Curious People will not take a statin but will get a stent or coronary bypass

Curious people will not take diet medicines lifelong but will get a gastric bypass surgery.

Curious nutritionists tell type 2 Diabetics to avoid fats not carbohydrates that raise sugar.



There is an epidemic of heart disease and obesity and diabetes type 2.

As a physician with obesity and diabetes type 2,  I have personally struggled with these 3 diseases.

I lost 80 pounds by the traditional 1500 calorie plus hour day exercise method but then gained back 50 pounds despite exercising more than 2 hours a day.

I began to learn why when I read Gina Koleta's book: Re-Thinking Thin 2008

In my book, The Tubby Theory from Topeka written in 2009, I had not yet read Koleta's book and advised 3 diets with less than 10 per cent saturated fat because that was the teaching of the National Lipid Association.  I did add the caveat on page 128 that weight loss diets don't work.  

I went ahead and listed three diets at 3 different calorie levels:  1850, 1650, 1450 calories. I relied heavily on frozen meals to have accurate calorie and saturated fat counts because I could think of no other way for people to calculate the percentage of their saturated fat.  Imagine my surprise when I learned while studying for the Obesity Boards that Meal Replacements are the most effective way to lose weight. I reviewed Ornish 5 year trial 1998 after AACE guidelines for LDLp and apoB were posted.  I found some interesting items that lead to some interesting questions.

For Very High Risk Patients
                                     apoB                    LDLp
AACE advises        less than 80           less than 1,000

Allan Sniderman     less than 65


Ornish trial      Dropped apoB from 100 to 76

Ornish quoted:
"Twenty-five cardiac events occurred in 28 experimental group patients vs 45 events in 20 control group patients during the 5-year follow-up (risk ratio for any event for the control group, 2.47 [95% confidence interval, 1.48-4.20])"

Patients in the experimental group lost 10.9 kg (23.9 lbs) at 1 year and sustained a weight loss of 5.8 kg (12.8bs) at 5 years, whereas weight in the control group changed little from baseline.

"We found more than twice as many cardiac events per patient in the control group than in the experimental group. These findings are consistent with other clinical trials showing that even small changes in percent diameter stenosis are often accompanied by marked reductions in cardiac events."

Questions?

1- Was the drop in apoB from weight loss, 8% fat diet or a diet that was reduced in carbohydrates as well? The control group did not have weight loss. 

2- There still were 25 cardiac events in the low fat diet group.  Is this just the residual risk to be expected?  Ornish reached the AACE goal for apoB  less than 80 but perhaps he could have avoided the cardiac events if he had reached apoB less than 65 as Sniderman advises.

3- Statins have a pleiotrophic effect which Ornish diet does not provide? 

AACE has LDLc goal of less than 70 for very high risk patients.  On the chart below that correlates with apoB of 54.