest, and even if we know, say, that quitting smoking saves lives, we can't always make it happen.
This is why I find simplistic medical aphorisms to be so offensive. They are rarely helpful, sometimes harmful, and give a distorted view of what medicine can and cannot do. An apple a day does not keep the doctor away, and although a diet that relies more on fruits and vegetables is beneficial, it is no guarantee of anything.
Dr. Oz and other medical charismatics love aphorisms. They make good sound bites, they're easy and quick to read, and consumers love them, but cui bono? Certainly not patients and others seeking to improve their health. These naive maxims serve only the narcissistic and economic needs of modern medicine men.
A reader pointed me to this particular piece at Dr. Oz's website, which reads more like an add on the back of a glossy magazine than useful advice from a real doctor. It's called "28-Days (sic) to Prevent a Heart Attack." Heart attack prevention happens to be something I know a bit about. Primary prevention (preventing a first heart attack) and secondary prevention (preventing subsequent heart attacks) is one of an internists most important tasks, given that heart disease is one of the three top killers of North Americans. We've gotten very good at this through helping people stop smoking, encouraging proper exercise and dietary habits, and treating diabetes, high blood pressure, and high cholesterol. We have decades of data to guide us (and as an engineer recently pointed out to me, without data, it's just another opinion).
So what does Dr. Oz recommend?
Week 1: artery maintenance. Oz's recommendation: flax seed oil, baby aspirin, and stretching. The real data? Avoid tobacco, keep a healthy cholesterol level and blood pressure through diet, exercise, and drugs when needed, and control diabetes. Aspirin as primary prevention is a bit controversial. We know it can prevent a first heart attack, but we also know that in people without many risk factors, the rate of complications from aspirin therapy may negate its benefits. In secondary prevention, aspirin saves lives unequivocally.
Week 2: challenge your heart. He recommends exercise. This is not controversial.
Week 3: lower your blood pressure. He recommends fruits and vegetables. The more complex answer? Dietary changes can help control blood pressure. Certain diets, such as the DASH diet, have been proven to help lower blood pressure, but that is different from "controlling" blood pressure. To prevent heart disease, blood pressure should be kept within a certain range, one that is sometimes achievable through diet and exercise, and sometimes not.
Week 4: reduce stress. Seems reasonable. This isn't as potent a risk modification as the others, but it's not a bad thing.
Here's my science-based alternative to Oz's simplistic month of prevention.
- Have your risk for heart disease assessed by a professional. Some useful---although imperfect---tools exist to put a number on your risk, such as the Framingham Heart Score.
- Identify the most important risk factors in your life: smoking, cholesterol problems, high blood pressure, and diabetes. Work with your doctor to develop a life-long strategy to lower your risk. You may need drugs to help with any of these, you may not. In some cases, if you already have heart disease, the data show that you almost certainly will need drugs to prevent further heart attacks.
- Don't give up. In quitting tobacco, relapse is the rule. When you relapse, go back to your doctor for help rather than giving up. Missing medications, giving up on exercise, returning to bad dietary habits are all common, and rather than avoiding your doctor in fear of getting a finger-wag of shame, go back and ask for help.
- There are no simple, magic answers. There is no one plan, one pill, one supplement, or one doctor who can help you avoid heart attacks. Every family medicine doc, internist, and cardiologist is trained in this, and the best ones keep up with the data as it changes, and can help apply what we know to you as an individual. No TV show or website (including this one) has answers that are applicable to everyone or that are always effective. Have questions for your doctor? Write them down and ask, and if you can't get satisfactory answers, find another doctor (remembering that sometimes the correct answer is "I don't really know").
Everyone knows that good eating and exercise are good. Having someone repeat it over and over, and telling you it is a sure thing to prevent heart attacks is idiocy. Set goals, aim toward them, and use the data to guide you.