The Medical Establishment Will Stop Treating People Like Cattle – An Autobiographical Book Report with Personal Commentary by Gary S. Smolker on Caldwell B. Esselstyn, Jr., M.D.’s book “Prevent and Reverse Heart Disease,” Tom Rath’s book “Eat Move Sleep” and David Perlmutter, M.D.’s book “Grain Brain.” This Is an Autobiographical Book Report Which Describes Steps Personally Taken by Gary S. Smolker to Put into Action Ideas, Opinions and Theories Presented in Those Books As A Way to Prevent Heart Attacks, Prevent Stroke, Prevent Diabetes, Prevent Alzheimer’s Disease. This Book Report Also Contains Commentary on (a) The Current State of Medical Knowledge, (b) The Current State of Medical Practice and (c) How The Practice of Medicine Is Currently Undergoing A Process of Creative Destruction. This Book Report Also Presents A Predictive Look Over the Horizon at the Future of Medicine, the Future of the Health Care Industry and Future Medical Practices Related to the On-going Creative Destruction of the Current Practice of Medicine. (PART ONE)

Take Away

I read the three books referred to in the title of this book report because

• I am interested in preventing diabetes, reversing heart disease, preventing stroke, and preventing cognitive impairment (i.e., preventing memory loss, loss of mental acuity, Alzheimer’s disease, etc.).

• I want to preserve and improve my mental faculties.

• I want to live a vibrant healthy life.

• I want to know if it is safe for me to be taking cholesterol lowering medicine.  Relatedly, I want to know if it is safe for me to continue taking the cholesterol lowering medicine that I am currently taking.

• I want to know if it is a waste and/or if it is unreasonably dangerous for me to continue taking any of the prescription medications I am currently taking.

• I want to understand the impact of the prescription medicines I am currently taking on my short term and long term health and well-being.

• I want to understand the impact of the foods I consume on my health.

In this book report

• I comment on some of the ideas, opinions, theories and facts presented in the three books listed in the title of this book report.
• I report on changes I have made in my life for “medical reasons.”
• I report on steps I am taking in my life in attempt to prevent having a heart attack, in an attempt to reverse heart disease, in an attempt to avoid having a stroke, in an attempt to avoid having diabetes, and in an attempt to preserve and improve my mental faculties.
• I also report on steps I have taken in my own life in my attempts to receive more efficient and more effective medical care and on frustrations and disappointments I have experienced while doing so.

I have read Caldwell B. Esselstyn Jr., M.D.’s book “Prevent and Reverse Heart Disease” three times, Tom Rath’s book “Eat Move Sleep” once, and part of David Perlmutter, M.D.’s book “Grain Brain.”

Previously, I read William Davis’ “Wheat Belly”, John A. McDougall’s “The Starch Solution”, and parts of Mark Hyman’s “The Blood Sugar Solution” and JJ Virgin’s “The Virgin Diet” because I wanted to lose weight and to avoid having diabetes and to avoid having a heart attack and wanted to know what I should do about being “overweight”, and how to lower my  blood sugar level, my triglyceride level and my total cholesterol and “bad cholesterol” levels.

It is not a secret that the practice of medicine is controversial or that the current practice of medicine is extremely inefficient and wasteful.

I have heard it said by a world renown cardiologist that at least one third of prescription medicines don’t work and that many backfire.

There is a groundswell of disappointment at the lack of personal attention and information physicians give patients.

Tremendous frustration is generated by the hoarding of information by medical professionals which leads to lack of opportunity to digest lab test information before meeting with a physician to discuss lab results, and at the flippant way physicians report, if and when they or their office reports lab test results to patients.

The public is frustrated by the fact that its interests and the medical professions interests are not aligned.

The practice of medicine in the future will be transformed because of public reaction to the disconnect between the profit making goals of the medical industry and the wellness goals of people.

People are in revolt at the focus and priorities of the pill driven mentality of the medical profession focused on producing office visit income for physicians, producing laboratory testing income for medical laboratories and producing pill producing income for pharmaceutical companies rather than on maximizing the amount of relevant helpful preventive health information, reporting and monitoring provided to patients.

