April 2004

Vol. 3     No. 4  

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Favorite Five

My Favorite Five Articles Found in Recent Medical Journals

Need Potassium?  Take Vegetables, Not Pills

Potassium supplementation, diet vs pills: a randomized trial in postoperative cardiac surgery patients by Wendi Norris in the February 2004 issue of the journal Chest found that a diet high in potassium – that is, a diet high in fruits and vegetables – was equally effective at maintaining potassium levels as were supplements (pills) in patients on powerful diuretics (in this case, an average dose of 84 mg/day of Lasix).  This is the first study where diet is compared to pills for the replacement of potassium.  Furthermore, this study of 48 patients, who had just undergone cardiac surgery, found that those on a high plant-food diet required less hospitalization (5 vs. 6.3 days); and 79% of those tested preferred the diet over the pills for replacing lost potassium.

Patients with high blood pressure and heart failure, and people who have swelling (edema) are commonly treated with diuretics, such as Lasix (furosemide) or HCTZ (hydrochlorothiazide).  The intended purpose of these drugs is to remove sodium and water from the body; however, they also cause potassium to be lost through the kidneys.  If the potassium level in the body becomes too low, then the patients can have irregular heart rhythms, and if the level goes even lower, patients can sometimes die.  Thus, this replacement can be lifesaving, and is routine medical practice. The usual method employed by almost every doctor is to use potassium supplements given by mouth as potassium chloride.  These pills are inconvenient: they are sometimes large in size and may have to be taken often. The common side effects are nausea and vomiting.

The McDougall Diet, which is based on high-potassium fruits and vegetables, provides more than twice the potassium as does the American diet (5000 vs. 2000 mEq/day).  In addition, this kind of diet is patient-friendly, because it is high in dietary fiber (relieves constipation), low-cholesterol (prevents heart disease), low-sodium (prevents fluid accumulation), and low-fat (encourages better circulation).   These healthy qualities of a fruit and vegetable diet were, most likely, the reasons for the reduced hospitalization seen in this study. You would think feeding sick and dying patients a high quality diet would be standard practice in hospitals – sad to say, not so!  They are fed the very foods that brought them to the hospital in the first place.  It is called “job security.”

Examples of Potassium Supplements:

(Costs can be as high as $100 to $200 a month for supplementation)

* Kaochlor
* Kaon
* Kaylixir
* K-Lor
* Klor-Con
* Klorvess
* Klotrix
* K-Lyte
* K-Tab
* Micro-K
* Slow-K

Norris W, Kunzelman KS, Bussell S, Rohweder L, Cochran RP.  Potassium supplementation, diet vs pills: a randomized trial in postoperative cardiac surgery patients. Chest. 2004 Feb;125(2):404-9.

 

More Sex, Less Cancer.

Ejaculation frequency and subsequent risk of prostate cancer by Michael Leitzmann in the April 7, 2004 issue of the Journal of the American Medical Association found that men who had a greater frequency of ejaculations had a lower risk for development of prostate cancer later in life.  This benefit was only observed for those men at the extremes of sexual release – young men who claimed 21 or more ejaculations per month had about 1/3 less risk of prostate cancer over a lifetime, compared with men of the same ages reporting 4 to 7 ejaculations per month.

One possible reason for this study’s findings was an association between an active sex life and a healthy diet. Men who feel more physically energetic would be expected to have more sexual experiences.  The same diet that causes men to be more physically vigorous – a diet high in plant foods, and low in meat and dairy products – also reduces the risk of prostate cancer. (Remember, the diet of endurance athletes is high carbohydrate and is based on starches – see my September 2003 newsletter article “Building Your Own High-Performance Athletic Body.” Also see my February 2003 Newsletter article “Saving Yourself from Cancer - the Prostate (case in point).”

Side Note:  I had always hoped there was a health advantage to an energetic sex drive.

