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An Owner’s Manual for the Heart

In writing about science-based medicine, we give a lot of attention to medicine that is not based on good science. We use bad examples to show why science is important and how it is frequently misapplied, misinterpreted, misreported, or even wholly rejected. It’s a pleasure, for a change, to write about a straightforward example of the best of science-based medicine in action. The book Heart 411 is such an example.

The medical literature is a jungle of conflicting and complicated studies. It’s difficult for novices and even for sophisticated non-specialists to navigate. It’s useful to have experts as guides who can apply their knowledge, experience, and judgment to analyze the data and put everything into perspective. I can’t imagine anyone more qualified as guides to “matters of the heart” than the authors of this book. Heart surgeon Marc Gillinov and cardiologist Steven Nissen practice at the Cleveland Clinic, which has been ranked as the number one heart hospital by U.S. News & World Report for the last 15 years and is currently ranked 4th best hospital overall. They have treated more than 10,000 heart patients over 30 years of clinical practice and have also done extensive research and published hundreds of articles in peer reviewed journals. Their book contains everything they would like their patients to know about the prevention, diagnosis, and treatment of  heart disease.  It amounts to an owner’s manual for the heart. 

They begin with a valuable explanation of different levels of evidence and how to spot flaws in clinical studies, covering everything from surrogate endpoints to publication bias. They go on to cover risk factors old and new, the role of cholesterol, weight, diet, exercise, how tests are done and when they are not indicated, stents vs. surgery, heart failure, arrhythmias, sex differences, children, and predictions about future advances in the field. I was amused by one chapter title: “Vitamins and supplements: Trick or treatment?” recalling the title of Singh and Ernst’s book.

The book is a goldmine of information. Here is a sampling of just a few of the items that caught my eye for one reason or another:

  • Only 20% of our cholesterol comes from diet; the liver manufactures the other 80%.
  • Forget about special lipid tests: the standard lipid panel tells you all you need to know.
  • Statins are incredibly useful but some are more effective than others.
  • Red yeast rice is a “natural” alternative to prescription statins that is risky because dosage is uncontrolled and 1/3 of products contain chemicals that are toxic to the kidneys. 
  • A “low fad” diet is best for weight loss; calories matter, not the proportions of macronutrients. The Ornish, Esselstyne and Pritikin diets are not recommended: they explain why.
  • Saturated fats in the diet contribute to heart disease; studies showing otherwise are flawed because they only compared high fat diets to other unhealthy diets.
  • The first coronary angiogram was an accident.
  • Cardiac catheterization via the wrist is safer than via the groin, but only 10% are done by that route in the U.S. compared to 60% in Europe.
  • Chelation for heart disease is nothing but “a wallet biopsy” and is dangerous.
  • Stents do not prevent heart attacks; they only limit damage from heart attacks in progress.
  • Surgical checklists save lives: make sure your surgeon uses them.
  • A normal heart ejects at least 50% of the blood from the ventricle with each heartbeat; but some patients function well with an ejection fraction as low as 10%.
  • One type of LVAD (left ventricular assist device) pumps the blood continuously, so these patients do not have a pulse!
  • Mixing supplements with prescription drugs is as dangerous as mixing drinking and driving.
  • If vitamins and supplements are going to be used as medicines, they must be tested using the same rigorous standards we use for prescription drugs.
  • The data on fish oil are questionable. If you’re going to take it, they recommend a specific brand: Carlson Super Omega 3.
  • They disagree with the American Academy of Pediatrics and would not use statins in children under the age of 13 even if they are at high risk from familial hypercholesterolemia.
  • The deficits of so-called “pump brain” after open heart surgery are probably not attributable to the pump.
  • Eliminating cardiovascular disease would increase life expectancy by 7 years, compared to 3 years from eliminating cancer
  • Although existing studies are not definitive, the evidence indicates that the Mediterranean diet is probably the best diet for heart health.

The book validates what I had previously written about heart disease, statins, diet, weight loss, and other subjects. I was reassured to know I’d gotten those things right, but I also learned a number of new things from it. They clarified one point I had been wondering about. Why do cardiologists tell patients to limit their egg intake when most of our cholesterol is manufactured in the liver? They explain that there are good reasons to restrict cholesterol and saturated fat in the diet, even for patients on statins: the contribution of diet is small but still significant, and a low fat diet permits a lower dose of statins, minimizing the risk of side effects.

