Biggest Strides in Health? Not due to Doctors and Certainly Not Counseling by Doctors

I can fuss at overweight people and smokers, but they’re not going to change until they’re ready. As doctor, I had more questions about mattresses than diet.

By Mike Gorback, MD, for WOLF STREET:

Once upon a time, there was talk of reimbursing doctors based on certain parameters. It’s typical for bureaucrats to tally what they can, instead of what they should. For instance, one proposed measure was how many of your diabetic patients had acceptable hemoglobin and levels.

No doctor can control that. Who can make sure their diabetic patients are eating right, taking their insulin, or exercising? If you’re my patient and won’t follow advice, I’m going to punt you out of my practice because I’ll be punished for your behavior.

You know what talks and what walks. These days it’s about Accountable Care Organizations (ACOs) that keep costs down. I think that redefines the mission to financial health and brings up whether you want your doctor to be a doer or a not-doer.

The biggest strides in health have not been due to doctors but rather public health. Dysentery killed more soldiers in the Civil War than bullets.

Vaccines have also played a huge role so medicine gets some credit, but it wasn’t an army of doctors across the land spraying penicillin. It was a relative handful of researchers. Who do you know that died of smallpox, polio, diphtheria, pertussis, or tetanus?

Think about air quality. People bitch about smog but in the 1800s there was horse shit all over the streets. Horses and pedestrians ground it into the dirt and then rain would mix it all together.

Then the sun would dry up the street and all the foot traffic would stir up the shit dust for people to breathe.

The automobile changed that, but as I like to say, the solution to a problem creates a new problem.

Thomas Midgely was a prolific genius who came up with leaded gasoline for engine knocking. Nobody seemed to take the hint when workers at the chemical plant died of lead poisoning. Midgely himself got lead poisoning.

He also invented CFCs, including Freon. Before that cooling systems used ammonia, sulfur, and propane which had an unfortunate tendency to burst into flames or even explode. They were also toxic. Freon was a welcome relief.

I know about Midgely from reading Bill Bryson’s A Short History of Nearly Everything. Bryson said Midgely had “an instinct for the regrettable that was almost uncanny.” That included his manner of death. Midgely got polio and was severely disabled. He devised a complicated rig to get in and out of bed. He died of strangulation when he got tangled up in it.

A less kind observer said Midgely had “more impact on the atmosphere than any other single organism in Earth’s history.”

Changes in air quality, clean water, housing codes, and other measures completely changed the major causes of death.

In 1900 the top three were pneumonia/influenza, tuberculosis, and diarrhea. Now only one – influenza/pneumonia – are in the top 10. The top 3 now are heart disease, cancer, and cerebrovascular disease.

Sanitation has prevented more disease than all the doctor counseling in the history of the world, not surprising since tobacco was once considered medicinal. I think the theme will catch a lot of people on the back foot.

Nutritionists are the Hari Krishnas of health care. Always in your face about it, but the science is fuzzy (unlike Hari Krishnas, who are bald).

When I was a medical tadpole, I remember two debates. One was eating too much cholesterol.  I was in the unpopular camp that said our bodies make cholesterol, so why would exogenous cholesterol be bad? I was also really pissed about the unavailability of whole milk. 2% fat milk? Blech. I was right. It’s way more complicated. Egg yolks are good for you now. A rich source of omega-3.

I also used to advocate avoidance of refined sugar and carbs. I had a real toe-to-toe with a pharmacy professor decades ago who maintained that sugar is sugar. Well, now we know that refined sugar pops your blood sugar and unleashes holy hell.

Ironically, I pulled a Midgely on myself. My favorite drink used to be bourbon and ginger. Then I had a kidney stone. My urine was filled with uric acid crystals and my blood uric acid was high. The nurses forgot to strain my urine after I passed the stone so we can’t be 100% sure, but I’m 99.999% sure it was a uric acid stone. I grieve for that lost stone, who I planned to name Rocky after my favorite squirrel. How many people give birth to their own pet rock?

You know what’s the worst? Beer. If you have gout drinking a beer is like praying for a kidney stone. I’ve had one beer since I passed that stone in 2017. OMG did that taste good. Blue Moon Belgian White.

Ginger ale contains high fructose corn syrup. Alcohol plus sugar raise uric acid levels.

My family doctor prescribed allopurinol for my gout. I never took it because I knew what I had to do. Dietary counseling never came up. My urologist never said a word. Now I drink martinis and tequila. Olives and citrus fruit like limes are good for you. Big Macs contain protein, grain, and lettuce – health food. And remember, ketchup is a vegetable…

By Mike Gorback, “screw the formal MD crap; we’re all in this together.” He also wrote, Enter GreedCare, where the White Coat is Supplanted by the Grey Pinstripe of Corporate Conglomerates

Enjoy reading WOLF STREET and want to support it? Using ad blockers – I totally get why – but want to support the site? You can donate. I appreciate it immensely. Click on the beer and iced-tea mug to find out how:

Would you like to be notified via email when WOLF STREET publishes a new article? Sign up here.

Many experts agree that metal roofs are a great defense against wildfires. Click here or call 1-800-543-8938 for details from our sponsor, the Classic Metal Roofing folks.

Classic Metal Roofing Systems, the leader in fire safe roofing for residential applications, manufactures products that are 1/20 the weight of most tile products and eligible for Class A, B, or C fire ratings as determined by roof preparation.

  266 comments for “Biggest Strides in Health? Not due to Doctors and Certainly Not Counseling by Doctors

  1. Bubba says:

    There’s a lot to be said for the health benefits of a legitimate strength training program. Carrying extra muscle mass and bone density makes a person resistant to many ailments that “cardio” doesn’t. The same can be said for sun exposure: your body needs it. The problem is this advice makes no revenue for the medical/pharmaceutical industry.

    • Joe Saba says:

      was doing fine with exercise til I got covid and had to quit working out for 2+ weeks
      and trying to get back into it now is very hard
      of course I lost 15+ lbs

      • Ed C says:

        After staying away from the gym for a year to avoid covid I’ve been back for a few months. Extremely difficult for this geezer to reclaim my cardio fitness. The stairclimber is no fun. I do that first to get it out of the way. The progress is just so slow.

        • EdLop says:

          If you want strength, do strength training FIRST. Use the energy to gain lean muscle mass. For cardio do Kettlebell training. It is cardio+strength training in one and so much more.

      • Hans says:

        I’ll be 80 the end of the year and I play racquetball but haven’t played for a year and a half due to Covid.
        The first time I came back I could hardly play a half game. I was so out of shape and it was hard to breathe. Now after about 6 weeks back playing twice a week I’m playing 5 to 7 games an evening and feel great … I’m back. You can do it!

      • jimells says:

        Exercise does not cure sickness. Bodies need time to rest and heal after big exertions like fever and very hard exercise.

        I feel sad for the Long Covid folks who will be told to exercise and psychotherapy their way back to health. Most CFS (chronic fatigue syndrome) and ME (myalgic encephalomyelitis) patients (probably the same disease) know by instinct that overexertion will cause a crash and probably delayed symptoms.

    • Wolf Richter says:

      Bubba,

      I hope no one takes your advice about cardio seriously. But that’s just my advice. I do agree that strength exercise is important. But don’t neglect cardio exercise. Again, that’s just my advice. And I do both.

      In terms of “The problem is this advice makes no revenue for the medical/pharmaceutical industry.”

      Re-read the article. The problem is that people already know all about healthy living, but they’re not doing it until they’re ready to do it, if ever. The fact that smoking is bad for you was already known when I was a kid, and even I knew it. It’s just that a lot of people keep doing it. Some people keep drinking and driving though they know it’s a huge killer. The point here is that counseling by doctors doesn’t help because people already know what they should do but don’t follow advice.

      • ivanislav says:

        Wolf, you have a tendency of reading into people’s comments things that they didn’t say. He said nothing about cardio being unnecessary, i.e. you’re both right, except that you’re disagreeing with him!

        • Javert Chip says:

          ivanislav

          You accuse Wolf of “reading into … comments things … they didn’t say”, but Wolf never said cardio was unnecessary (only you used those words).

          Quite the contrary, Wolf clearly expressed his personal opinion that both are necessary, and indicated he does both cardio & strength.

      • Bubba says:

        “Cardio” is beneficial if it’s done in short, intense sessions on top of a solid base of strength. The problems that plague the elderly in particular are correlated with a loss of strength (force production) and not 5k times. I’m familiar with the crowd that will do mile after mile of running while subsisting on a vegan or near-starvation diet, and the results do not look good. They have many negative side effects from this behavior. At the same time, there are some misleading metrics out there. Take BMI for example. It may offer some information for the purely sedentary individual, but is worthless for someone who trains for strength. My BMI is about 34 which makes me “obese”, but I have never been healthier or stronger in my life. And I can still run 5 miles if I had to.

        • Escierto says:

          If you had to lol. I hate weights and I love running but I do my weights.

        • ivanislav says:

          Hmm I gave you too much credit when Wolf replied to you. BMI 34 is too high for near-optimal health, even if it’s muscle. Your digestive system and other organs have to work harder to support that and your joints won’t last long with that weight if you jog regularly.

          In case people are curious, BMI 34 ~= 250lbs on a 6′ frame.

        • Bubba says:

          A 6′ male frame could easily handle 275+ lbs if he trained for strength. Mass moves mass. Skinny people are frail and easily killed. But don’t take this to mean you can just be a tub of lard. You have to train.

        • Cashboy says:

          The only exercise I do is walk at a reasonably fast pace for an hour (usually to the supermarket and back) and I do starvation diets (5 days) once a month and the rest of the month OMAD (One meal a day) and have cut out carbohydrates. I learned so much from Dr Sten Ekberg on YouTube about food and diet and health of the body.

      • Tom says:

        Fun article full of legitimate comments: refreshing..

      • Ole C G Olesen says:

        It is dangerous to LIve … You can Die of it …. OCGO

        • Auldyin says:

          @ OCGO
          So that’s why the ‘Precautionary Principal’ rules.
          I always wondered.

      • Richard Greene says:

        If you work hard to keep your body in good shape … your mind will go first … and what’s so great about that?

        Of four of my parents and in-laws, three had dementia before they died, ranging from a few years to nine years. The parent with the worst diet, by far, and no exercise, lived by himself, with a clear mind, and died at 98 from a heart attack.
        So there’s no advantage I can see in having a “body that outlives the brain”.

        So keep learning. to keep your mind in shape.

        — For exercise:
        Jump to conclusions, and
        Sidestep responsibilities.

        And never eat any food you don’t like,
        such as Brussel sprouts or kale.

        • Dan says:

          Sounds like a lot of bull.No sugar, low carb ,hit, some cardio. 10 years, wouldn’t go back. No colds, no flu, great immune system.

        • JoeC says:

          Guess you never learned what anecdotal evidence means?

    • gametv says:

      that is the core of the problem with medicine. good healthcare doesnt align with profits.

      i think the biggest problem in healthcare is that the pharma industry has basically infiltrated the teaching process and the education of doctors. since only patentable drugs can afford to run double-blind studies, they are the prescriptions that have the “proof” necessary to be accepted as standard of care. In reality, nutrition and other lifestyle factors should be a major part of healthcare.

      The real challenges in healthcare are more related to symptom clusters and causes that are multi-variant. For example Alzheimers. There is no single cause and it is highly unlikely that there will ever be a single pill that cures it. It is a multi-factored inflammation process. But most neurologists are close to clueless about intervention strategies and most GPs dont refer patients to a neurologist until it is far too late. So we end up spending alot of money on dementia care instead of less costly prevention.

      I had posted previously that AI is the solution, Wolf chastised me for it, but I stand by my post. Wolf compared healthcare decisions to teaching a car to drive, but he just doesnt understand logic systems or AI to make that statement. Healthcare diagnosis and treatment are exactly the type of very structured logic system that computers can do much better than people. Sure, we need doctors to perform the complex heart surgery, but we sure dont need to pay a doctor 400K a year to ask the same exact questions and come up with the same treatment plans over and over again, every day. The task of visual perception to drive a car is an infinitely more complex perception and decision process than 99% of healthcare. I would admit that psychiatry is probably an area of medicine where AI will take much longer to replace physicians.

      • Soupcon says:

        Good diagnostician MDs are hard to find in my experience (retired RN in transplant critical care) but certainly far better IMHO than a machine (AI) which is no better than the programmer who programmed it.

        • BrianC - PDX says:

          “no better than the programmer who programmed it.”

          Bingo! As a SW developer with ~40 years of experience, I have no faith that any SW dev process that implements an AI diagnostic program will be of any value whatsoever.

          Who pays the programmers? Who gates how the decision tree gets made and what weights are assigned to the answers? Companies can and will game the output of any AI diagnostics software, not for patient outcomes, but for profit maximizing.

        • sunny129 says:

          Soupcon

          ‘Good diagnostician MDs are hard to find’

          Wonder Why?

          B/c it takes a lot of time, patience and a lof of coordination and INTEGRATION of one’s history ( past, family hx, surgical hx, hx of allergies, a through physical physical exam , blood tests of varying kind, imaging (xray, CT, MRI. Nuclear Medicine, positron, ultrasound) previous hospital admissions, various consultants reports and what NOT?

          How many docs can afford to do ‘these things’ under the Corp controlled medicine, let alone a single practioner or an organ specialist(s) with tunnel view!

          Seen it, Been there and done it too!

          (Diagnostic Radiologist of over 40 yrs- retired)

        • Michael Gorback says:

          Actually I’ve seen some encouraging studies with AI for diagnosis.

          What gets in the way of good diagnosis is not having enough time to listen to the patient. Theodore Woodward, who many med students both worshipped and feared as a god, used to to tell us if you listen to the patient long enough they’ll tell you what’s the matter.

          Of course he was exaggerating but I’d say maybe 80-90% of my diagnoses started just with the history. I watched this art deteriorate (agree with sunny129) over the years.

