I've been asking a lot of questions lately...questions of myself, of my profession, of the health care industry. I guess this is par for the course. As an eye doctor, it's my job to ask a lot of questions. In fact, the better I am at this, the easier it is to do my job. It's said that careful history-taking ( i.e., questioning) can determine the diagnosis most of the time. This 1975 study reported a correct diagnosis made by case history alone in 80% of the cases (physical examination wasn't needed!): http://www.jstor.org/discover/10.2307/20473216?uid=3739560&uid=2&uid=4&uid=3739256&sid=21102585650647
So, each workday, I ask a lot of questions. Whether it be to determine which prescription is the right one for my patient ("which lens is better, 1 or 2?") or to help in the assessment of a patient's health ("do you have hypertension?" or "do you smoke?" or "do you have any family history of glaucoma?"), I try to ask the right questions and listen effectively to what my patient tells me. If I see diabetes or hypertension in the eyes, I generally have a game plan. If I see macular degeneration or glaucoma, I know what I am supposed to do. But, what do I do when I see cholesterol in the eye?
From the front of the eye (corneal arcus)...
...and surrounding tissue (xanthelasma)...
...to the back of the eye in the retina (emboli; Hollenhorst plaque),
it seems I am seeing, more and more each new year, evidence of cholesterol in the eyes of my patients. Indeed, even if there truly is more cholesterol seen nowadays in peoples' eyes (i.e., five years ago an eye doctor would see only 1 patient a day with cholesterol in their eyes, now they would see 3-5 patients a day with cholesterol in their eyes), what would that mean? What would it matter? Sure, if an embolism is present in a retinal artery, this can have a disastrous effect on ocular health and vision. But, if cholesterol is building up in the cornea ( arcus), does it mean anything? Does it matter?
Lastly, one more group of related questions- and this is probably where I'm trying to go- do I believe in the cholesterol-heart disease hypothesis or the lipid hypothesis? Do I follow along with the health, food and political industries (among others, these last few decades) that say we all need to eat low-fat, high-carb diets to keep heart-healthy? Do I really agree with these same industries that say we are fat or obese because we are lazy (don't exercise enough) and we have no self-control (eat too much)? Is "a calorie a calorie" and is saturated fat to blame for everything un-"healthy"?
Well, I think there are many more questions to ask ( and much deeper ones as well) but let's start there. Maybe we in the health care field are too busy to talk about eating REAL FOOD while cutting down on or eliminating processed foods and sugars......too busy to discuss the possibility that maybe what we feed our bodies-what we eat- does have a tremendous affect on our health. Let's continue the discussion and continue asking questions...
"Being a clinician, I'm responsible for outcomes. Studies are fine...evidence-based medicine is fine...but really what drives clinicians is the health of our patients. And, if we give them advice that works and they follow it-they get healthier. And, so over time, this is what we look for...we look for these patterns. If you tell an overweight person to restrict their calories and exercise...your outcomes are going to be pretty lousy. And patients are going to start rolling their eyes because they've tried that for 20 years-it doesn't work. So, if you give patients good advice that actually helps them number one their compliance improves and outcomes improve."
Bill Wilson, M.D., CARB Syndrome
If we keep telling obese or fat people that they need to eat less calories (have more self-control, starve yourself) and exercise more ( get off your toosh/stop being lazy!), then we are going to continue in the last 50 or so years of dietary/health advice concerning the heart, health and obesity, the same advice that maybe got us here in the first place! When "they" replaced "bad" lard with "good" crisco, replaced "bad" butter with "good" margarine and replaced "bad" saturated fat with "good" vegetable oil...I think I might have a few more examples, but hopefully we get the point...we bought in to a system that overwhelmingly tells us that fat is bad so we should eat less of it and carbohydrate is good so we should therefore eat more of it. And don't even try to think about protein-look what happened to Atkins! But I digress...
What Dr. Wilson is saying is that we have tried the low-fat, high-carb way for 20 years and it doesn't work! When we give the right advice...not just the "better" advice, "outcomes improve." Some people have no problem staying skinny (or not-fat). These people can eat all they want and they have no problems. But there are a lot of other people that can look at a cinnabun and put on weight just looking at it ( and salivating...well, this is probably not true but it sure feels like that to some of us!). For these people (one of which I count myself), we have been sold the criscos, the margarines, the canola oils, the exercising more and the eating less...but it hasn't really worked or if it does work for a little, it isn't sustainable...it doesn't last. Yes, you can be fed the "better" advice of "have moderation in all things" and lose some weight for some time perhaps...or you can go with this advice of "be a vegan" and lose some weight for some time perhaps or until maybe other things in the health become a problem...but mostly these things probably work due to giving up things (more processed foods and sugars) rather than eating more plant-based foods than animal-based. When we eliminate white flour and substitute whole wheat maybe we get some improvement...when we eliminate white rice with brown rice...well, this won't necessarily solve everything ( as the analogy goes...that one broken leg is better than two). When we tell overweight people to follow the Mediterranean diet, it isn't always the answer either ( these diets still include whole grains and "healthy" vegetable oils). This type of reasonable advice may not be getting to the core problem.
Let's get to the core here. If you have been riding the fence about the cholesterol hypothesis, go to the last post with the four lectures. Fence riders can listen to one or all of the Jimmy Moore podcasts with Dr.'s Briffa, Gerber, Shanahan and Lundell as you continue in your quest to "seek truth" much as Professor Tim Noakes admits in his lecture before TEDxCape Cod (found under videos).
This next interview is for those NOT on the fence about the cholesterol hypothesis-you don't even think it is a hypothesis...you thought it was proven already, that there is no doubt of its validity. Probably if you are that person, you quit reading a long time ago or more than likely never even made it over to this blog or anything like it which could actually question "hard science" and the "facts" that cholesterol does indeed cause heart disease. Anyway, if you made it this far...I actually really appreciate that you made it. Thank you. And please listen to this podcast and tell me what you think (humor me...haha).