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Dan S
On Sep 9, 2013, at 10:38 PM, "Brian Swale" <bj@xxxxxxxxxxxxxxx> wrote:
> Contrary to my normal practice where I respond to replies after quoting them,
> this
> time I make my response first.
>
> I am frankly amazed that Chuck and Moose are unable to put two and two
> together
> and come to the logical conclusions reached by Dr Esselstyn and Dr
> Prendergast
> who are practicing doctors.
>
> And I will point out that reliance solely on peer-reviewed published material
> has them
> fall into the exact same blinkered trap that outfits such as the Heart
> Foundation in
> both New Zealand and Australia have fallen in to and I have little doubt
> contributes to
> their pathetic rate of success in reducing CVD (Coronary Heart Disease) and
> stroke
> in these countries. Prendergast and Ignarro level a very similar accusation
> at USA
> hospitals and medical professionals.
>
> Keeping this as brief as I can.
> Dr Esselstyn points out in his book on page 41 "And nitric oxide, as I have
> noted, is
> absolutely essential ..
> read the rest here..
> http://www.brianswale.com/zuikoholics/2013/L-arginine-1500-90%25.jpg
>
> "Using the Nobel Prize for discovering the messenger effect of nitric oxide
> (NO) in
> such a way as to seem as though it is also an endorsement of the L-A
> treatment is
> unethical", is bullcrap.
> Without L-arginine, nitric oxide WOULD NOT EXIST in the bloodstream, because
> it
> is created there by L-arginine by feeding the enzyme which scientists call
> "nitric oxide
> synthase".
> Further, as the scan of pages 42 & 43 reveals, if ADMA (asymmetric
> di-methyl-arginine) is present, it competes with L-arginine for access to
> nitric oxide
> synthase, and the more it succeeds the less NO is produced.
>
> There is another enzyme called DDAH = di-methyl-arginine
> di-methyl-amino-hydrolase, which will destroy ADMA and thus restore the
> production
> of NO, *but* the major cardiovascular risk factors plus oxidative stress from
> foods
> that generate free radicals impair the ability of DDAH to destroy ADMA.
>
> Esselstyn chose to protect the L-arginine -> nitric oxide synthase -> NO
> mechanism
> by keeping free radicals OUT of his recommended (vegan) diet. Was it
> successful?
> Certainly it was in his first trial where he aided about 20 ( I forget the
> exact number
> but it was about 20) terminally ill CVD patients stay on a vegan diet. At the
> formal
> end of that study, 12 years later, not one of those people had worsened CVD
> and at
> least one was shown by CAT scan to have had the CVD reversed.
>
> Prendergast was faced with sure premature death when in his 30's he was shown
> to
> have severe arterial disease (equivalent to what an 80-year-old 'Murrican'
> could be
> expected to have) in the arteries in and around his stomach. So he chose to
> (with the
> advice of Dr J Clarke) augment his supply of L-arginine, and as he told me in
> an
> e-mail, did not modify his diet. As a result of this L-arginine
> supplementation,
> somewhere around 8 - 10 years later two CAT scans showed that his abdomen was
> totally clear of arterial disease and so were his cardiac arteries.
>
> At the same time he adopted this course of action for himself, he, as
> endocrinologist
> for diabetics, placed them on the same supplementation.
>
> Pay attention here please Moose.
>
> Diabetics in his region of California typically get CVD at the rate of 35%,
> so typically
> he ended up referring that 35% of his patients to cardiac surgeons etc.
>
> The volume of his referrals up to that point in time kept 3 cardiologists in
> business.
>
> Over a period of ?16? years he put 5,000 ( five thousand) diabetic patients
> on
> L-arginine supplementation.
> NONE of them ( as far as he has been able to ascertain) had CVD worsen, if
> they
> had it and most would well have had their arterial health improved as a
> result.
> Hence because his patients were no longer at risk of CVD and presenting with
> such,
> forthwith none were referred to the three cardiologists.
> These three closed their practices and moved elsewhere.
>
> Due to this wonderful achievement, the USA Diabetics Association awarded him
> with
> their "Father of the Year" prize. of which he is justly proud.