Leitzmann MF, Platz EA, Stampfer MJ, Willett WC, Giovannucci E.  Ejaculation frequency and subsequent risk of prostate cancer.  JAMA. 2004 Apr 7;291(13):1578-86.

 

Mammography Over-Diagnoses Millions of Women with Breast Cancer

Incidence of breast cancer in Norway and Sweden during introduction of nationwide screening: prospective cohort study by Per-Henrik Zahl in the April 17, 2004 issue of the British Medical Journal found one-third of all invasive breast cancers in the age group of 50-69 would not have been detected in the patients’ lifetimes without this x-ray examination.  In other words, these women, diagnosed with invasive cancer of the breast, would have lived their entire lives without ever knowing they had cancer except for meddling doctors insisting on mammograms.  This study of 1.4 and 2.9 million women in Norway and Sweden, respectively, above 30 years of age, looked at real cases of cancer (invasive breast cancer).  The reason one-third of the women would have lived without knowing they had cancer is because this is a slow growing disease – often taking 20 to 30 years, and more, after diagnosis until it becomes life-threatening.  Yet the fear and pain of knowing you have the disease, and the treatments for it, are immediate. 

You may be thinking that all this suffering caused by the awareness of cancer and the treatments that follow diagnosis might be justified if a substantial number of women’s lives were saved by present day treatments.  Unfortunately, this is not the case – surgery, radiation, and chemotherapy have little impact on saving lives.  For further information on mammography and breast cancer treatments please see The McDougall Program for Women book.  For the past 30 years I have recommended that women avoid screening mammography, and if they are diagnosed with breast cancer, that they should choose very conservative therapy – like a lumpectomy. (See also my February 2002 newsletter article “Mammography is Unjustified--A Letter Few Newspapers Will Print;” and my January 2004 newsletter article “Mammography Is Fraud Promoted by Industry and Governments.”) 

So what is your option? Your defense against this disease should be to be fully armed with a healthy plant-based diet, exercise, and clean habits (no smoking and minimal alcohol).  Don’t let your guard down by thinking you are going to be saved with early detection and treatments. 

Zahl PH, Strand BH, Maehlen J.  Incidence of breast cancer in Norway and Sweden during introduction of nationwide screening: prospective cohort study. BMJ. 2004 Apr 17;328(7445):921-4.

 

US Preventative Task Force Says “No” to Heart Tests

Screening for coronary heart disease: recommendation statement by the

U.S. Preventive Services Task Force published in the April 6, 2004 issue of the Annals of Internal Medicine concluded that doctors should not be looking for heart disease with a resting electrocardiogram (EKG), an exercise treadmill test (ETT), or a heart scan (electron-beam computerized tomography – EBCT).  In other words, if you are otherwise healthy, you should not have tests to find out whether or not your arteries are plugged up.  The reason is these tests lead to treatments – like heart surgery – that will not help you live longer and healthier.

Their exact words are: “In the absence of evidence that such detection by ECG, ETT, or EBCT among adults at low risk for CHD events ultimately results in improved health outcomes, and because false-positive tests are likely to cause harm, including unnecessary invasive procedures, overtreatment, and labeling, the USPSTF concluded that the potential harms of routine screening for CHD in this population exceed the potential benefits.”

The reason these tests don’t help and do cause harm is because the treatments that can be expected to follow – angioplasty and bypass surgery – do not save lives.* The reason they do not save lives is because the operation is directed toward diseased parts of the arteries that rarely kill – these surgeries bypass or open up stable restrictions (large hard plaques) caused by chronic disease (atherosclerosis). The artery disease which actually kills the patient is very tiny volatile plaques – these rupture, causing the blood to clot (forming a thrombus).  This clot suddenly occludes the artery and kills the heart muscle, and often the patient.

A person’s risk for future heart attacks can be estimated by older age, male gender, high blood pressure, smoking, abnormal lipid levels, unhealthy diet, diabetes, obesity, and sedentary lifestyle.  Gathering this information is of low risk to the patient – but also low-profit for the medical business – so this approach is belittled when compared to high-tech, high-profit tests and treatments.  The greatest benefit from learning more about your heart health is that this information should serve as great motivation for long-overdue changes in your diet, exercise and habits (smoking).