The stress is on prevention: they estimate that 90% of heart attacks are preventable. They would be glad to be put out of business. They say

Don’t worry about us; we will gladly hang up our scalpel and stethoscope if we can find a better way to lead you to a heart-healthy life.

The book was written for the general public but is equally appropriate and informative for doctors and scientists. The promotional material says “If you have a heart, you need this book.” Even if you don’t “need” it, I certainly think you would find it worthwhile, whether you are a layman or a doctor treating heart patients.

Posted in: Book & movie reviews, Science and Medicine

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45 thoughts on “An Owner’s Manual for the Heart

  1. PJH says:

    Was there any mention of RDA for salt , and whether ‘excess’ salt does cause hypertension, or whether our kidneys do actually perform a good job of filtering the excess out of our system?

  2. DrRobert says:

    Great review, made me want to buy it! I just pre-ordered. Looks like its available at the end of the month!

  3. Dile E. Tante says:

    Thanks for this Harriet!

    A friend of mine has Esselstyne’s book (“Prevent and Reverse Heart Disease”). I did nothing more than look at the cover, which describes the book as: “The revolutionary, scientifically proven, nutrition-based cure.” This statement did NOT inspire confidence in me regarding the book.

    Based on the very little information I have at this point, “Heart 411″ appears to be a more reasonable book. Now I intend to buy both “Heart 411″ and the Esselstyne book and compare them as an exercise for further developing my skills at judging medical claims.

    I’d be interested in your views of the Esseltyne book if you should ever feel moved to review it.

    1. Harriet Hall says:

      @Dile E. Tante,
      “I’d be interested in your views of the Esseltyne book if you should ever feel moved to review it.”

      I covered Esselstyne’s “evidence” briefly at http://www.sciencebasedmedicine.org/index.php/bill-clintons-diet/ After reading what he has to say on the Internet, I do not feel moved to review his book.

  4. george_seifert says:

    While it’s good to be informed about all the woo out there, it’s nice to hear about the good side of science based medicine for a change.

    Thanks for this review.

  5. nybgrus says:

    I second geroge_seifert. Thanks Dr. Hall!

  6. Harriet Hall says:

    @PJH,
    Since they cover everything, of course there is an extensive discussion of salt. They advise limiting salt because the evidence shows that it affects blood pressure. The RDA is only a starting ballpark: recommendations vary by age, race, and blood pressure. For details, you’ll have to read the book.

  7. Dile E. Tante says:

    @Harriet Hall (re: Bill Clinton’s Diet)

    Thanks for the link, Harriet. It’s very helpful.

  8. Quill says:

    Thank you for this review. It sounds like an excellent book. I plan to pre-order and recommend to our local libraries for purchase.

    One correction to all: the other doctor being talked about is Dr. Caldwell Esselstyn, not Esseltyne or Esselstyne. Interestingly enough, he was a surgeon at Cleveland Clinic for many years and headed several sections. It is also interesting to me that while his former employer and former colleagues have not formally endorsed his book or methods Esselstyn is listed as the Director of Cardiovascular Disease Prevention and Reversal Program at the Cleveland Clinic Wellness Institute.

  9. laportama says:

    Of course “they know everything about the heart”. They are the heavies, and if you don’t know — or believe — what they do, you don’t count.

    But I’ll grant them that they’ve created an anthology/compendium of current attitudes toward the heart — if you believe that the heart is a piece of meat.

    After all a PHYSIC-ian is one who practices PHYSICK: biology.

  10. Geoff says:

    As I understand it, statins have shown a very suspect level of benefits in trials. They are associated with a small increase in life expectancy for men who have had preceding heart events under the age of 65, and these findings are questionable. They show absolutely no benefit in life expectancy for any other group.

    On the other hand though, they have shown in multiple observational studies to increase the risk of new onset diabetes in people on them. This appears to be a class-wide phenomenon, and shows no statistical significance with respect to dose. Latest one is here: http://archinte.ama-assn.org/cgi/content/short/archinternmed.2011.625

  11. Harriet Hall says:

    @Geoff,
    “As I understand it, ….”

    You understand wrong. You really need to read this book. To quote from it: “Statins are associated with a small increase in the risk of diabetes, but the cardiovascular benefits outweigh the risks.” Statins save lives. Trials do not show “a very suspect level of benefits.” They show a large decrease in risk of death from all causes, as well as a large decrease in heart attacks. The benefits vary according to overall risk status, and the authors discuss how they should be used selectively.