          People would be referred for hip pain. I’d ask them to point to their hips. They put their hands over what I call “Simon says” hips, which are your true hips. They were over the sacroiliac area.

          I’d poke them in the SI joints. There’s actually a name for this, Fortin’s test. We’d do a few other provocative tests for SI pain along with an exam of the true hips.

          At that point I’d show off a little and start telling them their symptoms- the symptoms of SI joint pain. That was kind of fun, but it also helped the patient believe my diagnosis. A good theory can predict things accurately.

          Then finally I’d look at the x-rays. Hip x-rays. And I knew that this was a patient who had never been asked anything or examined. They walked in, said they had hip pain, and got hip x-rays ordered. Next!

          You can tell that patients have been conditioned to get out as much info as they can as fast as they can. It was common for them to say “I have hip pain. Here are my x-rays”. Please, have a seat first.

        • Michael Gorback says:

          Erratum:

          “Simon says” hips, which are your true hips.

          Should be Simon says” hips, which are NOT your true hips.

        • Ann Drake says:

          “No better than”…wrong! AI is definitely better than…it learns and has a nearly infinite memory. Of not only facts but processes. You don’t understand how AI works. It gets better and better with time.

        • Dan says:

          Check and balances. Someone paid by masses to oversee.Less gut feeling and more facts. See fat emperor podcast or youtube .

      • J says:

        I agree that the problem is good healthcare doesn’t align with profits.

        I disagree that Pharma is the main problem. I didn’t get exposed to pharma in school; we had to memorize generic names of drugs, not brand names, and we were taught Pharma is evil and not to attend any lunch they paid for.

        When I was looking to escape the broken healthcare employment scene, I had to strike out to join pharma on my own. Now as part of the “evil big pharma empire” I’m doing more good for patients than I did as a provider.

        Medicine is an art as well as a science. Diagnostic science is about asking the right questions and putting together the pieces the patient tells you as well as the ones they don’t. Being forced to see patients for only 15 minutes or less because you have to spend way more time billing, writing notes (so you can bill), or arguing with insurance companies often decreases your ability to really be there for the patient. Once you develop a robot that you trust to understand humans and relate to them better than you do, I’ll start considering that AI might be able to replace healthcare workers.

        • yossarian says:

          I’ve done a fair amount of work in pharma advertising and i DO consider it to be the main obstacle to health in the usa. Pablo Escobar was an amateur compared to these people.

      • MyLadyHumps says:

        I agree, AI is the answer here. I don’t see the need for GP’s. It’s just not that complicated. Remember how bad mechanics were at diagnosing automotive repair?

        Humans are fallible and full of biases. It could take time to correctly program the AI, we are still learning what is healthy. It seems medical researchers have wasted the last century doing research the amazingly points to the efficacy of the product paying for the study.

        The monetary system should also be handled by AI. A properly created AI system would not have led us down a corrupt and cowardly path that ends with complete and final currency debasement. The Fed seems to think a sound currency with purchasing power has no relevance for the economy, sadly they are corrupt cowards and they are wrong.

        • Thomas Roberts says:

          As far as healthcare is concerned, AI in that situation (patient diagnoses), at current progess, would function equivalently to just using statistical methods. AI for most proposed uses, at the current time, is equivalent to being the best statistical and forecasting methods. It’s has to be used alongside doctors. The entire Healthcare system in America, has to be redesigned, then doctors will function far better. Improving the quality of food, would be the most important thing in America, in improving health outcomes. Over time, the number of doctors will be continually reduced.

          AI controlled surgery robots, could with a big push, replace most surgeons in the near future, and perform at a far greater level. Using AI controlled surgery robots, would greatly accelerate the progression of the medical field, especially if DNA analysis was the default (you can opt out), if an entirely redone Healthcare system, had your DNA it could linkup the data between diagnosis, the surgery robots, DNA, family history, pharmaceutical researchers, and more; and push medicine forward. The doctors will still be needed for various purposes for much longer, for roles, such as guiding the nurses. The DNA collected by the medical system, would be in better countries, kept separate from law enforcement for privacy reasons.

          As far as the FED goes, AI in this instance, would be far more capable, in the present, and would greatly exceed current FED rulers. An AI controlled FED, would be able to link up with AI assisted planners across the country, and lead to a far better economy. It would also be able to detect and stamp out most corruption. This would be massive.

          #ReplacePowellWithAI

        • Bobber says:

          You are saying sound money should be the basis of monetary AI, but how many people we agree we need sound money? I doubt a majority of politicians would agree to that.

          In that sense, monetary AI would a form of autocracy that takes control away from people. You can say Joe shouldn’t smoke because it will kill the fool, but Joe gets to do what he wants.

          Monetary policy is the same. Trump and Biden get to send marching orders to the Federal Reserve because they were elected and that’s apparently what their voters want.

          Intelligent people find that detestable, but the desires and foolhardy beliefs of dimwits have to be respected in a Democracy.

        • Thomas Roberts says:

          The FED isn’t democratic in any way, an AI FED can only be more democratic than the current FED. The current politians probably wouldn’t America to be more democratic, but, they do realize that America has to hold it together, in order for there to be money to steal. If America’s economy grows faster due to an AI FED, there will be more money in general for them to steal. While, an AI FED would be part of a grander series of changes, that would reduce corruption. The top politians (congress) still have plenty of opportunities to steal, that wouldn’t be effected. The lower level thieves won’t be as lucky. Replacing the FED can only be done by congress and doesn’t depend on anyone lower than that.

          #ReplacePowellWithAI

        • Cynical Engineer says:

          I’ve been working on software for over 30 years now, and this seems to come around every 10 years or so. Somebody comes up with a new wrinkle on “intelligent” software and suddenly everything will be solved by the new “AI”.

          In the ’90s, it was “neural networks”, this time around it’s “machine learning.” All have suffered from the same “Garbage In, Garbage Out” problem because none of it has been “intelligent.”

          The challenge with machine learning systems is that we typically do not understand how they’re making decisions. A classic example of this: Somebody wanted to train the system to recognize chairs. They fed it a bunch of images with chairs and a bunch without. The system reached a point where it could accurately identify the images in the test data set that contained chairs and reject those without.

          Then they turned it loose in the real world and the results were completely random. When they analyzed the decision data, it was discovered that the algo had figured out that all the “chair” images were at a different brightness level from the “no chair” images. It was just measuring the brightness level and announcing that the image contained a chair.

          We have a LONG ways to go before we have anything resembling “intelligent” machines. A good first step would be to figure out how people do it. We still have no real understanding of how the brain works, human or animal.

      • Dr Dearth says:

        Absolutely correct! It’s much easier to build an expert system in medicine than a self driving car. It’s been done already but there’s a lot of resistance from the known monopolies, cartels, guilds etc. Also not as sexy as self driving. Medicine should stay boring though. I don’t need innovation, I need proven solutions.

        • Wolf Richter says:

          Medicine is bad enough as it is. There is no reason to pay a bunch of coders and Big Tech to make it vastly worse. But you’re welcome to go to your AI doctor and get killed in order to enhance Big Tech earnings per share.

        • Paul from NC says:

          I don’t know what yall are arguing about. AI in medicine has been a productized thing for well over 8+ years. As in, my wife who is a triage RN for a service serving health groups in 30+ states, uses their AI triage ‘assistant’ every single day, all day. With every single call, it gets better and more accurate. That *doesn’t* mean the nurses have no self-judgment they put to work when the AI tool doesn’t have a clue, it just means it helps the human cut through the bullshit (although, sometimes it does in fact *add* to the bullshit, its garbage software after all). Same with AI transcribing notes in real time, in multiple languages, for doctors of all kinds – this has been happening for well over 14 years. Don’t kid yourselves, there’s a reason Amazon, Microsoft, Google and Apple are acquiring health-related tech/software companies. The writing is bright and bold on that wall.

      • Auldyin says:

        @GTv
        I always saw the modern medical ‘industry’ as a natural evolution from the old snake oil sales industry.
        The govt controlled it in the public interest but the snake oil interest was always strongly there and it eventually re-subsumed Govt given time and persistence.
        Just sayin’

    • raxadian says:

      The key is moderation, too much sun causes skin cancer, too much training hurts you. Plus not every person is the same, some people can be out in the sun and day and have no problems, other get sunburns in less that twenty minutes. Same for exercise.

    • c1ue says:

      Its fine when you’re young – what about when you get older?
      A lot of weightlifters get really fat then.

  2. Markus says:

    Very excellent! Much thanks!

  3. Henry Barth says:

    Excellent. Please continue writing columns.

  4. VintageVNvet says:

    Love the iconoclastic approach you verbalize so well MG!!
    As one who dropped out of med school in 1970 after ONE day, because the entire huge building it was in reeked not only of sickness, but corruption to the rafters and beyond…
    Admin I talked to at the school to implement dropping out said I couldn’t drop out,,, and I said, ”try and find me, LOL” and went ahead and finished the BA as easily as possible with an ”experimental” basis that continues.
    It’s SO easy to blame all the very deep shit of the ”medical services delivery system” on the docs, but that is SO clearly NOT the case these days that I do not blame any MD or other doc for dropping out, at least for a while.
    After that while, with the full MD education, almost always heavily if not fully subsidized by WE the Peon taxpayers, WE can only hope those folks can figure out THEIR way to put their education to work again to help as many and as much as possible.
    Thanks again for the honesty and good writing.

    • J says:

      As someone who took a decade to go through medical training, and appreciates that much of it is subsidized by the govt (despite landing into 6 figures of debt, which was lower than average for my classmates), it took me that long to realize that the best way I can give back to society is by going into “evil big Pharma”!

      I am much better at working on new drugs to change outcomes in cancer, than clicking check boxes on a computer as fast as possible or arguing with insurance companies. Also, I did not get paid for spending long hours with patients and coordinating care, which was the most important part of my job. Society’s “investment” in me would have gone to zero had I committed suicide (which I had started to consider when I was practicing), but luckily I was able to escape. Now I can contribute by putting my oncology background to use to improve patients’ lives more than I did as a doctor.

      • Harry Houndstooth says:

        All of us should take advantage of the Warburg Effect.
        Cancer dies when the patient is in ketosis.

  5. Escierto says:

    A very entertaining and informative essay. Long may you write, Doctor!

  6. Henry Barth says:

    I’m 81. Recently my doctor said I was ‘pre-diabetic’ and prescribed something to combat it, and said I had to change my diet. I was referred to the hospital nurse dietitian. I duly went to her office but never went in when I saw she was 5’6″ and easily weighed 300 pounds. The hospital is full of obese nurses and staff; I see them outside on smoke breaks.

    • DB Cooper says:

      Patient: Each time I look in he mirror I want to throw up. What’s wrong with me?
      Doctor: Nothing. You’re eyesight is perfect

      • Udee says:

        Nurses & teachers are & will always be (secret) smokers.

        • Petunia says:

          Lots of doctors are drug addicts.

        • Catxman says:

          It’s hard to be noble as a healthy person when everything around you is designed to “bring you down.”

          You walk into a 7-Eleven and you see nothing but rows upon rows of chips and Slurpee machines.

          You go to McDonald’s and it has been optimized across decades to offer quickly and easily made delicious treats like taking a shaker full of salt and BLASTING the fries with that sh*t.

          It’s everywhere. There’s even sugar with the peas. People respond to incentives. And the incentive is bad health in so many cases.

        • Duke says:

          Why are you walking into a 7eleven or a McDonald’s. That is your problem. Just don’t do it.

      • Michael Gorback says:

        “I want a second opinion”

        “OK, you’re ugly and your mother dresses you funny”

        • Richard Greene says:

          Patient:
          It hurts when I do this !

          Doctor:
          Don’t do that !

          Oldest doctor joke in the world.
          Your joke was a Rodney Dangerfield original.
          My wife compares me with Rodney Dangerfield: She says: “You look a lot
          like Rodney Dangerfield”

    • roddy6667 says:

      Nurses are more likely to be obese or smoke than the population in general. Been a fact for 50 years that I have known about.

    • MyLadyHumps says:

      I’m wondering why you keep participating in the the medical system. Unless you have an acute problem, like a broken bone, the system has nothing for you.

      You have successfully achieved 81 years of living, you could have done that without their interventions. For the most part, the medical system (and Wall Street) is a giant parasite sucking the life and vitality out of society. Just walk away and live a human life.

    • yossarian says:

      Not only are you 81 but you are wise. Mote veggies, less carbs. It’s that simple.

    • Harry Houndstooth says:

      There is little doubt that obese females are drawn to working in the medical field. Especially at the front desk in doctor’s offices. You can sit all day and work in air conditioned comfort with medical insurance. It is very unlikely that you will get any useful dietary information from a dietitian. Their profession has long ago been hopelessly corrupted by Food, Inc. Just like living on a hospital diet will kill you. Sugar causes heart disease and strokes, not cholesterol.

      It is very difficult to be in optimal health with a carbohydrate restricted diet (Low Carb Living by Johnny Bowden) see (FOOD- What the Heck Should I Eat and FOOD FIX by Mark Hyman).

  7. Nick Kelly says:

    Some good stuff, some whacky. Like singling out beer for godssakes. Would Russian medicine love to trade vodka drinkers for beer drinkers! Russia has declining life expectancy in males largely to chronic alcoholism. Beer is like pop there, it’s an insult to toast someone in beer. To drink means to drink vodka, often not mixed.

    ‘If you have gout it’s bad to drink beer’ Sure, no doubt. If you have gout you probably shouldn’t drink martinis either. You are a hell of a lot more likely to damage your liver with hard stuff than beer. As umpteen counselors have noted, the drinker of hard stuff, often pours them stronger as the night rolls on. So how strong is the martini?

    Beer is always the same % alcohol. In fact while you can actually kill yourself in hours drinking straight booze, this is impossible with beer.