* Bypass surgery provides a small survival benefit for those patients with poor function of their heart muscle (left ventricle) before surgery.  No improvement in survival has been documented from angioplasty.  Aspirin and cholesterol-lowering medications (statins) reduce the risk of heart disease and death, a little.  Learn more about heart health and disease treatments from the book, The McDougall Program for a Healthy Heart.

U.S. Preventive Services Task Force.  Screening for coronary heart disease: recommendation statement.  Ann Intern Med. 2004 Apr 6;140(7):569-72.

 

HDL “Good” Cholesterol is Not Worth Your Attention

Effect of intensive compared with moderate lipid-lowering therapy on progression of coronary atherosclerosis: a randomized controlled trial by Steven Nissen in the March 3, 2004 issue of the Journal of the American Medical Association, found that HDL  “good” cholesterol played no role in predicting the chance of worsening artery disease (growth of plaques).  Hopefully, this will be the study that finally changes doctors’ practices of recommending treatments for their patients based on this fraction of cholesterol.

Patients are often confused about the many different fractions of cholesterol – VLDL, LDL, MDL, HDL, etc. – and which ones they should take seriously.  High-density lipoprotein cholesterol (HDL, often called “good” cholesterol) has been the most controversial, and therefore, surprisingly, the one that many doctors place the greatest emphasis upon when counseling their patients. This fraction has been termed “good” because cholesterol appears in this condensed form during the final stages of cholesterol metabolism, when cholesterol leaves the body by way of the liver. 

In addition to lack of relevance to the nature of this killing disease, two common problems occur during everyday doctor-patient relationships when discussing HDL results:

First, a patient with high total cholesterol is often told not to be concerned because his or her HDL is also high.  This is harmful advice because the total and LDL cholesterol best reflect the future health of the patient – not the HDL.  Thus, the patient is often falsely reassured and does not make the changes in diet and lifestyle that would really make a difference.

Second, people following a healthy, no-cholesterol, low-fat diet usually experience a dramatic drop in total and LDL cholesterol, but the HDL cholesterol also decreases because when lowering cholesterol through a healthy diet, all fractions of cholesterol decrease.  Their doctors may tell them this decrease is harmful and they should make the HDL level go up at any cost – even by eating more cholesterol (meat, poultry, fish, and cheese).

For more information on this subject see my September 2003 Newsletter article, “Good Cholesterol ‘Worsens’ with McDougall?”

During the Nissen study, 502 patients were treated for 18 months with powerful cholesterol-lowering medications, and investigators discovered that decreases in total and LDL “bad” cholesterol were strongly related to reductions in the progression of atherosclerosis.  In fact, when the intensive treatment lowered total cholesterol to 151.3 mg/dl and LDL cholesterol to 78.9 mg/dl the progression of atherosclerosis was halted, and in many cases plaque disease was reversed.  For each 10% reduction of LDL cholesterol there was a 1% reduction in amount of disease over the 18 months of treatment.  Most importantly, the rate of progression of plaque disease is directly tied to the future risk of heart attacks and death.

For further discussions on how to lower cholesterol and improve the health of your arteries see the McDougall Newsletter articles: September 2002, “Cholesterol - When and How to Treat,” and June 2003, “Cleaning Out Your Arteries,” at www.drmcdougall.com.

Nissen SE, Tuzcu EM, Schoenhagen P, Brown BG, Ganz P, Vogel RA, Crowe T, Howard G, Cooper CJ, Brodie B, Grines CL, DeMaria AN; REVERSAL Investigators.  Effect of intensive compared with moderate lipid-lowering therapy on progression of coronary atherosclerosis: a randomized controlled trial.  JAMA. 2004 Mar 3;291(9):1071-80.

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