>
> It could well be that "peripheral arterial disease" which seems to be medical
> jargon
> for arterial disease of the legs (and perhaps arms), does not respond to
> L-arginine
> supplementation. It could well be that such cases need segregation.
>
> But it is very clear that arterial diseases in the cardiac arteries
> (supplying the heart)
> and carotid arteries ( supplying the brain) do respond. These two afflictions
> cause
> typically around 35% of all premature deaths in the "Western culture"
> societies, AND
> many more who are affected but not killed outright suffer crippling
> incapacity at huge
> cost to society.
> Adopting the so-called "Mediterranean diet" goes some way to maintaining NO
> supply, since its use reduces the 35% above by about 25% to 26% premature
> mortality. But is that good enough? I don't think so.
>
> Look at the mortality figures for your country in this database; I have set
> it for the
> USA but you can easily change countries. ( see that the combined death rate
> in the
> USA is 28.17%, no doubt reduced from the 35% of elsewhere due to the enormous
> amount of and expensive heart surgery carried out there).
>
> http://www.worldlifeexpectancy.com/country-health-profile/united-states
>
> Medical authorities which rely solely on refereed papers and ignore the
> evidence of
> such as Drs Prendergast and Esselstyn are stupid.
>
> I rest my case. Back to doing my tax ...
>
> Chuck and Moose wrote
>>
>> What Moose said. What Brian knows full well but fails to tell us is that,
>> of all the physicians he has mentioned as recommending L-arginine for the
>> treatment of CVD, only Dr. John P. Cooke
>> <http://www.methodisthealth.com/john-p-cooke-md-phd> has ever conducted
>> ANY peer-reviewed clinical research on the use of L-arginine. In 2002 Dr.
>> Cooke wrote "The Cardiovascular Cure" wherein he recommends dietary and
>> exercise regimens and also the use of L-arginine as a dietary supplement.
>>
>> But Dr. Cooke did not stop doing research on L-arginine in 2002. He and
>> others continued research on longer term supplementation and discovered
>> that long term supplementation had adverse effects. For example:
>> <http://jama.jamanetwork.com/article.aspx?articleid=202136> I pointed this
>> out to Dr. Cooke in a personal email to him and asked if he was still
>> recommending the use of L-arginine and got this response.
>> -----------------------------------------------------------------------
>> Yes, the book needs to be updated to take into account the new data, one
>> of which papers is mine(the one from Stanford published in Circulation in
>> 2007, showing no benefit and potential vascular harm from chronic use of
>> Arginine in patients with Peripheral arterial disease. Accordingly I no
>> longer recommend l-Arginine supplementation for heart and vessel health.
>> ------------------------------------------------------------------------
>> Brian would do better to pay less attention to L-arginine peddlers and
>> more attention to those who do clinical research such as Dr. Christopher
>> Gardner mentioned below. He's quite believable when he admits that his 25
>> years of vegetarianism is contra-indicated by his own recent research.
>>
>> Chuck Norcutt
>>
>>
>> On 9/7/2013 2:12 AM, Moose wrote:
>> On 9/6/2013 2:10 PM, Brian Swale wrote:
>> Moose wrote about what I wrote
>> .........
>> Michael C. Johnston seems to have just taken a broad-based look at the
>> range of diet books without going into important science.
>>
>> Agreed. I only linked to it because it is such a good summary of the range
>> of firmly held, 'correct' ideas about diet. In the world of nutrition
>> science, the main difference seems to be that the professionals don't have
>> best selling books. I like the video I linked to in part because
>> Christopher Gardner does not take himself too seriously as some sort of
>> expert who knows all the answers.
>>
>> I watched about 20% of the video
>> http://www.youtube.com/watch?v=eREuZEdMAVo
>> ie, 16 minutes of the total 1 hour 16 minutes, and it seemed that what he
>> is on about is obesity and weight-loss.
>>
>> Impatience ... It's at minute 23 that he starts showing the effects of the
>> different diets on cardiovascular blood chemistry risk factors. From then
>> on, it's a mixture of stuff about losing weight and the effect of diet on
>> health and well being. Only an hour long, before a question period. You
>> forced me to watch it again - but I'm not sorry.