  12. Geoff says:

    Here’s a quote from the insert in the Lipitor package:

    “There were no significant differences between the treatment groups for all-cause mortality: 216 (9.1%) in the LIPITOR 80 mg/day group vs. 211 (8.9%) in the placebo group. The proportions of subjects who experienced cardiovascular death were numerically smaller in the LIPITOR 80 mg group (3.3%) than in the placebo group (4.1%). The proportions of subjects who experienced non-cardiovascular death were numerically larger in the LIPITOR 80 mg group (5.0%) than in the placebo group (4.0%).”

  13. Geoff says:

    By the way, 48% is not a “small increase.” And it’s not the first time that this was observed; similar risks have been found in other trials and confirmed through meta-analyses.
    http://www.medscape.com/viewarticle/756688

  14. Harriet Hall says:

    @Geoff,

    Re mortality: You need to read the book rather than cherry-picking data and selectively quoting from one study on one dosage of one statin from a package insert.

    48% sounds large but it is relative rather than absolute, and the actual numbers are small. I had to laugh when I read the medscape article you cited, because it says “We don’t think the findings should change clinical practice guidelines, because for the vast majority of patients who are on statins, the benefits are expected to outweigh the risks.” Your own reference confirms what I said rather than the point you are trying to make! :-)

  15. Geoff says:

    My link was to supporting statistics, not to the opinion of medscape. That a 48% increased risk has been observed, and not just once, but in multiple studies. Obviously it could be worse, but that is not the point. The point is that the body is a self-regulating system. We don’t have cholesterol in our blood in order to give us heart attacks. Cholesterol serves a physiological function, and no one should be surprised that artificially lowering cholesterol is going to interfere with homeostatic mechanisms in the body leading to other problems.

    While statins may slightly reduce the risk of a heart attack, they do not increase life expectancy in any group to a statistically significant level other than males under 65 who have already had cardiac events. So whether it’s diabetes, cancer, or whatever else that goes wrong, there are side effects of statins that make them a net zero increase in life expectancy in the literature.

    The real shame of it all of course is how simple it is to actually lower cholesterol by removing the antagonizing environmental agents (see: unhealthy foods).

    “Re mortality: You need to read the book rather than cherry-picking data and selectively quoting from one study on one dosage of one statin from a package insert.”

    You need to read the literature rather than taking on faith the opinion of some hack who has been bought and sold by drug companies.

  16. Harriet Hall says:

    @Geoff,

    You are sadly misinformed, but I can see it would be a waste of time to try to discuss this any further with you, since you have already made up your mind that a book you haven’t read is “the opinion of some hack who has been bought and sold by drug companies” and since you think I take opinions on faith rather than reading the literature.

  17. Chris says:

    That 48% looks scary until you read this sentence in that link: “I looked at this question in the Women’s Health Initiative observational analysis of more than 153,000 women, ages 50-79 at baseline. During follow-up, more than 10,000 cases of diabetes were diagnosed.”

    All I see is that less than 10% of the women, who were all over fifty years old, were diagnosed with diabetes. There was no explanation as to why they assumed it was the statins. Was that 48% comparing a group of women who had normal cholesterol, or those who had high cholesterol and did not take statins?

  18. libby says:

    @ Geoff:

    “You need to read the literature rather than taking on faith the opinion of some hack who has been bought and sold by drug companies.”

    It goes beyond that unfortunately. Chauvinistic proponents of conventional medicine deny any influence by drug companies on physicians even though studies clearly show not only that there is, but that it is endemic. And even though there are groups made up in part of doctors, such as No Free Lunch, and medical depts such as the one at Stanford which are trying to change this misguided and inappropriate connection, doctors here can’t even accept that a problem exists, and will use testimonial evidence to support there case.

  19. Geoff says:

    @Chris

    There is no explanation because they don’t understand the mechanisms behind it, but the fact that it is a class-wide phenomenon suggests that it is something specific to the physiology of statins. It doesn’t matter the degree of the difference, the fact that the difference was statistically significant is what is important, because it demonstrates that there may be significant, unignorable side-effects to taking statins. This is a significant problem for me when someone tries to suggest that we put statins in the drinking water, for example.

    @Libby

    The sad part is that people like Harriet don’t realize just how endemic it is. I believe that she is well intentioned, just misinformed and ultimately wrong about a number of things. In this article in specific, she has shown a complete lack of understanding of statins, saturated fat, and weight loss. SBM is supposed to be a place where science stands above dogma, but unfortunately on these issues we’re still living in the 70s.