    I’m surprised more attention isn’t given to the LEADING lifestyle factor: smoking. The lifeco actuaries are the experts. There is a chart that tells you how long you will likely live. First thing you enter is your age. Next is smoking or not. It lowers your expectancy by up to seven years.

    This is why the life ins co wants to know if you smoke.

    • roddy6667 says:

      Life insurance companies like to weed out the smokers. Health insurance companies shouldn’t care. Smokers spend less on health care than non-smokers. They have less education and a lower income, so they (statistically) only go to a doctor when they are very sick, and do very few of the healthy, preventative things.

    • Michael Gorback says:

      That’s one reason I was unhappy about the post going out prematurely. I’m a hunter. I have a freezer filled with hog sausage and venison. Even a hunk of bear meat.

      Guess what is chock full of purines? Wild game, which is why I have a freezer full of that stuff. It never gets eaten unless I have guests over.

      So it’s mostly eggs, dairy, salmon (but only a little) and chicken. Even tuna, shrimp, crab, and scallops are off the menu.

      Beer is a double whammy. Alcohol competes with uric acid for excretion by the kidneys. But in addition beer has purines in it.

      If I put up a web site about life expectancy there would be one question – how old were your parents when they died?

      • Duke says:

        The plant based nutrition doctors have lots of science why dairy, chicken, eggs are not health promoting. I can link you to some info explaining how egg industry funded studies are designed to show eggs don’t affect blood cholesterol. But well designed studies show obvious connection.

        • Paul from NC says:

          Duke, we’re children when it comes to understanding the human body. Hence humans still regularly discovering new organs, after 5000 years of cutting ourselves up trying to figure out how all the parts fit together. Cholesterol is not an issue, but the amount of blind-prescriptions of statins, is. The more you look into the science, the more you realize, that cholesterol is produced by your body in *response* to an underlying “health” condition or an out-of-balance condition. It is 100% protective.

      • JoeC100 says:

        My father died at 55 form an acuteness heart report. One of his brothers died at 46, also form a heart attack. I am 75 and given my father’s history, I began working with my ND to take a better path. back then there was almost no genetic testing available (except for E4/Alzheimer’s risk – which also has some heart related diet information) and very little else of real value. Over the many years I have worked with her useful available testing has vastly expanded, with options like the Boston Heart profile quite valuable and affordable as an annual “check in”. Also as genetic testing expanded (23andme, etc.) some future genetic issues surfaced (methylation related) to be addressed. I remain in good health and a “punch list” to additional life style “to do’s) to catch up on.

        I have a great PCP who has encouraged me to keep looking for new useful information – like the Bredesen protocol for Alzheimer’s risk. He has been clear that he only really knows what he was taught in med school and is open to new options like genetic testing that could be quite helpful. A year back when I told my PCP Abour Bredesen’s work, he pulled up Brdessen’s website and about two pages in there was a description of his protocol. My PCP read that page and said “all of my patients should be doing this..”

        So don’t just rely on conventional medical care systems, supplement with self directed exploration – ideally with a serious medical professional “coach”.

        • JoeC100 says:

          Sorry re: typos above – my father died of a massive MI at 55 while playing badminton at the Pentagon gym. Heavy smoker most of his life and quite stressful job situations for about five years before he died (2.5 year RVN tour, etc.)

        • Harry Houndstooth says:

          Dale Bredesen’s book, “The End of Alzheimer’s” should be required reading for every health care provider in America. Unfortunately, there is a gigantic industry in caring for patients with dementia.

          Also, Grain Brain and Brain Maker by David Perlmutter.

    • Thomas Roberts says:

      Nick Kelly,

      Alcohol consumption has been in steady decline in Russia, for more than a decade. Beer and wine are now more popular than vodka, in Russia.

    • My neighbor went into rehab, three years ago, about Thanksgiving. He was in his early 50s, and at it a long while. When he was younger he mixed booze and meth. Work all day, party all night. He gave up the drugs, but he told me, if he went to the microbrewery and had a few, then he had to stop for vodka on the way home. I said, you don’t have a drinking problem, you have a shopping problem. If you want a drink that badly have a beer. Next month will mark his death two years now. Accident, or suicide? We’ll never know, but he was tapped out emotionally. I think the Meth did most of that. Very affable guy.

    • c1ue says:

      Your belief on Russian life expectancy is out of date.
      All that talk about vodka and smoking was mostly BS – yes, they drink and smoke but the main reason Russian life expectancy dropped in the 1990 to 2000 was the collapse of the USSR and the subsequent job losses, societal upheaval and mass uncertainty.
      No one talks about the French, who drink and smoke plenty.

      • Happy1 says:

        Russian life expectancy is improving from its nadir in the 90s, but is still far below most developed countries, mostly from alcohol and smoking. And this was also true in the 70s and 80s. The male to female difference in life expectancy is higher than in any other developed country.

        • c1ue says:

          You might want to look at Russia’s per capita income vs. the “developed countries”. It is a lot lower.
          They’re not poor but they’re definitely not wealthy like Western Europe. In fact, it is lower than China’s.

  8. DB Cooper says:

    “Always laugh when you can, it is cheap medicine.” …

    • Paulo says:

      That, and keeping busy.

      I walk everywhere around my neighbourhood. Never drive or ride when you can walk. And number 1 advice, DO NOT buy a recliner chair. I have a tenant who used to be a faller (cut trees for living on steep sidehills). He retired at 60 and then perched in a recliner. Now at 81 he is obese, can hardly walk, uses a cane and wheeled walker, and has had several falls these past 18 months. He watches TV all freaking day because he can’t do anything else. I have found him on his floor twice, and both times required an ambulance and 1 week in hospital. Now he is on several meds to control ‘issues’. Due to his lack of exercise he even needs a regular laxative for normal function.

      I blame it on that chair. It’s electric so it rises and descends with power. 20 years ago he was running up and down sidehills packing a chainsaw and tool belt.

      Stay busy, involved, interested, and practice balance. Even bending over to tie shoelaces is something positive. Honest to God my friend even sewed his shoe tongues to his shoes so he could keep them laced up and use a shoe horn to put them on. These are runners. The shoe horn is about 3′ long and he uses it to reach stuff from his chair so he won’t have to get up.

      • QQQBall says:

        And once you start walking everywhere it becomes more and more enjoyable. Walked to the Farmer’s Market today and lugged back food for a week. Up and down hills. So much more satisfying than driving.

      • Argus says:

        You’re absolutely right. We’re an elderly couple hanging on to our double story house because taking the stairs many times a day strengthens the leg muscles (we just hold on to the railing as security against falls). Gardening is a great all-round exercise, even in a relatively small space – we don’t need to lift weights when we’re lugging bags of compost and full watering cans about.

      • WES says:

        Agree. Staying busy is the only way to stay alive.

        You need to go to bed each night with a whole bunch of things that you need to do tomorrow. That way you can’t afford to die that night because you need to be alive when you wake up, so you can get all those necessary things done*!

        I knew an old Texan who was as skinny as a bean pole. He had this attitude towards exercising. Whenever he got the urge to exercise, he would lay down until the urge passed!

      • Auldyin says:

        @P
        Humans evolved for thousands of years as hunter gatherers it took around a thousand years for a mutation to become mainstream. Life consisted largely of sleeping, lying around, fighting and screwing until you got hungry, then you engaged in an intense burst of nervous and physical energy to catch a prey which was then humphed on your back to the cave where it was roasted on the fire, your most precious possession. After the feast you slept for days until it all started again. The human frame was engineered to carry heavy loads on your back for long distances.
        It’s only 200yrs since the industrial revolution totally transformed lifestyles, not enough time for mutation, so we are stuck with the old hardware and all the ills modern life wreaks on it.
        I try to mitigate by never using lifts and by carrying food from the supermarket on foot for a mile each week. Don’t know if they had whisky in the tundra.

  9. Citizen AllenM says:

    One of the biggest lies ever told is “all men are created equal”.

    In medicine, you are presumed equal, but differentials start with your very genome- 46 chromosomes, great, 47 eh, 48 bad, 49 dead fast….

    Now, then it all starts from prenatal nutrition, got that, then you have great chance at full potential development at birth.

    Next cut, birth problems…..

    etc etc etc.

    Environment, genes, all mix together to generate highly disparate outcomes, and vulnerabilities.

    Add in a medical system that only begins treatment with the recognition of problem and you have huge damage done to the patient before “treatment” begins.

    IF it is amenable to treatment, and the doctor is aware of the best treatment, and if the patient has the ability to pay for said treatment….then and only then do you get the great outcome everyone desires.

    Then you get hit by the bus crossing the street.

    Someday this war’s gonna end…(Afghanistan finally did…)

    • Nick Kelly says:

      The vast majority of humans have 46 chromosomes. If the rare variations (49= one in about 100, 000) were a significant factor in life expectancy then it would have been impossible to increase life expectancy.

      For better or worse, most variations in numbers of chromosomes do not greatly affect life expectancy including the male variation of 49.

      • Thomas Roberts says:

        Nick Kelly,

        Individual mutations, don’t mean a lot. But added together, your DNA can greatly change your life expectancy.

        • JoeC100 says:

          And can potentially provide useful advice about how to mitigate some not so good genes..

  10. rory says:

    moderation is what the old time farmers preached and many lived to old age.

    • Ron says:

      They also worked daylight to dark hab clean food water. Still wasn’t polluted

    • Duke says:

      Moderation in a modern grocery store equals 90% processed crap. Moderation is subjective and thus useless advice. I quantifiable. Moderate heroin, cocaine, smoking, different animal protein at every meal? Good luck with that.

  11. Anthony A. says:

    Nice essay Mike.

    At 78 (in one month), I watch my carbs and really watch HFCS intake. All my blood work is in the normal ranges. I walk a lot and used to be a long distance runner (years ago) and now have two new hips! Other wise I am all me.

    Let me finish one of your sentences:

    “And remember, ketchup is a vegetable”…and also contains HFCS.

    I have seen one brand of ketchup with a label that says “NO HFCS”, but contains sugar! The rest I have seen contain HFCS.

    Please keep the essays coming.

    • Michael Gorback says:

      I can’t believe nobody recognized the “ketchup is a vegetable” reference.

      Early in the Reagan administration they tried to classify ketchup as a vegetable for school lunches, and I think they also tried to get pickled relish on the menu too. This was in response to cuts in school lunch subsidies or something.

      I guess the idea came from the concept that ketchup, being made from tomatoes, could count as a vegetable. Tomatoes are fruit. This was the USDA!

      The Difference Between Knowledge and Wisdom:

      * Knowledge is knowing that tomatoes are fruit.

      * Wisdom is understanding not to put them in fruit salad.

      • Duke says:

        Animal protein and cow juice are off the USDS myplate (modern day food pyramid)….. because despite industry lobbying, the science is clear, they don’t promote health.

        Ketchup is a vegetable was a way to get nutritionally deficient school lunches approved.

      • Richard Greene says:

        Hey Gorback
        You’re pretty amusing for a doctor.
        Is that legal?

        That ‘ketchup is a vegetable’ nonsense really annoyed me when I first heard it. As a diabetic, who does not need insulin, I am very aware of sugar and carbs in foods. Ketchup is sugar sauce flavored with tomatoes. Eat mustard instead !

    • Duke says:

      Primal kitchen organic un sweetened ketchup. Costco.
      Still not a hralth food. But better.

      • Richard Greene says:

        Definitely better for health, but is salty, and doesn’t taste like (sweet) ketchup. I’d call it tomato sauce.

      • Paul from NC says:

        Don’t look to the supermarket if you want health. Making home made ketchup is dead simple and takes little time. Preferably, you grow your own tomatoes if you want a taste that pops – also dead simple.

    • Robert Hughes says:

      Look hard, sugar free catsup without HFCS, is available, even in some major groc stores, not all. Same with a variety of other similar products, just look hard.

      Conversely make some items: ex, cocktail sauce – catsup, horse radish, capers, lemon and worcestershire, as an example.

      Once you get out of eating processed condiments, etc., without sugar ( avoid HFCS like the plague ) it’s amazing how good meals can taste.

      A system of training the body, tongue to what is real. Go to Europe and many places the food is so real compared to the crap served in US restaurants.

      • Happy1 says:

        I’m amused that anyone eats enough ketchup to be concerned about how healthy it is. I can’t think of a single thing a person eats with ketchup that is healthy. I certainly do eat those things, but not frequently, and a bottle of ketchup lasts months in my refrigerator. Salsa is better with almost anything anyway.

    • Yossarian says:

      “SIMPLY” heinz hax sugar instezd of HFCS.

  12. lenert says:

    Whatever happened to tort reform?

    • Michael Gorback says:

      It happened in Texas. Pain and suffering is capped. The result was that without those added damages, and only being able to sue mostly for physical injury, loss of income, cost of future care, etc, it became unprofitable for lawyers to sue.

      Lawsuits are hideously expensive. As a result malpractice insurance is hideously expensive. A neurosurgeon might pay $300,000 a year for coverage.

      One of my closest friends had a son with severe drug issues. He was seeing a shrink who was giving him amphetamines. The shrink also failed to do urine drug tests, which is standard of care whenever prescribing scheduled drugs a/k/a controlled substances.

      The kid OD’d. Parents tried to sue but couldn’t find a lawyer due to the malpractice caps.

      Frankly, doctors desperately needed relief from predatory plaintiff’s lawyers. It was like open season. But the fix also robbed people who deserved justice.

      • RockHard says:

        There was this doctor named Christopher Duntsch in TX who was completely incompetent, killed a few patients, injured more. I’ll quote from the Texas Monthly article (you’ll have to search on your own, I think Wolf’s site doesn’t allow links)

        “One key factor: the private equity–funded Dallas hospitals have a profit motive, which incentivizes doing as many surgeries as possible. And patients hurt by Duntsch had limited recourse, because in Texas, two decades’ worth of tort reform (thanks to a mendacious conservative campaign) both slashed the maximum amount of damages malpractice victims could receive and, worse, insulated hospitals from responsibility for the doctors they hired. “

  13. sydneycollin says:

    The dogma “high cholesterol causes heart disease and stroke” is parroted by most doctors. They tell you that if you don’t get on a statin your arteries will be riddled with plaque.