>>
>> If you watch the whole thing, I expect you will find it hard to support a
>> high carb diet for the majority of people. That is what you proposed in
>> your post, and one of the things in it with which I disagree. Gardner is
>> too smart to explore the possibility in public, but there is the
>> possibility that high carb diets, as recommended by the
>> medical/nutritional establishment, have contributed to the large increase
>> in incidence of diabetes. Can't likely be proven, but the differences in
>> response to a high carb diet by people with different insulin responses,
>> near the end of the video, is suggestive.
>>
>> Those are irrelevant to what interests me, which is the total obliteration
>> of the leading cause of premature death in the Western World; vascular
>> disease, caused by atherosclerosis and arterosclerosis. Currently,
>> somewhere around 35% of premature deaths are cause by heart attacks and
>> strokes, and nearly all are preventable; BUT most of the health advisers
>> seem to think these are not avoidable. Through knowledge of biochemistry
>> relating to artery health, these premature deaths ARE avoidable, and if a
>> person has arterial disease already, this can be reversed.
>>
>> The problem is that there are many conflicting opinions about how to
>> stop/reverse the course of the disease. Many are from important
>> authorities who simply disagree.
>>
>> Please look at this 10 minute video; the voice is that of Dr Joe
>> Prendergast.
>>
>> http://www.youtube.com/watch?v=BDqLcblMyIY
>>
>> Well, that was a fairly slick piece of promotion, almost completely
>> lacking in anything substantive. I am not quite the uninformed tyro you
>> might assume. When Dr. Myer Friedman was recruiting subjects for a 10 year
>> study of cardiovascular disease, he showed us what was then the most
>> famous slide in cardiology, the first slide showing a ruptured plaque and
>> the resulting clot that had killed the patient.
>>
>> As the video says, up until an assistant of Dr. Friedman's found it,
>> everyone assumed that plaque buildup eventually slowed blood flow to
>> dangerous levels. What no one knew until then was the actual cause of the
>> acute infarction. It doesn't really go with a very slow restriction, but
>> no one had a cause of the sudden event.
>>
>> So I've known about one of the great revelations of the video for well
>> over 20 years. I did qualify for that study, which required NO evidence
>> whatsoever of CV disease. I still had no signs at the end of my
>> participation ten years later.
>>
>> Dr. Friedman had followed up on his famous book, "Type A Behavior and Your
>> Heart" by conducting a series of increasingly ambitious studies of the
>> effect of time urgency and unwarranted, chronic anger on the course of CV
>> disease.
>>
>> His immediate prior, five year, study tracked the lives of two groups of
>> people who had just had a first heart attack. It was stopped early, based
>> on ethical grounds. The results were so statistically strong that it was
>> considered unethical not to offer the results to the control group, who
>> were dying off much faster.
>>
>> At that time, his protocol, which is entirely based on behavior
>> modification, was the single, most effective treatment for reducing
>> subsequent mortality of survivors of first heart attacks.
>>
>> The study I was lucky enough to be a treatment subject in was a ten year
>> study of people between the ages of 45 and 65 at the beginning who had no
>> detectable CVD. It was going well, i.e. my group was having fewer heart
>> attacks and dying off more slowly, (we got periodic progress reports) when
>> statins came on the scene.
>>
>> It wasn't that they were more effective, or even whether they were
>> effective at all. The problem was that the sample size wasn't large enough
>> to statistically separate any effect from statins from the effects of the
>> research protocol. So the study was never published. Unfortunate, as I
>> believe it would be a major treatment had the study been publishable. More
>> info here. <http://www.youtube.com/watch?v=wxMopJ_eb3c>
>>
>> Research starting in 1840 has shown endlessly that morbidity and mortality
>> are closely linked with social status. The facts aren't in doubt. The
>> question was always what the actual physiological causes behind this are.