Every thinking person realizes that society can not afford the way medicine is being practiced today.

There is no doubt in my mind that in the future the use of smart phones will change the way medicine is practiced.

Wireless medicine is coming.  Patients with chronic disease can be monitored in real time from their own homes.

Medicine has entered the digital age.

The use of electronic medical record keeping is expanding.  It now enables doctors and scientists to scour hundreds of thousands of patient records in seconds to find specific pieces of information they need in their work.

For the first time it is technically possible to plug every doctor, every patient, and every hospital, university and laboratory in the world in top a single healthcare data system.

The power of such a unified system to improve health and fight disease is almost beyond imagining.

At the most fundamental level, data and information technology promise to transform medicine from what it has long been – an art – into much more of a rigorous, objective science.

Hopefully, electronic medical record systems will soon be able to make predictions, based on scientific evidence concerning the outcomes of particular interventions — hopefully through the use of computers doctors will make better decisions, patients will enjoy better outcomes, and the cost of treatment will be reduced.

Currently, there are over 7,000 self-tracking apps for smart phones.

I use a health monitoring smart phone app called Fitbit to track how many steps I take each day because I want to take at least 10,000 steps per day.

A Fitbit can also be used to track how many hours a person’s sleeps each day, how many calories you “burn”, the number of calories eaten and number of fluid ounces of liquid consumed each day as well as how much you weigh each day.

Other apps make other medically useful measurements.

The market for such gadgets is exploding.

The use of such devices theoretically will lead people into lifestyles that promote good health.

Smart phone apps are available today by which a person can track, calculate, plan and research just about anything health related and personalize that information.

In the not too distant future we may be checking our vital signs on our phones.

I can envision a future in which physicians will prescribe more “smart phone apps” than drugs.

The Cleveland Clinic has a computerized registry called the Cardiovascular Information Registry.  As of 2013, the registry includes data on more than 220,000 patients.

In “The Cleveland Clinic Way” Toby Cosgrove, MD says, “Soon a patient will be able to enter her information into a ‘comprehensive risk calculator’ that uses algorithms to calculate the patient’s risk of complications or success based on the experience of thousands or even millions of other patients, taking into account all the specifics of the patient’s situation. Cleveland Clinic already has some risk calculators online.  Although they’re primarily for doctors, consumers can use them as well.”

Dr. Cosgrove also says:

• In the twenty-first century, no provider can afford to offer anything less than the best clinical, physical and emotional experience.  As patients become savvier, they will increasingly judge health care providers not only on clinical outcomes but on their ability to show compassion and deliver, patient-centered care.
• Medical professionals are thus feeling increasing pressure not just to talk about empathy but to take steps to demonstrate real compassion, even while lowering costs.
• Medical centers, like all businesses, need customers more than customers need them.
  

By the way, the statements, opinions and ideas expressed by me in this book report are either taken from what I read in the books mentioned above or are my own.

The most striking thoughts I took from reading the books written by Esselstyn, Rath and Perlmutter are:

1. There is a general consensus that the typical American diet, what most Americans eat, is toxic.
2. The current practice of medicine with respect to heart disease, stroke, diabetes and brain health is extremely inefficient, primitive and wasteful.
3. If you take cholesterol lowering medication and are “physically fit” that does not guarantee you will not have a heart attack or that you will not have a stroke and the cholesterol lowering drug you are taking might increase the odds that you will get Alzheimer’s disease and/or that you will get diabetes.
4. With respect to preventing heart attacks, experts disagree on what to eat, what not to eat, and what medication (if any) to take.  You might “die” learning which one is right.
5. They disagree on whether having low cholesterol is good for you or bad for you. They disagree on whether or not your total cholesterol or so called “bad cholesterol” level matters.
6. They disagree on whether taking cholesterol lowering drugs is good for you or bad for you.
7. They disagree on whether your cholesterol level is a good predictor of the chance/probability/risk of you having a heart attack or a stroke.
8. They disagree on whether eating meat and eggs is good for you or dangerous, bad for you.
9. They disagree on whether having a high carbohydrate diet is good for you or bad for you.
10. They disagree on whether eating wheat and wheat products is a good idea, is safe or will cause you harm.
11. They disagree on whether the so called Mediterranean diet (i.e., consuming so called healthy oils, virgin olive oil and/or canola oil) is good for you or will harm you.
12. They disagree on whether eating dairy products will be harmful to you.
13. They disagree on whether fish consumption is harmful or helpful.
14. Their state of knowledge (understanding)  of what causes heart attacks, strokes, Alzheimer’s disease, Parkinson’s disease, memory loss, and cognitive impairment seems conjectural to me.
15. Expert opinions and explanations of what “causes” heart disease, heart attacks, strokes, Alzheimer’s disease etc., and their prescription(s) for preventing heart attacks, strokes, etc. seems to me to based on a fallacy which has been recognized since Roman times (400 BC) – post hoc ergo propter hac – it follows this, therefore it was caused by that.
16. It is a logical fallacy if one event follows another the former must have caused the latter.  If that were the case, medical science would dictate that male baldness causes men to die because so many men lose their hair years before they die.
17. Much current advice by the medical profession regarding what should be done to prevent heart disease, etc. – reported by Dr. Esselstyn in “Prevent and Reverse Heart Disease” and reported by Dr. Perlmutter in “Grain Brain” – appears to me to be based on the logical fallacy post hoc, ergo propter hac (that because one event follows another the former must have caused the latter).
18. It appears to me, that medical doctors are guessing when they prescribe cholesterol lowering medications, i.e., they guessing that if you take the cholesterol lowering medication they have prescribed that it will do more good for you then the harm it will cause (i.e., it will be more beneficial than detrimental).
19. The only thing that is true is that you are going to die.
20. All medicines cause effects.  Some of those effects are known and some of those effects are unknown.
21. It is likely that any medicine I take to lower my blood cholesterol level will cause “some effect”; it is not clear to me whether the effect or effects caused by this medication will overall be to my benefit or be to my detriment.
22. One expert (Esselstyn) theorizes that if you lower the cholesterol level in your blood and eat a plant based diet (including grains) you will lower the risk of having a heart attack, while another expert (Perlmutter) theorizes that if you lower the cholesterol level in your blood and/or eat a diet which includes grains [i.e., wheat products (gluten)] such as bread, you will increase the likelihood of brain degeneration, i.e. of having Alzheimer’s disease, dementia, memory loss, cognitive impairment.
23. Here is what Perlmutter says about cholesterol in “Grain Brain”: Cholesterol is at most a minor player in coronary heart disease and represents an extremely poor predictor of heart attack risk.  Over half of all patients hospitalized with a heart attack have cholesterol levels in the “normal” range.  The idea that aggressively lowering cholesterol levels, will somehow magically and dramatically reduce heart attack risk has now been fully and categorically refuted….when I see patients with cholesterol levels of say, 240 mg/dl or higher, it’s almost a given that they will have received a prescription for a cholesterol lowering medication from their general practitioner.  This is wrong in thought and action.  As discussed, cholesterol is one of the most critical chemicals in human physiology, especially as it relates to brain health.  The best lab report to refer to in determining one’s health status is hemoglobin A1c, not cholesterol levels.  It is rarely, if ever, appropriate to consider high cholesterol alone to be a significant threat to health.”
24. Here is what Esselstyn says in “Prevent and Reverse Heart Disease”: … no one who achieves and maintains total blood cholesterol of 150 mg/dl and LDL levels below 80 mg/dl – using strict plant-based nutrition and, when necessary, low doses of cholesterol-reducing drugs – experiences progression of heart disease.  Many, in fact, are able to rejoice at clear medical evidence that they have actually reversed the effect of their disease…. I am convinced from my research and from counseling hundreds of patients with heart disease that you, like them, can make yourself heart-attack proof.
25. “Our research data have clearly confirmed that we were right.  My patients’ decision to enter the study not only put an end to the progression of their disease; the information we have gleaned from their experience has set a new gold standard in the therapy for coronary artery disease.  We can arrest and reverse it.  We can make ourselves heart-attack-proof.  Coronary artery disease need not exist, and if it does, it need not progress.”
26. In general, physicians do not provide their patients with information patients need in order to make informed decisions about preventing heart attacks, preventing strokes, preventing diabetes, or provide worthwhile information on how to maintain their mental faculties.
27. Perlmutter claims the two biggest myths are (1) a low-fat, high-carb diet is good and (2) cholesterol is bad.  Perlmutter claims study after study shows that high cholesterol reduces your risk for brain disease and increases longevity.
28. With respect to preventing heart disease, stroke, diabetes and brain diseases, in general, physicians do not efficiently or effectively provide their patients (such as myself) with sufficient quality information – about the debate briefly outlined above or any other aspect of heart disease, stroke, diabetes, brain diseases, etc. – to enable their patients to make well informed decisions about what to do to increase their chances of living a vibrant healthy life.
29. Instead, physicians treat their patients like unthinking robots.
30. In general, medical doctors are not trained in nutrition; they are trained in writing prescriptions and treating symptoms.
31. I am intuitively sure there is an overlap between what Dr. Esselstyn and Dr. Perlmutter recommend.
32. By the way, I do not believe that wet streets cause rain.
33. I am going to think about that.