    I’m 5’6, 110lbs, run, lift weights, eat low carb and happen to have a total cholesterol of 342 (HDL 80, LDL 250, triglycerides 62).

    I’ve always had high cholesterol since first having it tested in my 20s. Doctors have pushed me to take a statin for decades, but I’ve refused because all my other markers are stellar.

    Finally, I did a coronary calcium scan and came up with a score of zero (which shows there is zero arterial plaque build up). How could this be if high cholesterol causes plaque?!

    Interestingly, statins are the most profitable drug ever.

    I did my own research & became my own advocate. Protect your health and do the same.

    • Michael Gorback says:

      I stopped taking statins. Turns out they can hurt you.

      Do you take baby aspirin for cardiovascular protection? I stopped that too. Seemed like a good idea. Made a lot of sense. My wife didn’t buy into the story about why I had bruises in unusual places, but it can indeed make you bruise easily.

      I didn’t stop aspirin to save my marriage. I stopped aspirin because as a prophylactic measure it only works if you’ve had a vascular incident already. No stoke or MI, no aspirin.

      The problem is that we tend to run towards the goalposts with only half the information, such as which goalposts to run to. Midgely is a great example. His solution to engine knocking worked. CFCs were a vast improvement over the contemporary refrigerants.

      I’m glad that he died before he saw the long term results. He truly was a magnet for disaster although his intentions were good.

      • sydneycollin says:

        I don’t take baby aspirin because I’ve never had a vascular incident either. I get the sense that by prescribing pills & procedures, it makes doctors feel like they’re doing something. Even if that something just masks symptoms, or worse, creates new ones.

        I was hesitant to statins because I did my own research and discovered they actually create more problems than they solve (i.e. muscle wasting, insulin resistance, cognitive decline).

        Yet most doctors parrot the relative risk statistically deceptive manipulation pharmaceutical marketers push instead of actual risk. When you look at all cause mortality – even for men who’ve had a previous vascular event – statins barely move the needle, if at all.

        I agree with you – try to get as much information as possible before you decide which goalposts to run toward. Do your own research and draw from multiple sources to become as knowledgeable as possible. This will enable you to advocate for yourself.

        • Michael Gorback says:

          It makes the PATIENT feel like the doctor is doing something. The doctor knows that quite often the best treatment is nothing.

          Sometimes you write a prescription just to get people out of your face. Kid has runny nose. Mom wants an antibiotic. You explain that it’s a cold and antibiotics won’t work. Mom throws a fit.

          Here’s your prescription. Thanks for your contribution to the development of antibiotic resistance. The new replacement drug will be more expensive and you can blame the drug companies and doctors.

        • sydneycollin says:

          Yes, of course some patients demand drugs.

          However, in my case, it’s been DOCTORS who were pushing drugs on me.

          Thank god I resisted & instead found the solution in diet & lifestyle.

    • Michael Gorback says:

      Part deux. Interesting story about CT calcium score.

      I saw my cardiologist pre-pandemic. I wasn’t happy with my BP medication. During the visit he suggested we repeat my stress test. I told him my staff, patients, and insurance companies tested me every day. He ignored me, having no sense of humor. He’s from Pakistan so maybe it’s cultural.

      Let’s rewind a bit. A stress test in an asymptomatic person is not standard procedure. How did we get to this point?

      In 2005 one of the local family docs keeled over and died in his office. He was in his 40s. Soon thereafter, the husband of one of the neurologists died while riding his bike. He was in his 40s. Both were MIs (myocardial infarctions, or heart attacks).

      This burned through the doctors lounge like a SoCal wildfire. Soon all these doctors who knew better wanted a workup. If two healthy men with no symptoms were ticking time bombs we wanted our tickers checked.

      Just for emphasis: not one single doctor thought about getting a cardiac evaluation until we heard two stories. Not science. Stories.

      In 2005 I was . . . Hang on I need to take off my socks to do this calculation . . . 52. I had no symptoms.

      I scheduled a stress test. My cardiologist assured me I’d be fine. I wasn’t. My EKG suggested inferior wall ischemia (low blood flow to an area of the heart). My cardiologist said it was probably a fluke. We then did the second part of the test, which involves injecting radioactive treacer into the bloodstream and then scanning over the heart to see if there are any areas that aren’t taking up the tracer.

      The radiologist called me that afternoon. I had a “cold spot”.

      The next day I was in the cath lab. I asked my cardiologist what the chances were that I’d need a stent. He told me I knew better than to ask that question. We were doing the test to find out (“you dummy” was implied). There’s a simple reason that this is a dumb question if you understand statistics. Statistics apply to groups, not individuals.

      So we do the cath. Suddenly I feel terrible. I look up at the monitor. My BP was 60/0. I can hear my cardiologist yelling out orders for fluids and nitroglycerin. The catheter had dinged my left main artery and it had gone into spasm. I was finally going to get my MI after all.

      I survived. My left anterior descending artery just kind of tapered off at the end. Probably congenital and probably been like that forever.

      So that’s how repeating the stress test came up. I was against it but doctor culture strongly leans towards listening to your consultants. My EKG was normal and the nuke showed no cold spot.

      But some people can’t leave well enough alone. He wanted to do a calcium score. This is a low dose radiation study to see how calcified your coronary arteries are. I asked why do it if I was BETTER?

      I showed up for test and in typical hospital fashion no one had told me it’s not a covered service. They wanted $150.

      Now I happen to be a cheapskate, and as a pain specialist I spent a lot of time standing next to xray beams to guide needles. I needed more radiation like a fish needs a bicycle.

      I canceled the test and decided to read up on it some more. Calcium scores rarely come up in pain management unless you have a female patient with osteoporosis, and that’s a different kind of calcium score anyway.

      I immediately knew I was not going to get this test. The xray exposure isn’t all that bad. Maybe equal to a year of normal background radiation. But if you check it every 5 years from age 45 through 75 (after 75, screw you and your heart) there will be 42 extra cancer cases per 100,000 men. I know, low risk but when it’s you it’s 100%. Besides with my luck I’d get all 42 of the cancers.

      Here’s why I bailed. I have always practiced according to the tenet that before any test ask what you’ll do if it’s positive and what you’ll do if it’s negative. If the answer is the same, don’t do the test.

      I knew what the answer was going to be because (1) I wasn’t going to give him another chance to kill me, (2) my stress test was perfect, and (3) I could whirl my girlfriend around the dance floor without dying.

      No matter what the test showed we were going to discuss diet and exercise. So skip the test.

      He sold me some magic vitamins to decrease inflammation. Inflammation is the new concept in vascular disease. One bottle was a bunch of B vitamins. B vitamins are water soluble which means whatever you take in excess of what the body needs gets peed out. The vast majority of people just make expensive urine when they take B vitamins.

      The other bottle was D and K. I already take D3. Spinach, which I love and grow in my hydroponic rig, is chock full of K.

      The B vitamins also contained betaine, an amino acid named after the sugar beets it was discovered in. Betaine is one of the new designer supplements. It’s been investigated for heart disease but of course the supplement crowd is off to the races with a plethora of claims for betaine. Guess what else contains betaine? SPINACH!

      Popeye was a true visionary. Better than Midgely.

      • Michael Gorback says:

        myocardialminfarctiins = myocardial infarctions

        • David Hall says:

          Prevent and Reverse Heart Disease, by Dr. Caldwell Essylstein, 2008, Kindle version available.

          This Cleveland Clinic doctor led a group of patients on a diet that actually reduced cardiovascular disease and plaque. It partially unblocked arteries. Essylstein is alive at the age of 87.

        • Michael Gorback says:

          Essylstein’s “research” was one of the most laughable experiments in world history. It would have lost a high school science fair.

          Here are his dietary rules:

          you may not eat anything with a mother or a face

          you cannot eat dairy products

          you must not consume oil of any kind

          generally you cannot eat nuts or avocados

          The science:

          A randomized controlled study is one of the strongest types of clinical trials. A double-blind study (neither the doctor nor the patient know who is getting which treatment) is impractical for diet. How do you hide the food from the test subject?

          But randomized controlled studies are pretty good. As the name says, the subjects are not selected for a certain group by the researchers, they are randomly assigned. Controlled means the subjects are followed, interacted with, and surveyed the same way. RCTs minimize bias.

          The RCTs on diet consistently show that nuts, olive oil, and fish consumption are protective. Do you see that in the list of Esselstyn’s rules? No.

          Esselstyn’s study comprised 24 patients who were not randomized. Instead it was one group of 24 patients lumped together.

          The study was contaminated by the administration of cholesterol-lowering drugs and then tatins when they became available.

          Only 18 patients completed the program. The other 6 bailed and went back to their cardiologists.

          9 of the 18 had undergone coronary artery surgery and 2 had received angioplasty prior to entering the study.

          So Esselstyn’s “study” was 18 patients, 11 of whom had already had their coronary lesions fixed, all taking statins.

          This is not a study. It’s mishmash of 18 stories.

          Esselstyn is 87. My parents ate whatever they wanted. They were former smokers. Dad died of a weird liver fibrosis in 2020. He did not have cirrhosis. Mom died this past April of a broken heart (she was anemic and stopped taking her iron infusions; they had been married 70 years). They were both 93 when they died of noncardiac causes.

          Many studies have been done on the various fad diets. Ironically, the Atkins diet (the first low carb diet) has been shown to be very effective at weight loss, better blood sugar conttol and reducing cardiovascular risk. You can eat as much as you want except carbs are restricted. I tried this diet years ago before it was modified. I was willing to kill for a piece of toast. Other diets like Paleo, Keto, Mediterranean, Zone, etc have also shown promise.

          One problem with all of these diets is that you can’t conduct the studies forever. The Atkins study lasted 2 years. Given the cost and labor intensive nature of RCTs its just not practical.

          Other than vegan diets, none of the more popular diets run the risk of malnutrition, but even the most restricted vegan diets aren’t as onerous as Esselstyn’s.

          A more credible version of Esselstyn’s diet is the Ornish diet. Ornush claims that his diet has been proven to reverse coronary artery disease.

          If you want to get into the rough and tumble world of dieting, read this amazing article in Scientific American where Ornish and another doctor square off. There’s a lot of money in this industry and Ornish has created a business empire out of his diet and wellness programs.

          https://www.scientificamerican.com/article/why-almost-everything-dean-ornish-says-about-nutrition-is-wrong/

        • David Hall says:

          Dr. Michael Greger’s grandmother had bypass surgery, then the bypasses narrowed with plaque. She was sent home from the hospital to die at age 65. She went to a health and nutrition center run by Nathan Pritikin. She reversed the blockages and lived to be 96. Dr. Greger publishes nutrition research online with his NutritionFacts website.

      • sydneycollin says:

        Awesome story, doc!

        Reason I did the coronary calcium scan was to see if my arteries were full of plaque due to a lifetime of very high cholesterol.

        Every doctor I went to put the fear of god in me, that if I didn’t start popping statins, I’d certainly die of a heart attack.

        The zero score allowed me to rest easy, proving that my high cholesterol does not cause arterial plaque, regardless of what the medical dogma propagandizes.

        I get all the vitamins I need from a whole foods diet, with plenty of fresh green veggies, lots of nutrient dense organ meats & almost zero carbs. Why supplement if you can obtain it from real food?

        • Gandalf says:

          The CT calcium score is an imperfect correlation with the amount of coronary artery plaque, since you can still have soft non calcified plaque.

          Total cholesterol level has less relevance than the levels of HDL vs. LDL (high HDL=good, high LDL=bad). You can have a high total cholesterol and if that’s mostly from a high HDL, you are doing great.

      • Duke says:

        Thanks for the personal story.. Dr’s POV of own health very interesting.

        Dr. Kim Williams: I Don’t Mind Dying, I Just Don’t Want It to Be My Fault

        – President of the American College of Cardiology
        Plant Based because of nutrition science.

        MG… go see Dr. Joel Khan

      • RedRaider says:

        My elderly mom was taking 7 pills daily. 1 was to keep her BP from going too high. Another was to keep her BP from going too low. I asked her doctor about the seeming logical inconsistency in this. We decided to cancel all pills and see how things went. Things went just fine. If anything her appetite improved a little.

        Are all these pills being prescribed really doing anything worthwhile? Or are they more of a crutch for people growing old? I’m sure there’s a pill every now and then that does some good. Bot you can run a Pharm industry on a couple of pills.

      • Geoffrey Sherwood says:

        I’m sure that the K he was proposing was K2 — which is very often taken with D — rather than K1, which you find in spinach. It is unfortunate that they are both labelled K because they act quite differently. K1 is used in the process of clotting blood, and K2 interacts with D with regards to calcium utilization, supposedly helping it to deposit in teeth and bones rather than other unwanted places in the body. K2 is typically found in dairy from grass-fed cows (mk-4 version) or from bacteria (mk-7 version). I don’t know if the reality lives up to the claims for K2, but I take both it and D3. Seems like cheap insurance.

    • California Bob says:

      Years ago, my total cholesterol averaged around 210 (whatever unit they use). I tried a product called ‘Cholest-Off*’ and bought a home cholesterol tester–my GF at the time was an ER nurse and she said they used a similar type in the ER–and watched my total. It went from over 200 to around 175-something over a period of months. A year or so later, at age 65, I got a ‘full physical’–which was disturbingly cursory–and my blood panel confirmed my home tester. My doc was surprised, so I explained what I’d done; he said he’d recommend it to his (many) patients who disliked taking statins. C-Off’s ‘active ingredients’ are ‘plant sterols/stanols.’ A recent blood panel showed TC at 180-something, but I’m living in a hotel while our house gets remodeled and I haven’t been following my regimen as closely.

