The Disease Delusion

David L. Katz, MD

This past Sunday (3/11/18) I was privileged to speak on a panel, addressing the fundamental importance and powerful influence of diet to heart health, at a session of the American College of Cardiology conference in Orlando, Florida. The ACC is a large organization, and its annual conference is a big draw. The result is a rather massive meeting, inevitably housed in a cavernous convention center. Orlando was no exception.

My wanderings through that vast and labyrinthine building prior to my session took me through the exhibition hall, where I snapped the photo shown above. In a space that stretched to the limits of one’s gaze in every direction were sleek displays, ranging from modest to grandiose, of drugs and more drugs, devices and technology and the instruments and procedures of revascularization. All of this vast display, and the implied, monumental mobilization of money, time, training, effort, pain, treatment, recovery, and resources of every description- were for a disease that virtually no one needs to get.

Make no mistake- with very rare, genetically-induced exception, coronary artery disease does not need to develop. In the spirit of all that’s old being new again, this very revelation- rather than the barrage of popular nonsense– was the primary conclusion of Ancel Keys’ famous Seven Countries Study. Keys was among the first to suspect, based on population-wide differences, that coronary artery disease was not an inevitable consequence of aging, as was widely believed at the time, but was induced by adverse exposures and lifestyle practices.

Keys was right, as is now universally known, and this was the principal finding of his seminal study. He and his findings now have abundant company, spanning the spectrum of mechanistic research, intervention trials, and observational epidemiology at a grand scale.

In the world’s five Blue Zones, people routinely live to be 100 in the absence of chronic disease, including coronary artery disease. This is attributable to lifestyle, which is in turn attributable to culture. But whatever the causes, and the causes of those causes of Blue Zone blessings, the fundamental message is perfectly clear: coronary artery disease as a mid-life rite of passage need not occur.

The same compelling message issues from the Bolivian Tsimane, the well-studiedpopulation of modern-day “hunter gatherers,” or foragers, in the Amazon. They have stunned researchers with their consistently pristine coronary arteries that show no signs of atherosclerotic degradation across the decades of their lifespan.

And there is evidence, too, that none of the above can be dismissed with a wave of the hand, and a reference to “good genes.” For one thing, the populations above are not genetically homogeneous; they are quite diverse, ranging from Ikaria, Greece, to Okinawa, Japan; from Costa Rica, to Loma Linda, California; and from Sardinia, Italy, to the Amazon. Immunity to coronary disease is courtesy of culture and lifestyle, not ethnicity or some lucky assembly of genes.

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