Preventive health expert

[Guest guest]

Hi All,

From the NY Times today comes the fairly informative below message.

Mediterranean

diets are presented as not being best.

A fair description of his contribution to medical science regards a 2004 JAMA

article, which is pdf available, is in:

http://jama.ama-assn.org/cgi/content/extract/292/16/1941?etoc

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August 23, 2005

There's More Work to Do for Longer Lives and Better Health

By JANE E. BRODY

Dr. Stamler's name is synonymous with preventive cardiology.

Since the late 1940's, Dr. Stamler, professor emeritus and founding chairman of

the

department of preventive medicine at Northwestern University's medical school in

Chicago, has been at the forefront of efforts to identify the risk factors for

cardiovascular diseases and establish the concept that heart disease, strokes

and

sudden cardiac deaths can be prevented through measures people can control -

better

diets, regular exercise and not smoking.

Last year alone, Dr. Stamler, who is 85, published 10 journal articles and

monographs, adding to the nearly 1,100 publications bearing his name as author

or

co-author in his long and influential career. Showing no signs of quitting, Dr.

Stamler said in an interview in his Manhattan apartment that there was more work

to

be done if Americans were going to live long lives in good health.

Q. Since the 1960's, coronary mortality rates have declined sharply so that now

cancer, not heart disease, is the leading killer of Americans under age 85. How

did

this happen?

A. A research base was created - through animal, clinical, population and then

intervention studies that showed cardiovascular diseases could be prevented in

human

beings. Physicians with vision influenced public policy on improving lifestyles.

Americans heard the message, even though special interests - the egg, meat,

dairy

and salt industries - slowed things down and created problems.

Q. What remains to be done in preventing heart disease?

A. There are still questions about key aspects of diet that influence blood

pressure. We know that potassium has a favorable effect, and salt, weight gain

and

excess alcohol have an adverse effect.

But now we're asking whether vegetable protein is beneficial and animal protein

harmful and what role magnesium, calcium and other minerals and vitamins might

play.

We also need resources to implement sound public health policy.

Q. Will the increase in the number of overweight and obese people reverse the

positive trends of 50 years?

A. Weight gain and obesity adversely affect serum lipids, blood pressure and

diabetes. Still, cholesterol levels have come down from a high of 240 milligrams

to

200 due to compositional changes in the American diet.

Q. You've said we failed to anticipate the obesity epidemic. Why?

A. When we first talked about prevention in the 1960's, we emphasized

cholesterol,

blood pressure, smoking, saturated fat and cholesterol in the diet, but not

enough

attention was paid to calories.

No one anticipated that if you reduce total fat from 40 percent to 32 percent of

calories, people could still get obese in a culture of automobiles, TV and

concentrated calories. Companies responded by producing reduced-fat but

high-calorie

carbohydrate products that didn't help at all with weight.

Q. Medicine still focuses on treating people who have cardiovascular disease. Is

this is the wrong emphasis?

A. For people who need high-tech medicine, I fully support their getting it. But

the

interventions are ameliorative, not curative, because cardiovascular disease is

not

curable. Interventions lower the death rate in the next few years, but that rate

is

still much higher than among people with favorable lifestyles who are at low

risk.

Presently, only about 5 or 6 percent of people 35 and over are low risk.

Q. Doesn't a preventive strategy require changing our medical reimbursement

system?

A. It's been a farce for decades that insurance will pay for bypass surgery but

not

for measuring risk factors, routine physicals, dietary and exercise counseling

and

stop-smoking programs. This guaranteed we'd have the highest per capita medical

care

costs in the world

Q. In the last four decades, there have been several reductions in what is

called a

" normal " level of cholesterol and blood pressure. Why?

A. As data accumulated, it became clear that the definition of normal was way

off.

What you need is favorable or optimal. The relationship of serum cholesterol to

risk

is continuous from very low levels of 140 on up, that under 180 is optimal,

under

200 is favorable, 200 to 239 is borderline and 240 and up is high. The same

thing

happened with blood pressure.

Q. Do you expect still further reductions in what is considered desirable

cholesterol or blood pressure levels?

A. Having achieved a national average cholesterol level of 200, it wouldn't

surprise

me if there will be a further reduction to 180.

The goal for fat needs to go from 30 to 25 or 20 percent of calories, and for

saturated from less than 10 to 7 percent of calories.

Q. Most Americans start life with pretty good risk factors, low cholesterol, low

blood pressure, and little or no excess body fat. Is it normal for these factors

to

increase with age?

A. No. The rise with age is lifestyle-induced. We're accommodated to a nomadic

way

of life that had little salt, little fat, lots of exercise, little or no

obesity.

Most of us are not genetically adapted to current lifestyles. So our

cholesterol,

blood pressure, blood glucose and uric acid levels go up.

Q. Who needs to do more for good health?

A. Everyone. No mass disease problem was ever solved without public health

endeavors, beginning with national policies and extending down to grass roots.

We

have to create a situation where it's an advantage to industry to do it right

and a

disadvantage not to. Supermarkets need to help people better recognize the

products

they should buy - fruits, vegetables, whole grains, lean protein, low salt - by

putting up signs and displaying things attractively.

Q. You've spent a lot of living time in Italy. Is the Mediterranean diet really

such

a good one?

A. People talk about the positive effects of the Mediterranean diet, but they

gloss

over the high salt and high alcohol that contribute to high blood pressure and a

death rate from stroke in Italy that is twice as high as in the United States.

Q. What is your message to people who eat out or take out most of their meals?

A. Friendly persuasion needs to be steadily maintained on the fast food industry

to

make its products more varied, more healthful. When people order in or eat in

restaurants, they should ask for sauces and condiments on the side and foods

cooked

in olive oil, not butter. And when portion sizes are grotesque, at least half

should

be taken home for another meal.

Q. To what do you attribute your longevity and ability to still fight for a

healthier America?

A. My parents were relatively long-lived. My father died at 84, my mother at 90.

When I was a kid, a doctor convinced my father to change his diet - he was a

meat

and potatoes man - to lots of fruits and vegetables. I started smoking in

college

and quit in medical school when I became short of breath walking up two flights

of

stairs.

I always exercised, and I still do, a minimum of an hour every day. I love to

eat

and I believe in the pleasure of eating.

The idea is not to go on a diet, but to improve your eating style by emphasizing

and

de-emphasizing, gradually creating a modified pattern that is an enjoyable part

of

your life.

Al Pater, PhD; email: old542000@...

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