      * I have NFI interest in this company or product whatsoever. It’s not cheap, but Costco puts it on sale occasionally and I load up. No harmful side effects that I have noticed.

      • Gandalf says:

        High dose niacin (I take 1500 gm a day – Ruger brand) and various water soluble fibers ranging from Metamucil, guar gum, xanthan gum, etc. also work to decrease cholesterol.

        I used to take all three types, Cholest-off, niacin, and guar gum capsules. Got my cholesterol down from around 195 down to 140.

        But, it just got to be too much work, too many pills, so now I just take the niacin. I like the buzz it gives me (some people can’t handle it) and it really wakes you up also.

        The three types work at different levels of the cholesterol pathway, and so their effects are additive. The water soluble fibers bind the cholesterol in your gut and prevent it from being resorbed (this has been known for over half a century). The niacin binds something in your liver cells and interferes with the production/release of cholesterol. The Cholest-off also works on another part of the cholesterol production pathway.

      • Gilbert says:

        “ A year or so later, at age 65, I got a ‘full physical’–which was disturbingly cursory”

        Welcome to Medicare. The reimbursement is so low that doctors, etc., do very little. You get what you pay for.

    • Harry Houndstooth says:

      See “The Great Cholesterol Myth” by Johnny Bowden and Stephen Sinatra.

      Statins were the biggest scam ever pulled off on the American public.

      What you want is health assurance, not health insurance.

  14. RJ McElroy, MD says:

    Mike, there are a couple of additions to your article to be made. The development of public health can not be overemphasized leading to a marked increase in life expectancy. Let’s not forget that an effective dentistry has been a major factor. The early 20th century Flexner report resulted in a major change in medical education that led to the modern medical school—prior to these changes much of what passed for medical education was problematic. As for your gout, the major source of uric acid is from protein in most diets.

    • Auldyin says:

      @RJ
      Thanks for, at least, acknowledging the engineers.
      My first specialism, as a callow youth, was public health, drains, water supply not on anybody’s radar, as usual, but it paid well and was interesting.
      I never did dentist’s drills though.

  15. Keepcalmeverythingisfine says:

    So when I was 14 my dad had a massive heart attack at 50 right there in the living room. They saved him barely and he had triple by-pass surgery. That was right when all the anti-egg, anti-milk, anti-red meat stuff was rampant. My mom fed him fake eggs, fake butter, and chicken and turkey the rest of his miserable life. Things are different now, and most of that nutritional advise was wrong. I pay zero attention to all the nutrition crap the government spews. Just about everyone I know is overweight or obese. 63% of Americans are obese. I tell them if they don’t want to get sick then lose weight. Instead they gain more weight and take whatever uncle Pfizer says. Good luck with that.

  16. David Hall says:

    Some foods metabolize into acidic components, others into alkaline components. I was pissing small uric acid stones and had a bladder stone removed by laser surgery. I asked the physician’s assistant, “What causes uric acid stones?” She said, “Animal protein.” I became a vegan and the stones disappeared. Plenty of vegetables and fruits may increase potassium levels. A vegan heart surgeon named Ellsworth Wareham in Loma Linda, CA was driving at the age of 100 and lived to be 104.

    • Wolf Richter says:

      The Japanese and the Swiss are generally neither vegan nor vegetarian, and live longer than just about anyone else. In the Japanese population of 126 million, there are 79,000 Japanese who are 100 years or older. No biggie.

      • Xavier Caveat says:

        The Japanese government decided to give all citizens who reached 100, a silver sake bowl and in the first year in 1963 they gave away about 300.

        They had to switch to silver-plated sake bowls about 15 years ago, so many were making it to the century mark.

  17. Michael Gorback says:

    CRAP! THIS WAS A ROUGH DRAFT, NOT INTENDED FOR PUBLICATION!

    • SaltyGolden says:

      Don’t sweat it, still an interesting read.

      Cheers!

    • BrianC - PDX says:

      Looks pretty good. Wish the rough drafts I wrote came out this well. lol

      Aren’t computers and the SW that runs on them wonderful!

      Better living through software.

    • David Hall says:

      Useful topic anyway.

      I was using a hot tub before my bladder stone operation. Learned later dehydration causes stones too. Gave up a high sodium diet helped as well.

    • QQQBall says:

      I enjoyed it very much. Thanks for the mistake! :)

  18. Bet says:

    Husband was pre diabetic , high A1C. His doctor said “ I can “ cure” you of your potential diabetes through my suggested food plan. In three months his A1c dropped to 5.3 and he lost 45 plus pounds over the year and his blood sugar has been great in the last six years. This doctor is not popular with the pharms. No more metformin scripts to push. We are what we eat. Where I live there is a huge pervasive
    Obesity problem

    • sydneycollin says:

      What was the food plan?

    • Michael Gorback says:

      If you are what you eat, what are you if you’re a vegetarian? A vegetable? Sorry, couldn’t resist.

      To throw fuel on the fire, if God didn’t want us to eat animals why did he make them taste so good? :-)

    • Richard Greene says:

      5.3 is great news.

      I can have a 7.0 A1C with a low carb diet alone, but I take Metformin to get my A1C down to 5.5

      Losing weight is a big part of the solution, and reduces high blood pressure too. Type 2 diabetes is a symptom of obesity.

      They (doctors) say you are always a diabetic, like they say you are always an alcoholic, and that makes sense to me.

    • Harry Houndstooth says:

      Keep the doctor.

      Most of the Type II diabetics in America could be cured in the same way.

  19. Cobalt Programmer says:

    1. As far as strength training vs. cardio is considered, anything is better than nothing.
    In a nation where 70% are considered overweight and half are obese, 30 minutes of something is good.

    2. Doctors who said tobacco was good in the 60s. Big tobacco gave millions to American medical association.
    Lot of doctors favored tobacoo.

    3. Even today, lot of the doctors prescribed opioid pills which was harmful to lot of people.
    Addreall which is meth, prescribed to lot of school children. And everyone wonders why the children grow up to be stupid.
    Add to this sleep aids, anxiety relief pills, benzos and several others. Big pharma!

    4. Doctors never opposed the Viagra. The drug is a performance enhancer not a performance produced.
    If the bird is dead, it cannot be revived by Viagra.

    5. Recently, the number of people with high blood pressure went up so easily. Why? Simple. Doctors changed the diagnostic criteria to 130 instead of 140 as a sign of high blood pressure. More pills can be sold baby.

    6. There is a old saying in my country. Disease half and doctor other half of the suffering!

    7. Remember. A patient cured is customer lost!

    • sunny129 says:

      Cobalt Programmer

      ‘More pills can be sold”

      When I was med school the ‘normal’ fasting glucose at 120 mg/ml
      And now it is 100mg!

      Big Pharma wins!

      • Daedalus says:

        One problem, sunny, is that medical school research was once largely funded with public funds. Now, it is often funded by ‘private’ sources (read: ‘grants from drug companies’). This taints the results of biochemists and microbiologists who know where their purse strings are attached. In most cases there is no conscious manipulation of the experimental results, however the subconscious is impossible to control. Also, everybody knows that only certain questions in certain areas will be funded, and without funding you will be looking for another job.

        • Michael Gorback says:

          Oh there’s plenty of deliberate manipulation. I used to help people with their statistics. When the stats came back unfavorable to the new product the doc would ask me if we should try a different statistical test. Sure, if you don’t mind doing the wrong test.

          Shortly before I left academics I was invited to be on a panel at a drug company sponsored symposium. The company sent me slides and a script. When I told them I had my own slides and script they were not happy.

          We met in Boston to go over our presentations. After I gave mine, which shredded most of the papers written on one of the topics, the moderator said “Mike, if what you say is true then Jerry’s lecture is meaningless”. I just just told him there was nothing I could do.

      • Apple says:

        Heaven forbid doctors incorporate new knowledge.

        • Michael Gorback says:

          The first day of med school they told us half of what we learned would turn out to be wrong in 10 years.

          They were correct. I just found out the heart is on the LEFT side now.

          Things I learned back in the day:

          If you hurt your back you need 1-2 weeks of traction. This turned a lot of people into cripples. Current thinking is one day of bed rest maximum and then up and around.

          Kids with juvenile rheumatoid arthritis shouldn’t be allowed to play sports because it will wear out their joints. Someone finally did a comparative study and exercise was good.

          Same for osteoarthritis. I used to send all my arthritis patients to either yoga or Tai chi. One day an elderly lady called me up crying because her pain was so bad. I asked her about any changes. Yes, her family doctor told her to stop the Tai chi because it would wear out her joints.

          Common denominator for all of these: joints need to be moved.

  20. curiouscat says:

    What the world really needs is fewer people who know what the world really needs. :-)

  21. sunny129 says:

    4 key elements in improving of health of mankind:

    1. clean water
    2 Good nutrition
    3. vaccines
    4 Antibioitics

  22. Daedalus says:

    Great post, Doc. To many ‘Doctors’ don’t actually understand statistics all that well and tend overlook those pesky ‘side effects’. They weren’t trained to either do or assess research. Also, as you know, it’s way risky for a doctor to prescribe in a way that goes against the official ‘approved’ line, since they open themselves to lawsuits.

    I well remember the ‘cholesterol shaming’ days and the fact that your understanding of how cholesterol gets into the body was known over 40 years ago. And, yet, I still hear the same old story about keeping cholesterol intake low today.

    • Michael Gorback says:

      Not only is there a dearth of statistical understanding but doctors tend to read the abstract and move on. Dissecting every new paper you read is a lot of work.

      • Yes says:

        Docs may not be running statistical models but I feel like they do use stats, indirectly. They identify patient symptoms and then match symptoms to possible causes. In other words, the most common etiologies are considered first. Then secondary and so on down the list until you reach the rarest occurring causes in the population.

        In a way this seems appropriate. It’s a way to guess correctly for the largest number of people. The problem occurs when a patient’s symptoms are not attributable to the common, or expected, causes. If you’re lucky, the doc can work further down the list of possible causes with you. But at some point, if nothing is discovered, that’s when docs start trying to get rid of you, in my experience. They don’t know what else to do.

        A few days ago I sent my current doc a list of research articles from PubMed and academia in an effort to help the doc connect the dots between my symptoms and the cause. The cause is not one any doctor suspects: pharmaceutical drug side effects. Yet the research is there to show the connection. I’ll let you know how the doc responds :)

      • Richard Greene says:

        Abstracts are notorious for not being an accurate summary of the study.

  23. MonkeyBusiness says:

    My sleep quality was POOR for the longest time. It literally made life unpleasant. The doctors suggested CPAP and a whole bunch of other things. At one time I even hired a personal trainer. I even tried HIIT. None took. Eventually I had to try a bunch of things on my own and here’s what’s worked for me:
    1. Walk at least 3 miles every morning before breakfast.
    2. Take plenty of Vitamin D. None of the doctors I had ever suggested that I might be suffering from vitamin D deficiency. In fact I noticed it myself while doing blood work for something else.

    I have been sleeping so well the last couple of months, the difference in my life quality is almost night and day. Mind you, I’ve always had the best health insurance, heck at one place, a doctor would come to the office every week. But so what, none of them were really helpful.

    • MonkeyBusiness says:

      I am not a doctor, but my hypothesis is everyone’s different so find what’s BEST FOR YOU. Also account for variable change like age, etc. There’s no answer that will work every single time for every situation. Try something. If it works and makes you feel better than continue doing it. Keep a simple journal that tells you what’s working and what’s not.

      • Michael Gorback says:

        Another reason for the variation is that not everyone has the same problem. People would come see me and say the guy in the waiting said you did some kind of shot in his neck and now he’s doing great. Why can’t I have that shot?

        My reply was always the same. I’m just guessing here, but maybe it’s because you have a different problem.

        • MonkeyBusiness says:

          That’s kinda like what I tried to convey by saying everyone is different. Leaving injections and medicines aside, even if HIIT works for person A does not mean it’s going to be the best exercise for person B. For some people, low/medium intensity high duration exercises will work just fine. Always be suspicious of people who say exercise X is THE BEST. They are probably trying to sell you something.

    • Michael Gorback says:

      Vitamin D is a sneaky thing. Deficiencies can cause all sorts of weird symptoms, including pain, so I added that to my patients’ lab workups. It was amazing how many people had low D and many weird symptoms were addressed by replacement.

      Most doctors don’t worry about it unless you have osteoporosis. Then you’ll get calcium and Vitamin D, which should work but doesn’t.

      The reason D is low on the list is that supposedly a little exposure to sun will catalyze the production of D in your skin.

      But a lot of people avoid sun exposure because of skin cancer. Midgely would probably have sold sun lamps for Vitamin D production.

      Sunscreen diminishes the effect of sun exposure.

      A lot of people don’t get out much, especially the elderly.

      Take your D3 but don’t exceed 4,000 units daily. It can hurt you. OTOH I had one patient who required vast doses but we guided therapy with blood tests. Probably 1,000 units is more than enough.

      • kitten lopez says:

        you’re a STAR! i love watching what’s becoming of you here. thank you for stepping up and meeting Wolf and writing again. you’ve been hidden too damn long.

        i guess this is Your Time now. cool.

        x

      • cas127 says:

        MG,

        Any insight into why many docs prescribe huge doses of 25k to 50k IU to their patients who are vitamin D deficient?

        I get that everybody wants the patient to get back to sufficiency but those are scary high carpet bombing dosages and if there are adverse consequences/reactions to the D, they will come fast and ugly at those dosage levels.

        (D, a hormone, isn’t given the respect it deserves in *either* sufficiency testing *or* treatment dosing).

        I thought the byword was incrementalism and caution, not speed at any cost/risk. But mega-dosing of D (after ignoring it in patients for years) appears to be very, very common…I just can’t grasp the ostensible medical reason for abandoning cautious incrementalism when prescribing huge levels of remedial D.

