The Doctor’s Surgery Tom Stuttaford

Tom Stuttaford: The Doctor’s Surgery

The annual meeting of the European Society of Cardiology Congress can be guaranteed to provide headlines that will stimulate interest in heart problems and thereby be of benefit to the tens of thousands of patients with potentially life-threatening heart disease.

This year the research that became a front-page story in most newspapers was the news that the heart health of patients who enjoyed a Mediterranean diet was so improved that a better choice of food might enable them to do without their statins and other pills so disliked by the health-concious.

The line of reasoning that a good chef might prevent heart disease, or treat it more effectively than the combination of proven pharmacy and skilled doctors, seemed to conflict with another recent study aired in Rome. This showed that four out of five mainly older patients (average age 79), studied by Doctor Pardeep Jhund of the University of Glasgow, were prescribed inadequate drugs for their heart disease or, if the correct drug was suitable, in a dose that is less than that recommended as standard. Doctor Jhund is quoted as arguing that recommended therapies based on approved guidelines are often not prescribed or, if prescribed, are given at a lower dose than that approved by the experts. Doctor Jhund went on to say that it is vitally important that heart failure is more effectively treated and that patients receive the recommended standard treatment.

It is claimed that seven million people in Britain have some kind of heart condition and that in half a million this is advanced to the stage of heart failure. Heart failure is defined as when a patient’s heart muscle is no longer able to keep the central organs properly oxygenated and supplied with nutrients. Initially, the most tiresome features of heart failure are an ever-increasing tiredness – a real crippling tiredness rather than a pleasant weariness. Not only are patients tired and so sleepy that they can’t concentrate, they also become increasingly breathless, to begin with only after exercise but later it may be induced by prolonged standing or even occur at rest.

The value of the Mediterranean diet is generally accepted. It emphasises the prime importance of olive oil, a preference for fish, especially oily fish, over red meat and of vegetables over fatty and sugary foods. The jury is out on dairy products but these are no longer universally condemned. It is now accepted that calcium obtained from cheese and milk is metabolised differently from calcium tablets and is better for health.

Oily fish doesn’t have to be expensive salmon or trout: herrings or mackerel will do just as well. Neither do the vegetables have to be cabbage, kale, spinach or broccoli, a dislike of which has been attributed at various times to childhood experience or even genetic inheritance. Avocado pears – some experts suggest one a day – melons, tomatoes, small carrots, little turnips (the neeps of Scotland), beans and peas will all do equally well. Recently lettuce has seemed to some people to be as good as cabbage leaves. Fortunately, in my opinion, the popularity of lettuce hearts is recovering. Nuts are excellent but doubts are expressed about peanuts. It is noticeable that the recent widespread publicity about the Mediterranean diet has failed to mention the benefits of the red wine that, taken in moderation, accompanies most Mediterranean meals.

It would be criminally dangerous to suggest that people should substitute the Mediterranean diet for their statins or other cardio-effective medical treatment. Instead, this diet should be regarded as a supplement to lifeenhancing or even life-saving tablets.

The best known research that swayed both public and medical opinion and even softened up, to some extent, the bottom-line Treasury financiers, towards the benefits of statins was the 2013 review of more than 200,000 patients. This suggested that routine statins could save 7,000 lives a year.

The central Italian research has been accused, perhaps unjustifiably, of suggesting that a Mediterranean diet could substitute for statins and other drugs. However, the work is based on a study of only 1,200–1,300 patients, and whose health was followed for only seven years.