  20. Harriet Hall says:

    @Geoff,

    “there may be significant, unignorable side-effects to taking statins”

    There are. That’s why we don’t put them in the drinking water, but prescribe them selectively. Read the book. The benefits of statins outweigh the risks.

    “she has shown a complete lack of understanding of statins, saturated fat, and weight loss.”

    And you know this how? My understanding is based on my medical school education and on the totality of the evidence from the scientific literature. Essentially everything I have previously written these subjects has been confirmed by the world-class expert physician scientists who wrote Heart 411. Your understanding is based on package inserts and partial understandings of complex phenomena. You may think you see dogma, but I think I see Dunning-Kruger.

  21. libby says:

    @ Geoff:

    One specific issue are the free samples. These are the latest and usually most expensive drugs for a condition. When they are used up and a prescription needs to be filled to continue, the end result is more cost to the patient.

    This doesn’t mean doctors are evil, but they are malleable to the profit requirements of the drug companies. $19 billion dollars a year bribing doctors is not insignificant.

  22. WilliamLawrenceUtridge says:

    Geoff, cholesterol does indeed exist in the body for a reason. However, evolution only designed the body to last long enough to procreate, then it doesn’t care what happens. That’s how evolution and genetic selection works. Merely because the body does something, doesn’t make it good. What, for instance, is the good of Huntington’s disease, a genetically dominant disorder that kills between 30 and 50 – shortly after historically most people would have had children.

    Cholesterol does indeed serve a function in the body – but that function isn’t “living forever”. Nothing in the body is made to help humans live long lives, only long enough to reproduce. Many “natural” and “normal” processes, including cellular division (leading to cancer – which is inevitable given a sufficiently long lifespan, you can’t avoid it by avoiding “toxins”), cravings for salt, sugar, fats and proteins (leading to obesity) and hyperpyrexia (uncontrolled fever that cooks the brain) these functions serve most of us well up to a certain point. Distilling statins down to a sound bite of “they prevent the body from naturally being heart-attack free” betrays more about your commitment to ideology than it does a deep understanding of biology. Genuine experts don’t know the answers. Until they do – eat your veggies and exercise but don’t pretend it’ll help you live forever.

  23. Barry2 says:

    @WilliamLawrenceUtridge

    While it’s true that we haven’t evolved to live forever, it’s not true that we stop mattering to evolution once we procreate. Depending on our roles – e.g., caregiver, educator, defender – we may have a significant influence on the survival of people who carry and can pass on our genes.

  24. WilliamLawrenceUtridge says:

    For one thing, those genes would be selected at the group-level. Doesn’t matter if you’ve got one particular individual who lives a long time, so long as you’ve got someone, or enough adults in the group that’s old.

    Second, statins are prescribed starting as early as your late-40s, right? At which point, in the hunter-gatherer societies that most of human evolution is spawned from, you would be a grandfather and thus ripe to be removed from the gene pool.

    There may be links, but they’re certainly more tenuous than the direct coupling of cholesterol to heart attacks in post-child-bearing and -rearing age.

  25. weing says:

    @libby

    Only $19 billion to physicians? The last statistics I have are from 2000 and the biggest pharmaceutical companies spent $454.8 billion on marketing and advertising. I feel gypped.

  26. Harriet Hall says:

    I’m still waiting for my bribe! :-)
    And I’m still waiting for an explanation of why Geoff and Libby think their opinions should outweigh the consensus judgment of medical experts and the bulk of the medical literature.

  27. libby says:

    Since multi-national pharma companies have defined the direction of health care in our society, I’m not at all surprised that many doctors (all on this site) have no concerns about bribery.

    What conventional medicine is desperately trying to teach us is to be dependent on them. This is a shame, since it detracts from the good that has come from it.

  28. weing says:

    “What conventional medicine is desperately trying to teach us is to be dependent on them.”
    What a steaming pile of horse manure.

  29. Harriet Hall says:

    libby said “I’m not at all surprised that many doctors (all on this site) have no concerns about bribery.”

    She is imagining things. There is no one on this site who has “no concerns about bribery.” We deplore bribery in any form and have specifically criticized the efforts of drug companies to influence doctors. For example, see my article http://www.sciencebasedmedicine.org/index.php/osteoporosis-drugs-good-medicine-or-big-pharma-scam/ Mark Crislip has repeatedly said how he has always refused to accept any kind of gift from a drug company.