Personal Perspective

On September 14, 2013, I had a heart attack and was rushed to a hospital in Toronto, Canada while I was having a heart attack.

At the hospital it was determined that one of my coronary arteries was 100% blocked and two other coronaries arteries were seriously blocked.

The three blocked arteries were opened up by angioplasty and a stent was inserted in each artery.

After that, a friend told me that having a stent in an artery does not solve the underlying problem that caused the artery to be blocked in the first place.

My friend told me, You still have heart disease.  Inserting a stent in a “blocked artery” that has been opened by angioplasty does not cure heart disease.  STOP what you are doing right now and read “Prevent and Reverse Heart Disease” by Caldwell B. Esselstyn, Jr., M.D.”  He was a surgeon at the Cleveland Clinic and he has a proven track record.

That friend told me that I need to prevent and/or reverse the underlying problem (the disease) that caused me to have a heart attack.

My friend told me my underlying problem had to be my “diet” – what I was eating; the issue is not being physically fit, not being in “good shape”, not exercising enough, many “fit” people have/had heart attacks.

He told me that I should read and follow the advice given in Dr. Esselstyn’s book “Prevent and Reverse Heart Disease.”

I followed my friend’s advice.

Dr. Esselstyn’s message is: coronary artery disease is preventable, and even after it is underway, its progress can be stopped, its insidious effects reversed.

After I completed reading “Prevent and Reverse Heart Disease three times I began following Dr. Esselstyn’s recommendations.

I am still following Dr. Esselstyn’s recommendations.

Provocative Ideas and Opinions I Took Away As a Result of  Reading “Prevent and Reverse Heart Disease”, “Eat Move Sleep” and “Grain Brain”

HEART DISEASE

In fully one out of four patients with heart disease, the first symptom is sudden death.

In the course of a lifetime, one out of every two American men and one out of every three American women will have some form of heart disease that could have been prevented by eating the right food.

Heart disease, stroke, diabetes and brain diseases are largely preventable by eating the right food and are uniquely tied together.

How long you live your life is more about how you live your life and less about how long your parents lived.

In was observed in 1995 that by the age of twelve, 70 percent of American children had fatty deposits in their arteries, the precursors of heart disease.

In the United States, heart disease is the number one killer.

The United States contains just 5 percent of the global population, but every year physicians in American hospitals perform more than 50 percent of all angioplasties and bypass procedures in the entire world.

Unfortunately, about half of all angioplasties performed in the United States each year are unnecessary.

“Interventional cardiologists earn hundreds of thousands of dollars annually, and particularly busy ones make millions.  In addition, cardiology procedures generate huge revenues for hospitals.”