        • MonkeyBusiness says:

          I am not a doctor, but a friend of mine got a similar prescription i.e. he was to take 50K IU of Vitamin D EVERY WEEK (NOT EVERY DAY) for 7 weeks. Granted in his case, it’s ONE PILL containing 50K IU of Vitamin D, but still it’s a dose for an entire week.

          I am no longer Vitamin D deficient and I take 3000 IU a day (21K IU A WEEK).

      • Richard Greene says:

        “Take your D3 but don’t exceed 4,000 units daily. It can hurt you.”

        There is no science to support this 4000 IU claim.
        Or 8000 a day
        Or 12000 a day

        Also, people who lay in the sun on a beach, or work outdoors, get far more than 12000 IU Vit. D with no harm.

    • MonkeyBusiness says:

      Also forgot to say that I also take Vitamin K along with my Vitamin D.

    • Cobalt Programmer says:

      Also, we are not made for sitting in front of computer and a holding a administration position inside a cubicle. Our bodies are made to hunt, run and fight. All the inflation and MMT are not good to ruminate before night. Do not see current news or economics before sleep.

  24. cb says:

    Michael Gorback said:

    “Vaccines have also played a huge role so medicine gets some credit”
    ______________________________________

    Well reasoned and written article.

    With vaccines are you including the Covid Vaccines? Of Pfizer, Moderna or Johnson and Johnson, which do you recommend, and why?

  25. Kenneth M Luskin says:

    To paraphrase: “Your body makes Cholesterol, therefore eating cholesterol must be OK…= Horribly dangerous logic
    Your body also makes urine and feces…
    = Can I interest in you a feces burger with a large glass of urine to wash it down?
    Overly simplistic viewpoints can easily lead to horribly wrong conclusions…
    = The sun rises in the west and then goes down in the east … Therefore, the Sun must be revolving around the earth?
    Our bodies create a lot of things in specific quantities, which can become TOXIC in greater quantities.
    Vitamin D is produced by our skin when exposed to sunlight… but, in large quantities of vitamin D can be toxic.
    Clearly the author knows nothing about OXIDIZED cholesterol.
    Most of the animal products people eat contain oxidized cholesterol, which is different from the cholesterol are bodies produce.

    Our brains do oxidize cholesterol as way to push it out excess cholesterol past the blood brain barrier
    = oxidized cholesterol can enter the brain… which is thought to be a factor in the cause Alzheimer’s disease.

    • David Hall says:

      The Atkins diet sought to eliminate carbs from the diet. It inadvertently allowed more fats, meat and edible oils. According to one study all cause mortality was more than 30% higher on the Atkins diet than the standard American diet. Atkins dieters were dropping like flies.

  26. Rcohn says:

    Americans are more overweight than ever.Obesity was the most common comorbidity with COVID.
    They also perform worse on standard physical fitness tests
    Cut down on simple sugars and white flour.
    Increase consumption of vegetables and fruits
    Decrease consumption of red meat laced with fat .
    Increase daily exercise , both cardio and using weights.

  27. steeve says:

    And then there’s the direct poisoning.
    Like glyphosate in vegetables.
    Or Fluoride in water.
    Or graphene in….Never mind.

  28. Trucker guy says:

    I’ll volunteer to do the bad thing here and bunt out my objection. The advice is solid but eh, I’ve done the jog a 5k each morning, drink nothing but water for months on end, sleep a lot, eat healthier etc. All I got from it was sweaty from running and sleepy all the time from no caffeine.

    Life is short, and the majority of it is spent miserably toiling away at work, doing chores, or trying to kill time watching tv or whatever. I’m not recommending you shoot up heroin daily but I’d much rather fall over dead from a heart attack at 45 than live to 80 having to worry about my health which is fleeting with each passing day. Eating cinnamon rolls, laying in the easy chair, and swilling soda or alcohol is one of the very few day to day pleasures a working stiff can have unless I’m just missing something obvious. I hate cooking, fast food tastes better than good home cooking which I don’t know how to do to begin with so it’s chicken tenders and burgers for me. It’s a good example of why the principle is sound, but the reality of it just sucks.

    • MonkeyBusiness says:

      I am somewhat sympathetic to your point of view. I certainly don’t treat my body like a temple. I too would rather drop dead earlier if that means I’ve tried a bunch of great food at an age where I can still appreciate them and using my real teeth. What’s the point of living a super long life if the later part is filled with misery.

    • Kenn says:

      Trucker Guy, MODERATION is the key! If you want a burger and beer at your favorite pub, have one. Get a single burger, not a double or triple, and one quality brew instead of a half dozen tasteless light beers, and not every night. Bonus points if the pub is in walking distance of home. I can’t stand jogging around in circles, but I’ll walk a mile for a good meal. I used to travel for a living, and after getting to a hotel, I would walk to a restaurant for dinner.
      Try some of the other things on the menu. You may even like it.

      • Richard Greene says:

        I eat a burger for lunch about five times a week
        from a Burger King drive through just to get out of the house during the COVID epidemic and avoid a sit down restuarant.

        It is a 2 ounce bacon cheeseburger,
        considered a child’s portion.
        The cheese slice is small and thin.
        The bacon strip is about two or three inches long.
        Two slices of pickles.
        Costs only $1

        No one really needs a 6 ounce or 8 ounce burger with a big pile of french fries and ketchup.

    • Duke says:

      I love the trucker caricature. That was like a perfect stereotype.
      Better written than a fiction.
      You can adjust you palate so that you will get same joy from healthy food as from fast food which is just tricking your taste buds with sugar,fat,salt.
      But if you nothing to live for and no curiosity and no offspring to care about seeing grow then I guess you have a point.

    • Petunia says:

      I’m with you 100%. The problem with professional opinion is that it is rarely practical. People tend to do practical things, which the professionals, never examine.

      During the GFC, when we had almost no money, I became the fattest I have ever been. This seems illogical, but I didn’t know if we would have food tomorrow, and I overate each day. My experience taught me why obesity is worse in the poorest communities, it’s the food insecurity. No medical professional wants to acknowledge there may be a practical reason for the obesity.

      • Trucker guy says:

        People also don’t realize that crappy junk food is cheaper to live on than healthy food as well. I can spend 10 dollars at McDonald’s and be set for an entire day for food. 10 dollars at whole foods gets me a snack probably.

        Poor people are fat for a lot of reasons but healthy living is expensive for one.

        I’m a small guy at only 5 8 and 145lbs and that’s living off nothing but fast food and soda. But that’s only because I eat once a day and am cheap as hell.

  29. Seneca’s Cliff says:

    Thomas Midgely, the Bad Boy of the Sibley School of Mechanical Engineering. When I arrived as a freshman engineering student his picture was on the wall of the entrance hall, along with Sperry, Grumman, Carrier, Hammond and Kelly. But by the time I graduated he had fallen from grace and it was gone.

  30. TenGallonHat says:

    “M.D.” doesn’t impress me much.

    Relative is a doctor. No concept of health—feeds their kid processed meat while calling my fruit smoothie “junk”. Not kidding.

    As a teenager my mother made me go to the derm. I stopped one of his Rx face washes because it made my face burn so much (sulfur [peww!]). I said I wasn’t using it anymore because I didn’t want to. He snapped, “And when’d you get your M.D.?” Never went back! P.S. As an adult with much better diet, I get almost no breakouts.

    Took an elderly relative to see their doctor. I thought of the M.D., “This woman is sure getting old to be working…” Heavy-set, I figured 70. Turns out she was EARLY 50s!!!—found out a few weeks later she got cancer, died a couple months later. Surely an unhealthy diet. This M.D. also didn’t know what meds might interfere with one another—the elderly relative had a horrible reaction needing E.R.

    I STAY AWAY FROM M.D.’s!

  31. Randy Oldman says:

    Now I’m not a doctor but I have played one in a game of charades. Been drinking a bottle of wine every night for 30 years, spend $150 a month on vitamins and supplements, still renovating at 72, (four hours a day max).

  32. islandteal says:

    “Stay away from Hospitals”
    That seems to be even better advice.
    Especially in the craziness with which we now surrounded!!

    • polecat says:

      Especially when told NOT to come to the ‘Hospital until one is ready for Death’s ventilator – with said institutions, and All who are in their employ .. totally endemnified as per CDC/Big pharmacy guidelines, of any, um, ‘harm’ – regardless of better outcomes where earlier, and more efficacious treatments reign supreme …. but ONLY if one is a Horse, of course!

      • polecat says:

        And that’s not even mentioning the FDA’$ constant and medacious whoring-out to all things Corporate! .. minus a much needed spine .. ‘;[

  33. Phil says:

    My grandmother is 94, still living independently. Sharp as a tack. She drinks 2 Coronas every. single. day. She did make an allowance to her age and stop drinking red wine when she turned 90.

    Don’t discount genetics. And the nice thing is, you can’t buy that, not really.

    • Sierra7 says:

      Phil….
      Ah, yes…….genetics. The factor not mentioned enough in this post!!

  34. Halsey Taylor says:

    Older people (I’m 63 and remember when ketchup was a vegetable) are cash cows for the medical industry. With today’s technologies and delivery systems, we might expect a much larger portion of the population to experience extra years of dementia. Wait… there’s a new drug for that, woohoo.

    Younger, less affluent people struggle to get healthcare.

    What would be a better path? Back to the practices used in the 50’s? NHS ala UK? A fixed lifetime maximum for everyone? Expand physician assistant capabilities?

  35. Duke says:

    WTF..was the last paragraph sarcasm or is this MD an alcoholic McDonald’s eating health time bomb…?

    Plant based doctors that actually take the time to coach and educate and lead by example have great success helping people that want to change their lifestyle and reverse heart disease and diabetes without drugs or surgery. The problem is doctors that 1) don’t have time. 2) don’t believe or follow healthy lifestyle themselves.
    3) don’t know the new science of nutrition well anyway.

    • TenGallonHat says:

      Points 2 & 3: like!

      Why is W. wading in these waters? (wow, weird alliteration)

      Don’t get me started, I might sound off like some of the commenters here who go off the rails regarding the F e d R e s. hehe

    • Wolf Richter says:

      Duke,

      “WTF..was the last paragraph sarcasm …”

      Yes, obviously. The author explains this with some extra details in this thread.

  36. drifterprof says:

    For an excellent historical review of the invalid research conclusions involved in the low-fat / low cholesterol diet hypothesis, which has been promoted by pharma, AHA, government institutions, etc:

    “The Big Fat Surprise: Why Butter, Meat, and Cheese Belong in a Healthy Diet”

    Ironically, ideological fanatic vegetarians and pharma profiteers have the same goal of demonizing fats, when research indicates excessive sugar has worse all-cause death outcomes. So weird how many non- or low fat processed foods are packed with sugar!

    (Note: I have always tended to go for *mostly* a diet of vegetables, legumes, etc. non-animal flesh alternatives. Currently I avoid the Thai pork-centric diet, although now eat leaner cuts that I can see before cooked. And I try to meet the challenge of eating some of my wife’s traditional Thai fish dishes, which can be a little strong smelling).

    Living among friendly polite Thais, and eating wife’s traditional Thai cooking in Thailand, blood pressure went down from mid-140s to 120 or so (sometimes below 110).

    • Duke says:

      Thai food is mostly made with with whole foods.
      Most nutrition science is zeroing in on whole grains, legumes, vegetables, fruit, etc..
      You can’t say fat is good or bad. It’s what comes with it. Olives and avocados great. Bacon and steak bad. Blame food industry, they will market the shit out of anything that gains traction.
      I love seeing cholesterol free cereal or gluten free beef..

      • TenGallonHat says:

        Hey, read my comment below, we sound similar! lol

      • drifterprof says:

        I was always too much a cheapscate to buy store-bought cereals. It seemed like gross profit-gouging, and most types were sugar saturated. Homemade hot cereals are so easy to make in the microwave.

        My current version is quinoa and amaranth (4 minutes), then add rolled oats and rye, plus cocoa powder (non-dutched), fresh ground seeds (flax + sesame + perilla) for about 4 more minutes. Takes only about 10 minutes, during which before retirement I was getting ready for work. Nowadays, when done cooking it, I add yogurt and kefir (homemade), and fresh soy milk from vendor in Thai open market.

        Sounds complicated, but really pretty easy using microwave.

        • TenGallonHat says:

          Cocoa powder with oatmeal, that sounds good, I never thought of that.
          Soy milk? Beware.

        • drifterprof says:

          Forgot to add – also ginger powder and cinnamon powder.

      • sydneycollin says:

        If meat is bad, what on earth do you think hunter-gatherers ate when no one was dying of heart disease? Hint: It wasn’t just plants.

        See research on the Expensive Tissue Hypothesis explaining how humans evolved such large brains.

        • Duke says:

          Sydney. Are you a hunter gatherer living in scarcity? I would eat meat if starving too because it has calories. Or would you like to live healthily as long as possible based on modern science? Check the Blue Zones book out. Longest lived cultures on the planet all eat the lowest amounts (approaching zero animal protein).

        • sydneycollin says:

          Duke – Meat is not the villain health propaganda has claimed. Meat has been an essential part of the human diet forever. A diet of pure plants lacks essential nutrients like B vitamins.

          The true thieves of good health are:
          – too much sugar & fructose
          – seed oils (which used to be used as machine lubricants, but found a new market as dietary oils about 100 years ago).
          – modern grains (especially gluten)

        • Happy1 says:

          The meat our hunter gatherer ancestors ate has nothing in common with the corn fed factory meat at your local supermarket. Bush meat has very little fat.

        • sydneycollin. says:

          True.

          Just don’t eat the factory farmed, cornfed, grain fattened beef from your supermarket.

          But, pastured, grassfed beef or bison or elk…is very healthy.

          I hunt & butcher my own too.