    “What conventional medicine is desperately trying to teach us is to be dependent on them.” Not only is this horse manure, but apparently what libby is trying to teach us is not to depend on science-based medicine just because some of the science is funded by drug companies.

  30. DrRobert says:

    Just a note for us non-conspiracy theorists who don’t believe evil pharma is controlling the world, the book is now available for download from iBooks store.

  31. libby says:

    I understand why doctors are upset. Conventional medicine has had many failures resulting in a large, unsatisfied number of profit units leaving for greener pastures. To combat this, sites such as this one have sprung up to ostensibly create a free flow of ideas on medical science. In reality, it is not much more than a clumsy debunking exercise on anything outside a medical school text.

    In any case, to expect patients to hand their health (and lives) over to a system rife with bribery is a bit much to ask. As I have said before, and of course dutifully ignored by the minions of the medical industry, the negatives within the field have unfortunately detracted from the good that has come from it.

    My experiences with doctors has been mostly unsuccessful – ineffective problem solving coupled with a very large bag of pharma goodies. It’s not for me, and the fact that 60% of the US population refused the H1N1 vaccine should tell us that there are many like me.

    I understand your concern.

  32. Harriet Hall says:

    @Libby, “I understand why doctors are upset.”

    You don’t understand anything. Dunning-Kruger strikes again.

  33. WilliamLawrenceUtridge says:

    Uh…doctors are upset because patients don’t get better. Skeptical doctors are upset because lives are put at risk and money is spent on interventions that are paternalistic subterfuge and vary in effectiveness from worthless to outright dangerous. SCAM practices and practitioners take advantage of those “large, unsatisfied number of profit units” by prescribing unproven interventions and engaging in unsupervised psychotherapy. The failings of real medicine (which do include influence by pharmaceutical manufacturers, but also SCAM practitioners and their True Believing members of Congress like Tom Harkin) do not mean that SCAM practices are effective. Acupuncture, homeopathy and herbalism are either effective, or they’re not. All the bribes in the world (real and imaginary) don’t make meridians magically manifest.

    Noting that 60% of the US population refused the H1N1 vaccine probably reflects more the lack of awareness of why it was necessary (the large number of seniors, children and immunologically compromised groups who die from H1N1 and don’t respond to vaccination each year; the 1918 influenza pandemic; herd immunity; epidemiology) and scaremongering than any mistrust of the medical system. Again, two completely separate facts are conflated to produce a conclusion that was foregone.

  34. Scott says:

    Let’s also observe that sCAM is equally profit-driven, but doesn’t make even a pretense of attempting to compensate for that to ensure the patient’s interests are properly prioritized.

    A good example is the fact that an MD cannot (in general) legally sell you the medication they prescribe. This is because it would give them too much of an incentive to overprescribe. By blocking them from directly profiting in this way, the MD’s financial interests become more closely aligned with the patient’s.

    Compare that to the world of sCAM, where the more pills a quack tells you to take, the more pills they get to sell you. They have a direct financial interest in getting you to take unnecessary junk.

  35. weing says:

    According to one poll, 77% of Americans believe in angels. 60% of Americans also don’t subscribe to the theory of evolution. Any surprise that 60% would refuse the H1N1 vaccine?

  36. Harriet Hall says:

    I have two anecdotes about people who refused the H1N1 vaccine. One was my own daughter! She is a very intelligent adult, is well-educated, and fully understood the reasons for taking the vaccine. I even entreated her to get vaccinated to protect me, since I am in a group that would be at particularly high risk of complications if I caught the flu. I even offered to pay for it. She didn’t give me any reason for not getting it (although I suspect time, inconvenience, inertia, and discomfort were involved). She doesn’t mistrust the medical system at all. She knew the facts but interpreted the importance of getting the vaccine as less than I did. She was playing the odds, and in retrospect, her decision was “vindicated” because neither of us caught the flu. (Incidentally, my other daughter got the H1N1 as a matter of course and regularly gets her annual flu shots with no prompting.)

    The other was an individual I encountered in another forum. He gave a series of misinformed objections to the vaccine, and after I had demolished each of them with the facts, he finally said, “Well, OK, but I’m still not going to get the shot because I don’t like needles.”

    I’m not claiming that these anecdotes constitute scientific evidence or even that they are typical. But I think they point out why unwarranted conclusions should not be drawn from the percentage of vaccine refusal.