“All told, there has been little incentive for physicians to study alternative ways to manage disease, so the mechanical/procedural approach continues to dominate the profession even though it offers little to the unsuspecting millions about to become the next victims of disease.”

“HEALTH CARE, to put it mildly, is an industry out of control.

“If we don’t make some major changes, projections show that by the year 2014, spending on health care will account for one-fifth of America’s gross domestic product.

“By the middle of this century, spending on Medicare alone will consume an estimated 40% of the U.S. budget.

“This is unsustainable.

“Starbucks, one of the most successful companies of the past two decades, recently announced that it is spending more on health care for employees than it spends on coffee beans.”

SUGAR IS A TOXIN

Every bite of food you take is a small but important choice.

• Sugar is a toxin.
• It fuels heart disease, diabetes, cancer and obesity.
• Much like cigarettes, sugars are addictive.  Each time you eat sweets, it causes your brain to want more sugar.
• Your brain builds a tolerance to sugar over time.  As a result, once you consume sugar your body needs larger quantities over time to mimic the pleasurable sensation.
• At the current dose we consume, more than 150 pounds per person per year, sugar and its derivatives kill more people than cocaine, heroin or any other controlled substance.
• Sugar is “candy” for cancer cells.
• It accelerates aging and inflammation in the body and subsequently fuels tumor growth.
• What you eat can greatly reduce the risk of cancers growing and spreading.
• It is clear if you lower your sugar intake, you reduce the odds of cancer.
• Half of all men and one third of all women in America will be diagnosed with cancer.
• Cancer is the number 2 killer in the United States.
• Glucose levels of 82 to 110 mg/dL have an adverse impact on your health over time.
• Blood sugar levels at the higher end of the normal range have been linked to significant shrinkage of the brain.

The next time you are with two friends, consider that two of the three of you are likely to die from heart disease or cancer.

Heart disease, stroke, diabetes and brain diseases are largely preventable by eating the right foods and are uniquely tied together.

Unfortunately, due to lack of reliable information and proper advice, people find it easier to figure out their income taxes than to know how to eat right.

BEING SEDENTARY WILL KILL YOU

Being active throughout the day is one of the most important things you can do to keep you healthy.

• On average, we now spend more time sitting (9.3 hours) than sleeping in a given day.  The human body is not built for that.
• Reducing this chronic inactivity is even more essential than brief periods of vigorous exercise.
• “Sitting is the most underrated health threat of modern times.  On a global level, inactivity now kills more people than smoking.”
• “Sitting more than six hours a day greatly increases your risk of an early death.  … Every hour you spend on your rear end – in a car, watching television, attending a meeting, or at your computer – saps your energy and ruins your health.”
• “One leading diabetes researcher claims that sitting for extended periods poses a health risk as ‘insidious’ as smoking or overexposure to sunlight.  He contends that physicians need to view exposure to sitting just like a skin cancer expert views exposure to direct sunlight.”
• “As soon as you sit down, electrical activity in your leg muscles shuts off.  The number of calories you burn drops to one per minute.  Enzyme production, which helps break down fat, drops by 90 percent.”
• “After two hours of sitting, your good cholesterol drops by 20 percent.”
• “… people with desk jobs have twice the rated of cardiovascular disease.”
• The critical variable is how many hours you sit, not how many hours you work out.
• You should move around every twenty minutes.
• Find a few moments each day when you an walk briskly.  Do a few push-ups or anything else to break up a 10 hour span of limited activity.
• If nothing else, make sure you get up several times a day and move around your office.
• One way to force movement is to increase your consumption of liquid.  This makes you get up more often for refills and restroom breaks.
• At a minimum at least two or three times an hour get up and stretch lightly or change position or take a walk.
• “Don’t worry about breaks every 20 minutes ruining your focus on a task … taking regular breaks from mental tasks actually improves your creativity and productivity … mental concentration is akin to muscle that gets fatigued with prolonged use.  It needs a period of rest before it can recover.  Getting up for the sake of your body may yield as much benefit for your mind … organize your home and office to encourage movement over convenience.”
• People who walk fewer than 5,500 steps per day are considered sedentary.
• The average American falls below the sedentary level at just 5,117 steps per day, in comparison the average Australian takes 9,695 steps per day, nearly two times the average American steps per day.
• This helps explain why Australia’s obesity rate is just 16% while the United States is 34%.
• Ten thousand steps per day is a good target for overall activity.  This equates to roughly 5 miles per day.
• “When scientists from the National Institutes of Health followed 240,000 adults for a decade they discovered that exercise alone is not enough.  Even seven hours a week of moderate to vigorous physical activity was not enough to keep people alive.  Among the most active group studied, who exercised more than seven hours a week, those who spent the most time sitting had a 50 percent greater risk of death from any cause.  They also doubled their odds of dying from heart disease.”
• “… technology – from computers to washing machines – minimizes the need for manual labor and our health suffers as a result.”
• Today, only 20% of jobs require real activity.
• You can now accomplish countless tasks with the click of a mouse and a few key strokes.  While this increases efficiency, it comes at the expense of our physical health.
• In many ways we’ve engineered physical activity out of our lives, so we’ve got to find ways to put it back into our lives.
• You need to find ways to infuse deliberate movement into your day.