    • TenGallonHat says:

      Who the hell trusts Big Ph arma or the goo ber mint? Not I! Never have, never will!

      I doubt vegetarians shout for low-fat diets. I’m a veg and I just ate a bunch of olive oil. Vegetarians aren’t marketing “low-fat” fads, marketers perhaps are (20-30 years ago?). I can assure you most vegetarians have known for decades that sugar is the culprit of fat and dis ease.

      I haven’t read your source material, but it doesn’t sound very intelligent. How come humans aren’t waned off milk like animals are????

      • Michael Gorback says:

        There are a lot of vegetarian and vegan diets that shun fat in any form.

        • TenGallonHat says:

          There are low-fat or no-fat diets that happen to be vegetarian, yes, but low-fat or no-fat is not a mark of vegetarianism itself.

        • Duke says:

          MG. Plant based whole food diet advocates for healthy plant sources of fat. Olives. Avocados. Nuts. Seeds.

      • drifterprof says:

        The book is an in-depth review of the research literature over the last 50 or so years. Asserting that something sounds “not very intelligent” based solely on one’s biases … well *that* does not sound very intelligent.

        However, I should have emphasized that I mostly meant demonizing animal fats.

        TGH wrote: “How come humans aren’t waned off milk like animals are????”

        What? If you meant “weaned,” the definition is “to accustom (a young child or animal) to take food otherwise than by nursing).”

        Humans eat a lot of things as adults that were not used to wean them off of milk..

        • TenGallonHat says:

          Dude, I know all about weaning. Check the name. I am typing on an old keyboard which has had wine spilled into it, sometimes the letters don’t type! Waned is a word so it didn’t highlight. Wane, wean, and wine!!!!!!!!!!! Oh yeah, in your case, WHINE too. Lol

          Demonizing animal fats is a good thing. And that’s how I can say the title is unintelligent (I was being nice, what I meant was, “stu pid”).

        • TenGallonHat says:

          “Research literature over the last 50 years” – pleeease. Research literature over the last 50 years has told us that FAT causes dis ease, not sugar. Yes, you read that right, WE WERE FED FALSE/*FALSIFIED* INFORMATION STATING THAT FAT CAUSES DIS EASE, NOT SUGAR.

          I’m done. (Approaching W’s comment limits, not because I’m annoyed).

        • drifterprof says:

          TGH: “Research literature over the last 50 years has told us that FAT causes dis ease, not sugar.”

          No. You are wrong. Research over the last 50 years has NOT told us that. Biased interpretations of research, and cherry-picked research have told us that. As you would understand if you read the book.

          By the way, insulting people with forced ad hominem “jokes,” as a cover for your misstatements, misconceptions, and hyperbolic generalizations, is weak.

        • TenGallonHat says:

          Hey “Prof”, check this out:

          ” 50 Years Ago, Sugar Industry Quietly Paid Scientists To Point Blame At Fat “

          You’re, like, wrong, word for word, verbatim. Lmao.

          P.S. I forgot to type one letter. I see thousands of cattle every day. WANE, WEAN, WINE, WHINE is f/king hilarious, actually (especially when speaking with an accent). I can tell you only speak one language. Spelling isn’t a huge deal in reality!

        • drifterprof says:

          TGH: ” 50 Years Ago, Sugar Industry Quietly Paid Scientists To Point Blame At Fat “

          Yes, that proves my point. Biased research was influenced and cherry-picked by industry and fanatic vegetarians. Other unbiased research was valid. It only proves me wrong in your flaming imagination that puts your own words and thoughts into other peoples statements..

          The problem was not that you misspelled “weans.” The problem was that your statement did not make any sense at all:

          TGH: “I haven’t read your source material, but it doesn’t sound very intelligent. How come humans aren’t waned off milk like animals are????”

          Those two sentences are not connected in any clear semantic way? What logical point does the second sentence make in relation to the first sentence? Obviously, humans are not weaned off milk like animals — because they have different nutritional and developmental needs. Different animals are weaned off milk in different ways.

        • Duke says:

          In the plant based nutrition they often talk about the composition of different animal milks. Whale milk has fat and sugars and hormones that support a baby whales growth rate. Cow milk has components that support a baby cows growth rate. Human milk has the lowest protein content and supports human babies growth rate at its peak doubling early rate(first 2 years).
          The weaning comes in with the oft used comment that humans are the only species that drinks other animals milk after weaning. And while I would surely drink milk if stranded in desert with no other calories, it’s a bit silly to drink growth hormones meant for a cow while we are all mostly trying to lose weight in our cheap high calorie junk food society. Also, Asian people eating traditional rice and vegetable staples don’t have osteoporosis like we do until they move to western diets. Dairy doesn’t protect from osteoporosis. It promotes it!!!

    • Saylor says:

      “….living among friendly polite Thais…”

      **Imagine how much less stress we would have when we stepped out into the world if we were more polite?
      Life expectancy increase….5 years,*
      Health event issues… (-) 20% *

      *The above numbers do not reflect any actual study.
      **I am not a doctor and have not played one since I was 8.
      I am not trained in any great degree for statistics though I have used them professionally in the distant past.
      I have been know to make shit up.

  37. Nacho Bigly Libre says:

    “Dysentery killed more soldiers in the Civil War than bullets.”

    NIH says “Each year, in the United States alone, 7,000 to 9,000 people die due to a medication error.”

    That’s more deaths each year than HIV/AIDS.

    • TenGallonHat says:

      Estimated 200,000 die from medical mistakes in US hospitals each year.

      Co vi d was… 350,000?

      THINK ABOUT THAT, FOLKS!!

      Re-read those numbers and compare media coverage. It’s, like, whoa!

      • VintageVNvet says:

        Thank you tgh, for at least coming close:
        While ”hospital” groups give out 7K deaths per year from ”errors” or some such,,, some actual MD docs groups have, apparently based on the same time period,,, given out up to 225-400K for the same metric…
        While being one who has been kept alive with the interventions and clear inventions of the allopathic model,, many times in the last 60 years or so,,, I have also been blessed by the very clear intellects of many many MDs, several of whom have very clearly saved my life when I was down to the last few seconds IIRC…?
        SO, PLEASE,,, do NOT denigrate the MD docs,,, and in fact, the entire allopathic model; such model and the various and sundry ‘HEROES’ of that model CERTAINLY deserve our respect, honors, etc., etc..
        That that model does not work for DIS EASE is entirely another question/challenge, far shore…

    • Michael Gorback says:

      Maybe, maybe not. The problem is the data collection. They have categories like “failed therapy” that goes into the medical errors bin.

      There isn’t a doctor in the world that doesn’t understand that ultimately therapy fails. Death always wins.

      The available data are also gleaned from billing data and codes. For all we know, the numbers could be much higher or lower.

      For instance:

      https://www.mcgill.ca/oss/article/critical-thinking-health/medical-error-not-third-leading-cause-death

  38. AL says:

    Been off sugar and alcohol for 8 months and doing basic Keto. Down from 253 LBS to 229 LBS and falling. I’m age 67 and 6’2″ height. I don’t Dr. much but do an annual check up and my doc never discusses diet or ask me what I eat. I walk a couple of miles a few times a week and push my lawn mower for a couple of hours at a time….so not an exercise nut but might start to become one. Success breads success. I recommend the Keto plan as it’s healthy veggies, grass fed beef and butter. Eliminate all fructose. It’s easy once you get going on it. My target is below 200 lbs. and maybe around 185 if I get back into regular work out. Cheers!

  39. NoPrep says:

    Interesting article!

    Jack LaLanne made it to 96. His last week he refused to see a doctor, died at home. I don’t believe LaLanne ever would have gone in for a Covid jab. An Interesting character of a man for sure.

    There was also a guy named Bernarr MacFadden – another physical culture muscle man who believed in fasting and raw food diets, and in sexual energy. His wife apparently thought he was nuts, at least she came to believe that after the divorce, if her book about him was truthful. His health motto was “weakness is a crime – don’t be a criminal!”

    But the obvious truth is each of us if we get old enough is going to get weak and frail. Is it really criminal to be on one’s deathbed? MacFadden ended up there too, after all. There isn’t a diet or exercise plan or an innoculation that is going to stop it. The creature eventually falters and dies in its old age, unless it dies of other causes or a predator or enemy takes it out. That’s just part of the cycle of life. But modern humans often have a hell of a time accepting that..instead too often we “rage against the dying of the light”.

    Maybe there’s a better way than raging? Notions of peace of mind and soul, of spirituality, are an interesting concept to me, because they potentially offer an escape from the fear of the inevitable.

  40. polecat says:

    My wish is to be revived from my protective tinfoil wrapper.. some centuries later .. so my new-age physician can opine how smoking is actually good for me. Also, those little bubble-shaped self-driving cars of the future won’t kill you .. unlike the Muskmelons of Today.
    Hat tip to ‘ol Woody.

    Re. tonics to help alleviate Gout, tart cherry juice is my choice above all. Believe me, I know of which I speak. No whichdoktor drugs for me …
    ‘;]

  41. Paulo says:

    Next up, an article on public education. Everyone’s been to school so everyone is an expert and knows what exactly should be done. :-)

    I have a good friend who always disses MDs and the profession. He does his internet research and concludes the nature of his maladies lies in missing this or that trace mineral, or ‘they’ should have picked up on _________. Meanwhile, he hires a lawn service and drinks too much. But his Keto diet should fix everything.

    I don’t get the negative comments on MDs? They have a high level science degree, many years of med school, an on the job internship, and then work under supervision from colleagues, their clinic, or hospital. Do they know everything? Of course not. But they do know when to refer to a specialist. Would any laptop Larry know more? Not likely.

    This reminds me of my flying job. I would pick up a crew in some logging camp in my DHC-2. The same guy would scramble into the co jo seat and watch with rapt fascination. My movements were always slo mo, easy on the controls, no rapid power changes…..yawn yawn yawn. At least once per month some ‘guy’ would say, “I’ve been flying in and out of camp for years. I could do this”. My reliable reply, “Of course you could. It’s just a machine. If you can run your hoe you can fly this no problem. You just need the ticket”. Crazy. I guess he forgot about the trips in 1/4 mile viz and 40 kt winds.

    We forget about the MD who didn’t get enough sleep last night whose clinic booked him for 50-60 hours this week, then hospital visits on the way home. Maybe that is why he made a mistake. Or how about those new folks who know everything about Covid, cleaning cupboard medications, vitamins, or stuff at the feed store? You know, those simple cures ‘they’ are all keeping secret so_________ can just make more money, or get elected, or take away my freedoms?

    What chokes me these days, and this is NOT directed at any one in particular, is the lack of respect so many exhibit. It’s like no one knows what they are doing, and if they have been in the career, any career for 20-40 years, why then they are old and stale and out of date in their knowledge. But if they have milk whiskers, then they are just out of school and have no experience….probably know nothing because the ‘program’ was crappy. Or the hospital was crappy. Or or or.

    My GP, (the dreaded GP). “Hmmmm, I don’t like this, I’m going to send you for an ultra sound”. 2 weeks later, “Hmmm, I would like to refer you to __________, for another opinion.” One month later the new doc says, “I don’t like the looks of this, I would like to operate next Wednesday”. My reply, “But that’s a problem, I have work commitments”. His reply, “Well, that is a problem, but not your problem now, is it”? When I asked if he was being hasty he said, “Imagine it is 5 years from now and I am in court with your wife. You’re dead. They ask me, ‘you didn’t operate because'”??????

    Got it at stage 1, over 10 years ago. That is why I like doctors and let them do their job. They removed me from cancer surveillance 5 years early because the intervention was so timely. No bill, no co pay, no med costs, no appointment fees, just professionals doing their jobs.

    My Dad, shoot….1975, was on his way home from the BC cancer clinic. Reaching for his smokes he said, “Doctors, what do they know”? My mom, the retired nurse went ape. It was a showdown. The old man lost that one. Quit smoking and died of cancer. Both.

    • Yes says:

      People have different experiences. I personally have never been helped by a doctor. But I have been harmed, several times. I would give anything to go back in time and “un-see” those docs. Also father-in-law was killed by doc’s error. Also mother’s heart doc botched surgery and nearly caused her to get a leg amputated. Also step mother received permanent leg damage due to her botched hip surgery. She walked unaided *before* surgery. Etc.

      I personally learned not to trust docs at age 12 or so, when the dentist insisted he’d done a successful root canal and I should have no feeling in that tooth. Meanwhile, I hit the ceiling every time he poked the tooth. I know when I have pain. Why don’t docs trust patient knowledge? That was lesson one. Lesson two came later, and now I have permanent nerve damage from taking pills I did not want to take.

      Docs don’t get a pass just because they’ve been to medical school. Their decisions and attitude matter, a lot. I’ve seen the education they go through. It’s indoctrination as much as education. I’ve seen docs be wrong while filled with hubris. I’ve also seen more than one doctor and dentist look at me like a $ instead of a person, and I’m smart enough to know when they are motivated by something other than good will. Even this doc writing here is sort of pissing on vegetarians and things he does not perceive to be correct. He’s got a visible ideology. That’s a red flag to me as a patient. Ideology gets in the way of listening, and discovering. It’s all part of the hubris built into the profession and reinforced by seeing patients who are (often) idiots who have no understanding about any aspect of their own health.

      Glad you’ve been helped Paulo. But it’s a totally different story here.

      • NoPrep says:

        Dentists and root canals. “gutta percha won’t hurtcha”. A maverick doctor named Dr. Meinig wrote a book theorizing root canals as being a source of disease for many, due to chronic bacterial infection ensuing with the root canals.

  42. Shibumi says:

    Thanks for being one of the exceptions. Personally I have no respect for doctors, haven’t been to one in over 30 years and never would. Almost without exception they are money grubbing shills for the pharma industry.