  37. libby says:

    @ HH:

    You might want to take a look at weing’s entry just before yours because he just trashed your daughter’s decision about H1N1. Anyway I’ll let you two fight that one out.

    @ all

    Secondly, the fact that there are problems within alternative medicine does not automatically let conventional medicine off the hook. That’s identical to the Christian fundamentalist position used to prove God’s existence (Evolution is unproven therefore God exists/AM is bad therefore CM is good).

    Thirdly, and probably for the last time because I can’t a be remedial English teacher for you lot, conventional medicine is not driven by a conspiracy. That’s not the process.

    Fourthly, if HH acts towards her daughter the same as she acts towards me, I’m not surprised that her daughter rebelled against taking the vaccine.

  38. Harriet Hall says:

    @libby,

    Weing didn’t trash my daughter’s decision and there is nothing to fight out.

    No one has suggested that problems in alternative medicine let conventional medicine off the hook. The point is rather that problems in conventional medicine do not let alternative medicine off the hook.

    Any suggestion that my actions towards my daughter influenced her decision is belied by the fact that I acted no differently towards my other daughter and she got the vaccine. And your words seem to imply that because of your pique about the way I respond to your comments, you would rebel against me by not accepting the facts I present. That would be consistent with your rebellion against Big Pharma. Emotion tends to interfere with critical thinking skills.

    To get back to the subject of my article, do you have any evidence that the information in the book or in my article is wrong in any way?

  39. Harriet Hall
    “I have two anecdotes about people who refused the H1N1 vaccine. One was my own daughter! She is a very intelligent adult, is well-educated, and fully understood the reasons for taking the vaccine. I even entreated her to get vaccinated to protect me, since I am in a group that would be at particularly high risk of complications if I caught the flu. I even offered to pay for it. She didn’t give me any reason for not getting it (although I suspect time, inconvenience, inertia, and discomfort were involved).”

    I’m sorry this is a side track (big time). But I got the flu vaccine this year (that included H1N1 plus others) and it hurt like hell a few hours later, my whole arm and under arm muscles had pain, much worse than my latest tetanus, and then I felt achy and like I was coming down with something the rest of the day. The symptoms were better the next day, although my arm was still sore.

    What is that all about? What it a reaction to the vaccine that I should talk to my doctor about or was it just a fluke I shouldn’t worry about.

    Sorry I know this isn’t a medical help web site. But I’m trying to save myself the embarrassment of looking silly in front of my doctor, I’d rather look silly on front of you all. :)

  40. @HH, and another thing…

    The first year H1N1 was offered, it was almost impossible to get in our area unless you were a high risk patient. Our pediatrician didn’t have it. Public Health offices that did have it had big wait lists, even for younger children. If you are talking about your daughter getting the vaccine that year, then I would suggest that the problem was scarcity more than anything else.

  41. Harriet Hall says:

    @micheleinmichigan,

    My crystal ball isn’t working, so I can’t tell you whether it was a fluke or a local reaction. In general, whenever there is anything that worries you, you should mention it to your doctor without fear of looking silly.

    Scarcity was not a consideration for my daughter, since she didn’t even try to look for it.

  42. @HH, HeHe, I deserved that. At the time I felt worried, but since the symptoms resolved quickly, I stopped worrying, then I was a little worried that I should be worried. Then I worried that I was worrying to much, so I resolved not to worry. At which point I worried if that was the wrong thing to do. Then my brain started to hurt from the confusion so I took a walk and didn’t think about it anymore until I saw your comment….at which point I remembered my symptoms and wondered if I should worry.

    This is why I seldom based my decisions whether to see a doctor on if I’m worried, my brain just lacks in the perspective department.

    Typical I just ask someone ( or two or three people) who seems normal and sensible if they would worry, then go on that, (if it doesn’t seem too wacky). Often I end up getting an answer like “oh everyone I talked to who got a flu shot this year had a sore arm, yada, yada,” then I feel much better.

    I understand this is an imperfect system. But, the idea is to get the most accurate information, it’s to get the most normal information.

    But I will take the point and keep my sensible, normal advise asking to non-doctor folks. It’s not fair to ask anyone to do crystal ball diagnostics.

  43. typo, should be ‘the idea ISN’T to get the most accurate…’

  44. luarky says:

    Rudel did an experiment with monkeys where he found that monounsaturated fat – the main fat in olive oil and a big part of the Mediterranean diet – caused just as much atherosclerosis as saturated fat. See http://atvb.ahajournals.org/content/15/12/2101.long

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