Exercise prevents cognitive decline.  It flips the switch that spurs the growth of new brain cells.

Exercise actually reverses memory decline in elderly humans by increasing the growth of new brain cells in the brain’s memory center.

The more you move, the fitter your brain becomes.

Your brain’s healthy functioning requires regular physical activity.

Examine your surroundings and think about how you can prevent sedentary time.

Organize your home and office to encourage movement over convenience.

Exercise is a wonder drug.

There is no shortage or reasons to move more today.

SLEEP

Getting a good night’s sleep is essential.

Sleep is not a luxury.  It is a basic necessity.

If you sleep less, you eat more, you remember less, you get sick more often and you make poor decisions.

Every hour of sleep is a positive investment.  It is not an expense.

Sleep less, achieve less.

Poor sleep leads to high blood pressure, irritability, and poor decision making.

• In some work places it is a badge of honor to ‘pull an all nighter.’

• “One hour less of sleep does not equal an extra hour of achievement or enjoyment.  The exact opposite occurs.”

• “The person you want to fly your airplane, operate on your body, teach you children or lead your organization tomorrow is the person who sleeps soundly tonight.”

• “Getting fewer than six hours of sleep leads to burn out on the job.  If you want to succeed in your job, make sure your work allows you to stay in bed long enough.”

INTELLECTUAL STIMULATION

Keeping the brain mentally stimulated is a good thing for brain health.

The brain rises to the challenges of intellectual challenges.

When intellectually stimulated, the brain becomes faster and more efficient in its processing capacity and also better able to store more information.

Thinking is good for your health.

Personal Weight Loss

I have been trying to lose weight since September, 2012.

In September, 2012, I weighed 187 pounds and my waist size was approximately 40 inches.

In January, 2014, I weighed 135 pounds and my waist size had become 34 inches.

In the time period September, 2012 through January, 2014, I lost over 50 pounds and my waist measurement shrank approximately six inches, from a 40 inch waist to a 34 inch waist.

Personal Observations

Published information about health is very confusing, contradictory.

People need individualized guidance because they do not know enough to understand the “big picture”, how one thing is related to another thing or how everything is related to everything else.

We, not our doctors, are responsible for our health.

If we want to lose weight and/or if we want to avoid or prevent our self from having a heart attack or to avoid/prevent having a stroke or diabetes or Alzheimer’s disease we need to know the right questions to ask , we need to know what is the information we need to know.

Reading “Prevent and Reverse Heart Disease”, “Eat Move Sleep” and “Grain Brain” and talking to my friends about what I read helped me determine questions to ask, things to think about including the right questions to think about.

I would be happy to discuss my “quest” with you.

Gary Smolker

Copyright © 2014 by Gary S. Smolker