The Elusive Strict DietMarch 14, 2012
By Amy M. Collins, associate editor
Several days ago, we linked on our Facebook page to an abstract of a JAMA article that found that women hospitalized for myocardial infarction were more likely than men to present without chest pain. A few days later, my 59-year-old mother was told by her general practitioner that her ECG had shown an electric “blip” that could be due to scarring from an unnoticed heart attack. My mother—always too lax about these things (unlike her hypochondriac daughter)—calmly told me she always has random chest pains and it could have happened at any time.
A visit to the cardiologist a few days later eased our fears. She hadn’t had a heart attack, but was diagnosed with right bundle branch block and has to undergo further testing. With high C-reactive protein levels, elevated cholesterol, and a history of heart disease in the family, one can’t be too careful. A stress test and cardiac ultrasound have been ordered.
In discussing her cholesterol level, which had increased since my mother’s last wellness exam, the cardiologist suggested she start taking statins. Not keen on medication, and worried by recent reports of adverse effects from these drugs, she said she’d rather only start with that if there were no other options. His suggestion was to maybe try some over-the-counter products to lower the cholesterol, mentioning that there were products that acted liked sponges to absorb cholesterol, but not offering anything specific.
My mother’s general practitioner followed up by letter, giving her a three-month window to try to bring the cholesterol levels down by following a “strict diet,” with no further information on what that entails or what she could do to accomplish this. Exercise was not mentioned at all.
Today my mother asked me what she should eat to make her cholesterol go down. (She thinks that, as an editor at AJN, I naturally have all the answers!) Already thin and following a low-fat diet, she says she doesn’t know where to start. She also admitted to consulting WebMD to find out what she could do.
Resorting to searching online for answers, to me, raises a huge red flag that communication between provider and patient had broken down somewhere, or wasn’t sufficient. Surely this can’t be the best answer. A phone call and discussion or at least an information pamphlet seems warranted.
I guess we can’t expect physicians to be nutritionists and personal trainers, but it seems strange and all too familiar that the first line of defense always appears to be medication, without a mention of specific lifestyle changes that are within our control (treating the disease instead of possibly preventing it).
With heart disease and obesity topping the charts for morbidity and mortality in this country, it seems to me that a more multidisciplinary approach and personalized follow-up are needed. Shouldn’t health care providers be giving better information to patients on how to manage their health, informaton that doesn’t involve only medication? At the very least, shouldn’t exercise and diet play a bigger role in a discussion with a patient who has a risk of heart disease, regardless of whether or not they need meds?
A nurse I recently interviewed for an upcoming Profiles article would say yes. The founder of a nurse-managed community health center, this nurse stressed the difference between “health care” and “illness care,” highlighting the importance of helping patients manage the simplest of health care tasks to promote their own wellness, including the management of weight and diet. This community health-based model will be described more fully in an upcoming issue of AJN.