    Within my own extended family, they have brought nothing but pain and suffering…not that I blame them for the causes; most of which were self inflicted by bad dietary and lifestyle choices. But the maxim of medicine used to be “First, do no harm”. Whatever happened to that concept?

  43. Xavier Caveat says:

    I’m about the only person I know over 60 that doesn’t take a multitude of prescription drugs every day, are there others like me?

    How does all that Rx mess with your well being, in terms of physical fitness and appearance, I wonder…

    • cb says:

      Lot’s of them.

    • VintageVNvet says:

      Very similar here at 77 xc:
      Not many folks want to share that they don’t ;;adhere;; to the prevailing mind set, mass convictions,,, etc.,
      Most of which is based on,, whatever the now most clearly owned and operated by the oligarchy vast majority of media describe as needed, etc.,
      Just do your best to eat as clean and healthy as you can,, meaning if your are out in the wilderness and have not been able to harvest, eat the best you can from the can,, and keep trying to do better each day, while absolutely forgiving yourself for not being better prepared…

    • Anthony A. says:

      Xavier, yes, me. All blood work normal at 77+. I only take a Vitamin D pill and a baby aspirin (and I probably shouldn’t take that). I think good genes are in my family history. The only thing that killed my father was booze, and lots of it. My mom died at 85 or so when her kidneys failed. Grandparents were from Lithuania and lived pretty long lives as I was told.

      I did wear out the cartilage in both hips after a few decades of long distance running. So now I have two new, beautiful titanium implants and they have really helped my golf game.

    • Whatsthepoint says:

      I don’t take anything either….nada….and I’m 66! Way to go!

    • Robert Hughes says:

      76 here, nada pharma stuff, 2+ hours of pickleball a day at 4.0 level, d3, calcium, mg and daily vitamin. Very mixed diet, all in moderation.

  44. wkevinw says:

    Public “sanitation” has saved more lives than patient-to-physician activities, but I am glad we have both.

    Fact that most don’t want to accept: if you want a clean environment, incentivize high economic productivity (wealth), and use some of it to clean up.

    You really don’t want to live in the “good old days” of going “back to nature”.

    It’s much more environmentally friendly to have modern internal combustion engines for transport in NYC than a bunch of horses .

    https://www.nyhistory.org/community/horse-manure

    • leanFIRE_Queen says:

      Exactly. Sanitation and decent housing are so much cheaper than giving a super expensive cancer treatment to individuals.

      Once the housing shortage is solved, I’ll be ok with spending on bloated healthcare, not before. Spending on healthcare has to be second to housing.

  45. Zantetsu says:

    Wow so now the “get off my lawn” commenters get to write articles too. The devolution of WolfStreet?

    The first half of the article was OK, but it started sounding more and more like a wolf street commenter “airing of grievances” the further it went on.

    • Wolf Richter says:

      Zantetsu,

      Are you already drunk in the morning? Mike Gorback has been an author on WOLF STREET since 2014, when it was still Testosterone Pit. You can see his articles if you click on the link under his name.

      I understand from your past comments that ad hominem is your personal strength. But dude, you need to sober up before you comment here.

  46. Raging Texan says:

    Great column Dr. Gorback, I laughed my rage away

  47. Eferg says:

    Dr Gorback & Wolf

    Thank you again – a second great article accompanied by interesting discussion.

    For what it is worth: my wife knows I read Wolf regularly, but has little interest in the usual subject matter. This one I printed for her to read.

  48. Clete says:

    The main lesson here is simple: You have to use DIET ginger ale with your bourbon to avoid kidney stones.

    Interesting article, Doc. Thanks.

    • Wolf Richter says:

      Or diet ginger ale and alcohol-free bourbon :-]

      The real question I always have is this: why screw up a delicious thing (such as a good bourbon) with a friggin soda pop? Drink it neat to get a taste of life, for crying out loud.

      • Clete says:

        I hear ya, but half cheapish (Jim Beam) and half diet Canada Dry (only allowed choice) over ice is a refreshing afternoon treat. The goodish stuff (Makers, Woodford, et al) gets one cube in a good glass, after dinner. I leave Pappy and the other fancy stuff to the hipsters.

      • Russell says:

        Ice is all it needs. I may drink a Manhattan on occasion. Heading to Nashville in two weeks hoping to find some good local bourbon.

        Wolf – What is your personal favorite? My latest is Bib and Tucker for good and reasonably priced.

      • SwissBrit says:

        Simple answer – if you don’t use good bourbon, then you’ll be happy to adulterate the taste to someting more palatable, and it’ll be cheaper too…

        Good quality stuff should be appreciated sans additives, and that goes for alcohol, meat, cheese, even high quality vegetables, if prepared with love.

  49. Richard Greene says:

    I just read the first Gorback article, after I read this one, and look really forward to the third article.

    Gorback is a great writer.

    I’d bet that he is retired, and not taking new patients.
    I’d guess that his patients were lucky people.

    My biggest complaint with doctors are them not listening carefully to the patient, and then jumping to a very fast diagnosis.

    Those doctors who type into a laptop, and never look up, are annoying.

    It’s our job to stay healthy.

    It’s a doctor’s job to fix us if we don’t.

    I generally can’t stand doctors (and dentists) because they make me nervous and raise my blood pressure a lot … but I’m glad they are available when I need one.

    • Auldyin says:

      @RG
      “Those doctors who type into a laptop, and never look up, are annoying.”
      Googling No???

  50. Miatadon says:

    Sorry, Wolf, this essay is not that interesting or informative, not up to the quality of your regular postings. I’m a health food, supplement, and exercise junkie, and his story just didn’t resonate.

    • Michael Gorback says:

      Then go resonate somewhere else with your junkiness. Nothing will change your mind.

      This was not an article about which supplements, exercise, or food is the best. It was about misconceptions, drawing conclusions based on inadequate data, and why counseling doesn’t work.

      Quite honestly, the way the way this discussion has devolved into arguments about exercise, diet, supplements, etc makes me question whether I’ll ever write another piece here.

      A lot of people expressed their appreciation, but uncritical thinking like yours contaminates and impedes rational discussion and I’ve pretty much stopped reading and responding. I can’t spend my time addressing every jellyfish protein consumer and exercise fanatic here.

      It’s not what you know that kills you. It’s what you know that ain’t so. – appears in various forms attributed to various people.

      • anon says:

        Dr Gorback,

        Please do not stop writing here!

        Your opinions are informed with your years and years of Professional experience. People need to chill AND to be exposed to different points of view.

        But I’m just a happy lurker and sometimes commenter here.

      • wkevinw says:

        Dr. Gorback-

        On counseling- having gone through this due to a mental health issue of a family member, I would say counseling doesn’t work in a “linear” way. Sometimes all it does is keep a situation (that is deteriorating), under surveillance. If and when everything does go off the rails, you have some professional counselor that can give some kind of input as to what to do next- which might be admitting that what was done before was “wrong”.

        In mental health, sometimes you just mark time until some type of coping skills get acquired enough for a minimal level of function.

        Small, slow, expensive, dare I say being lucky enough to wait out the crises, – this type of success still counts.

  51. Michael Gorback says:

    My last word on the subject:

    “It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine.”

    “It is time for the scientific community to stop giving alternative medicine a free ride… There cannot be two kinds of medicine — conventional and alternative. There is only medicine that has been adequately tested and medicine that has not, medicine that works and medicine that may or may not work. Once a treatment has been tested rigorously, it no longer matters whether it was considered alternative at the outset. If it is found to be reasonably safe and effective, it will be accepted.”

    — Marcia Angell, MD, former editor of the New England Journal of Medicine

    Dr Angell’s husband Dr. Arnold Relman was her predecessor as editor of the NEJM. He was the first journal editor to require economic conflict of interest disclosure for published research.

    Sorry to rain on the bullshit parade, but most of the discussion on diet, exercise, and supplements here is marching in the parade.

    Some day some of you might be proven right and others wrong, but the present state of our knowledge puts us squarely in the “nobody knows” column.

    • Yes says:

      For consideration…

      1. Yoga. Yoga is a healthy way of life that Western Science did not discover, and it works whether it’s validated by science or not. That is my personal experience. Caveat: it is possible to do almost any activity including yoga in an unhealthy way. Also, not all yoga classes are real yoga. Here in the West yoga combines with other motives such as money, self-image, and instant gratification. Nevertheless, the health benefits of real yoga are legitimate but have been dismissed by Western medicine historically. Same with meditation by the way. Science can be slow to approve.

      2. Cannabis. Totally works for nerve pain, and some medical conditions also. But it’s not (yet) accepted by science. Interesting note: I had a virtual consult with a pain clinic last month. When asked which meds help my pain I said: “cannabis.” Total silence. Nothing. The call was being recorded. Total silence. I said again, “cannabis helps, and opioids do not.” Why was that so hard for a pain doctor to accept? The reality is this: few scientific studies can be done on cannabis due to its legal standing. Hardly any universities perform studies on it. And pharma certainly isn’t going to fund studies on it because it’s a competitor to pharmaceuticals and it can’t be patented. So it’s a catch 22. The lack of studies means many physicians do not see the medical applications of cannabis.

      Personally, I appreciated your posts because they gave me an opportunity to hear an insider’s view, and a way to express my own view. As a writer myself, I say keep writing. When I finish a piece of writing I check it for personal bias. Removing any unnecessary bias makes the reading more enjoyable for a larger audience. As for the comments, it’s a minefield no matter what. I have no advice other than good luck!

  52. Auldyin says:

    The gift that goes on giving.
    I come here to have a go at the ‘money’ industry,
    So now I get to have a go at the ‘medical’ industry as well. Magic!
    Let’s go for the ‘military’ industry and the ‘engineering’ industry and you’ve covered the Four Horsemen of the Apocalypse.
    Here’s a small starter for ten, what parallels do you see between the Boeing 737 saga and the Rna jags saga?
    Hubris anywhere? A plane that didn’t fly safely and a jag that ????
    Just askin’

  53. #42 says:

    Memorable post and comments.

  54. Cashboy says:

    I think the future is to keep fit and healthy by simple exercise like walking one hour a day, staying in the sun (our politicians were telling us to stay in our homes) and avoid eating processed food and keeping those carbohydrates out.
    The reason that so many Americans and British died from corona virus is basically that they were overweight and/or diabetic.
    I have been dieting, following Dr Sten Ekberg on YouTube, and I feel a lot healthier.

  55. Rev GJ says:

    I really like the article…and always skip the comments.

  56. Stranger says:

    Nutrition research is not fuzzy at all. Look up turmeric in pub med. Very, very beneficial, but my MD tells me not to take it. Weird. If you took turmeric and chocolate all your life and refused to eat sugar you would avoid many western diseases. Should my MD also tell me to not eat curry every day like they do in India? It is “only” a nutrient after all. It is out of your system in a few hours unlike a statin that is a chemical which your body does not know how to process and so stays in your blood (oh….and can destroy your muscles which you will only know about if your MD gives you a blood test to see if your muscles are in fact destroyed after they are destroyed!). Is that a good thing? Don’t get me started on quantum medicine which has a huge research base, but no MD “worth their salt” will tell you to use. Look up “pulsed electromagnetic frequency” for arthritis. This device sends out the same frequency of your joints when you go for a walk. It beams these pulses into your joint healing them (which is why walking is so good for you – among other benefits). My MD had NEVER HEARD OF IT. EVEN THOUGH IT IS FDA APPROVED TECHNOLOGY. What about red light for arthritic joints? Also FDA APPROVED and my MD also had never heard of it. It is a sad state of the “so called” medical system that they won’t even use researched and approved technology (by our own FDA) because of Big Pharm. They would be happy to prescribe Oxycodone and watch your life be totally ruined by addiction and eventual overdose. Did you know that Hitler and the Nazis actually invented Oxycodone? Look it up. Why our MDs and Big Pharma thought it was a good idea to prescribe is beyond me! Best advice I can give you is look for alternative, evidence based, home treatments using pub med or Google Scholar. Just put in your disorder and treatment and see what comes up. You are your best “MD”! Also make sure you look at the possible side effects of any medication to see if the risks are worth the benefit. If your MD hesitates to prescribe you something in any way, RUN, don’t walk!

  57. Loser999 says:

    Doctors have an obligation to let their patients know the options they have. Yes, some patients already know what they need to do, and there are some that don’t.

    The doctor may be ‘tired’ of mentioning the same non-medical steps over and over, but there are paper-based ways to pass the information on. It may change the life of a few patients.

    There are many medical ‘knowledge’ that are now considered wrong that are still being told to patients by doctors in its original form. The egg yoke/cholesterol science is an example.

  58. Mira says:

    Such was the know it all, exclusive, stuffed shirt, snot that was the medical profession ..
    Elizabeth Kenny, as a young nurse out in the Australian bush discovers an effective treatment for polio, but can’t get official recognition or sanction for her techniques or theories. For more than three decades she is prevented from treating acute cases & is ridiculed, while she seeks formal recognition for the efficacy of her treatment.
    Australian, Elizabeth Kenny, who’s treatment was hailed by many as a next best treatment to a cure itself.
    Sister Elizabeth Kenny 20 September 1880 – 30 November 1952.

    Elizbeth fought the snot that was the worlds medical elite for 30 years & won. 30 wasted years were so many polio victims could have been helped.

  59. Mira says:

    ‘sugar pops our blood cells’

    Yes to much sugar is no good .. but isn’t is it that if your potassium levels are to low your body may make less insulin. That could lead to high blood sugar. People with low potassium levels release less insulin & are more likely to get type2 diabetes.

    Something to be said for taking supplements.

    • Mira says:

      High cholesterol .. Lecithin is an emulsifier, it breaks down fats to minute partials that can be absorbed by the cells & utilized by the body as energy.

  60. Mira says:

    Great article
    It’s nice to have a different topic .. please write again.
    You can see why BigPharma is a failed venture .. they make most of their there money in the manufacture of alternative medicine & supplements.
    Thank you !!

Comments are closed.