WRITTEN BY Dr. Nancy A. Palermo, Thrive Personalized Healthcare and Wellness
February was Heart Health month. While we all donned red and vowed to fight the number one killer of Americans, it’s evident that one month of awareness is not nearly enough to alter the magnitude of this disease. The numbers are dismal. In 2018, over 800,000 Americans died of heart disease or its related co-morbidities, accounting for one in three of all deaths. Despite spending over $300 billion to “fight and treat” heart disease, we have made no progress—and it appears that the numbers are increasing. In 2015, only three years prior, there were a little over 600,000 deaths, accounting for one in four deaths.
Clearly, we are doing something wrong. Spending more is not feasible. Increased expenditures have not lowered death rates. In fact, the numbers reveal that spending has focused on prolonging the lives of patients with heart disease, not preventing or reversing it. Corporations have profited the most. Pharmaceutical sales of Lipitor, the number one statin in the US, have exceeded $130 billion since its introduction in the 1990s. Hospitals and cardiologists encourage imaging and procedures at $70,000 to $200,000 a pop, since insurance companies reimburse these procedures, instead of considering preventative approaches.
Change is needed: 80% of cardio-metabolic diseases are preventable through diet and lifestyle. In fact, clinical research shows that lifestyle interventions are also successful in reversing disease. Widening the lens on risk factor interventions can personalize preventative approaches and optimize outcomes.
Conventional screening modalities are incomplete in identifying those individuals at risk for developing heart disease. Traditionally, risk factors for heart disease have included elevated cholesterol levels, smoking, diabetes, lack of exercise and hypertension. By focusing on these large categories, we miss the chance to intervene effectively. In fact, 50% of patients who have a heart attack or stroke have normal lipid levels—the conventional cardiac risk screening tool. Updated research suggests there are possibly over 300 risk factors. Even addressing the top 20 risk factors could significantly affect outcomes.
Risk factors like fasting sugar, insulin and leptin resistance, genetic factors and measurements of inflammation and oxidative stress are now believed to be significant drivers of heart and vascular issues. Once identified, these risk factors can help personalize preventative and treatment protocols.
Lifestyle intervention is also powerful, yet few providers stress this approach in the care of heart disease. While addressing diet and nutrition should be first and foremost, most physicians never receive formal training in nutrition, and even when nutrition/lifestyle intervention is recommended, insurance companies rarely reimburse these services. Accordingly, there is little motivation to include these interventions in treatment protocols. Patients are left to “figure it out” on their own using data that can be conflicting and confusing.
“There is no such thing as a sudden heart attack. It requires years of preparation.”
There is some hope. More and more scientific evidence suggests that diet and lifestyle have an impact on the prevention and even reversal of many chronic conditions, including heart disease. Both research and outcomes are helping to drive change. In 2010, Medicare began offering reimbursement for the first Lifestyle Medicine program introduced by Dr. Dean Ornish. His program—which focuses on a whole food, plant-based diet, low in saturated fats and refined carbohydrates, teamed with exercise and stress management—produces outcomes that easily rival the top-selling heart medications. Even better, side effects are much more tolerable and include weight loss, increased energy, reduction of medication doses, improved libido and reduction in cancer risks.
Many forward-thinking health centers are taking the results to heart. Some top medical centers are opening “food farmacies” where patients can purchase healthy foods and take integrated cooking classes. While insurance companies and most health centers appear to be more talk than action when it comes to prevention, patients can read books from many of the top lifestyle physicians and learn how to introduce changes into their lives. This is not only educational—it is empowering and transformational. The only successful change comes from the bottom up, from thoughtful clinicians offering patients the tools to take their health into their own hands. In the words of Margaret Meade, “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it is the only thing that ever has.”