>> Research carried out by Robert Sapolsky on the metabolisms of apes in
>> Africa shows the vast difference between dominant males and submissive
>> males, and its health effects/implications. Friedman's research and theory
>> is similar, in that it posits metabolic and physiologic effects of long
>> term chronic, as opposed to occasional acute, 'fight or flight' bodily
>> chemistry, as caused by certain common behavior patterns
>>
>> I bring all this up to point out that not all prominent, expert
>> investigators of CVD believe that the chemical magic bullet approach is
>> even a useful path. And not all research points that way.
>>
>> As Chuck has pointed out, using the Nobel Prize for discovering the
>> messenger effect of nitric oxide in such a way as to seem as though it is
>> also an endorsement of the L-A treatment is unethical, to my mind. It
>> isn't stated directly, but clearly implied, in the video. And didn't Dr.
>> Prendergast later drop that treatment, over concerns about side effects?
>> Was this video made before that? If not, it's simply blatant
>> misrepresentation today.
>>
>> As to the claim of making no referrals to hospitals, I believe that is
>> either another misrepresentation, as presented in the video, in neglecting
>> to say it's only no CV related referrals, or a good reason to pull his
>> license to practice medicine. My mother had diabetes, and I was her
>> primary support through her final years. Her primary care physician was an
>> endocrinologist, very highly regarded, and he sent her to the hospital
>> several times, none CV related. Diabetes, especially in the elderly, is a
>> serious disease, with many effects/symptoms, a number of which may require
>> hospitalization. People, especially the elderly, not uncommonly require
>> hospital treatment for other causes, as well.
>>
>> He is either a liar, in the video, or an incompetent physician, if he has
>> treated thousands of patients without a single hospital referral in 15
>> years.
>>
>> All of that aside, I believe, as someone with more than usual lay
>> knowledge, that the causes of CVD are too varied, complex and interactive
>> to be fully understood to date. I also strongly suspect that ingestion of
>> large amounts of a single chemical is not likely to be a simple cure for
>> everybody, or even a majority.
>>
>> There is also the problem of placebo effect and Physician effects. The
>> promise of cure from a treatment and the effect of physician personality,
>> especially empathy and compassion and/or an aura of authority, on clinical
>> outcomes is quite powerful, and one of the reasons for double blind
>> studies, rather than anecdotal evidence, which is what the video story is,
>> at bottom.
>>
>> Sorry if this rains on your parade, but I believe my knowledge and
>> experience make my opinions in the matter the equal of yours. I doubt that
>> Dr Prendergast is a huckster, per se, but it seems to me that the video
>> puts him in that light.
>>
>> A. Skeptical Moose
> ....................
>
>> Brian would do better to pay less attention to L-arginine peddlers and
>> more attention to those who do clinical research such as Dr. Christopher
>> Gardner mentioned below. He's quite believable when he admits that his 25
>> years of vegetarianism is contra-indicated by his own recent research. He
>> certainly looks healthy, and not like he needs to diet, anyway. And if
>> he's not insulin resistant (and I'm betting he isn't), it's not a big deal
>> for him.
>>
>> I think the chagrin may be more for what he's advocated to those for whom
>> it may not be the best course.
>>
>> Running in the circles I do, I know various degrees of
>> veggie-vegan-macrobiotic, etc., as well as many who are in various stages
>> of avoiding sugars, gluten, red meat, cows milk, etc. etc. in various
>> combinations.
>>
>> Some Vs seem very healthy and happy, others I want to capture for a month
>> and feed something like a modified Atkins. I think it would do marvelous
>> things to their physical and mental health. It's weird to be eating with a
>> couple of vegans, one happy and apparently healthy, the other semi
>> cadaverous (to my eye), sallow, etc. and chronically depressed - and
>> neither of them seems to notice a difference.
>>
>> It strikes me that a great deal of obsession about what to and not to eat
>> is inherently political. Some seems spiritual, but I think much of that is
>> political, too, at bottom. (Does the term psycho-political make sense
>> here?) I have also known people with serious celiac disease, obviously
>> real allergies and/or other unpleasant reactions to various foods.
>>
>> I, for example, react quite differently to large quantities of alcohol
>> than others I've had occasion to be with when they were seriously
>> inebriated.
>>
>> Dietary Moose
>
>
> Brian Swale
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