Last month I reviewed and highly recommended Don’t Die Early, an excellent book by Rocky Angelucci about how to measure and improve your health. I recently sent Rocky a list of interview questions. We covered quite a few topics, so I’m posting the interview in two parts. Here’s part one.
Fat Head: Your passion for health began when you found yourself in the emergency room after suffering a bout of heart arrhythmia. How scared were you during that incident? Were you thinking, “Well, this is it, I’m about to die”?
Angelucci: I think a cardiac event brings much bigger implications than, say, a serious injury or an unexplained pain in the abdomen. Instead of thinking “Darn, I’m going to need stitches or maybe some surgery,” the finality of a cardiac event immediately takes us to a far more frightening place. Even though I knew what atrial fibrillation was, I had no idea why it was suddenly happening to me at such a relatively young age. My immediate thought was “What has gone so horribly wrong that my heart is doing this?” followed closely by, “Is this just the tip of the iceberg? Is my heart going to end up so damaged that I can barely climb a flight or stairs or I may never again walk faster than a decrepit shuffle?” And, yes, mixed in with all that were quite a few thoughts of “I really don’t want to die tonight.”
Fat Head: Did you any have clues before that incident that you were in bad health? Had you been warned by your doctors that your test scores weren’t so hot?
Angelucci: Nothing other than being told during my annual physicals that my cholesterol and triglycerides were “a little too high.” Thinking back on the failure of my regular physicals to reveal anything was the first step in realizing that physicians tend to treat symptoms instead of focusing on detection and prevention.
Fat Head: After a brush with heart failure, most patients are told by their well-meaning doctors to go on a low-fat diet, cut back on cholesterol, maybe take statins, etc. Is what you were told? If so, why didn’t you follow that advice?
Angelucci: Fortunately, I avoided the dreaded “statin speech” in the ER because my high triglycerides prevented them from testing my LDL. As you know, instead of measuring LDL directly, traditional cholesterol testing estimates LDL to save the insurance company a few dollars. If triglycerides are too high, the commonly used LDL estimation fails.
In the days after being released from the ER, I found a local cardiologist for follow-up care. His first suggestion was a statin and he initially seemed receptive to my first trying lifestyle changes to improve my situation. Oddly enough, during every subsequent follow-up visit I was seen by a nurse practitioner instead of the cardiologist. It’s as though the cardiologist had nothing else to offer me after recommending the statin (until it’s time to sell me a stent, that is). Even at this early point I wasn’t keen on taking a statin because I had already learned of the harm that statins cause and of the dangerously oversimplified advice that we are receiving today regarding cholesterol and the prevention of heart disease.
Fat Head: So you were recovering after the incident, determined to become healthier and you decided to educate yourself. How did you get started? Where did you go for information?
Angelucci: My first priority was learning more about the cardiac arrhythmia that took me to the ER. After noticing that one of the first things they attached to my IV was a bag of magnesium sulfate solution, a quick bit of research revealed that most of us are severely deficient in magnesium, which often causes atrial fibrillation. It didn’t take long for me to dispel the cardiologist’s claim of “once a fibber, always a fibber” by implementing a successful plan to increase my intake of magnesium.
The blogs of cardiologist Dr. William Davis dispelled the next myth: that stress tests show blockages as small as 15%. His blogs, and the Track Your Plaque online community, opened my eyes to the importance of testing, not speculating, about the presence of coronary plaque. About this same time, I discovered the Fat Head segment on You Tube. Fat Head’s discussion of glucose and insulin reawakened my appreciation for the hormonal effects of the foods we eat, something I remembered from reading Dr. Barry Sears’ Zone Diet books some years ago.
All of these insights, combined with a newfound appreciation for not being dead, formed a “perfect storm” that led me to quickly consume everything I could find from writers like Gary Taubes, William Davis, Jenny Ruhl, Richard Bernstein, and their ilk. Dr. Davis’ Track Your Plaque forum is a wealth of prevention-minded cardiology enthusiasts who were, and still are, an incredible source of knowledge and inspiration. Some person-to-person exchanges during all this were also invaluable, including email discussions with Dr. James Otvos, medical school professor and CTO of LipoScience (a lipid subfraction analysis company). Dr. Otvos was kind enough to serve as a sounding board when I was crystallizing my thoughts on lipid particles and their role in the formation of cardiac plaque.
Fat Head: There’s so much conflicting advice on internet for people who want to avoid heart disease … eat low-fat, eat low-carb, go vegetarian, go paleo, etc. How did you decide which advice to follow?
Angelucci: By sticking to the fundamentals, always bringing the discussion back to “what is the effect of this advice on me?” and trusting my BS detector!
For example, once I better understood the role that glucose and insulin plays in our bodies and realized the importance of preventing my blood glucose levels from spiking, it was very clear that any foods that cause glucose spikes are unfavorable. Once I had grasped this simple concept, the claim that whole grain breads are good for reducing diabetes risk or for lowering glucose levels didn’t survive the simple effort of squeezing a drop of blood from my finger and seeing that a grain-laden, low-fat meal spiked my blood glucose to over 200 mg/dL. The understanding that excessively high glucose levels are harmful, combined with a $15 glucose meter and some test strips, allowed me to dispel an avalanche of assertions that low-fat carbohydrates are healthful.
Similarly, after learning about how lipid particles really affect the formation of cardiac plaque, it was clear that the “LDL=bad, HDL=good” model of cholesterol health is dangerously oversimplified. This allowed me to see the flaws inherent in any advice that tried to equate lifestyle with total cholesterol or LDL.
Fat Head: When I was doing research for Fat Head, I was constantly surprised by all the evidence out there that much of what we’ve been told about healthy eating is wrong. Did you have that same experience?
Angelucci: Absolutely. Today’s nutritional advice reminds me of the game I played as a kid where we lined up and whispered a secret from person to person, watching how a simple phrase like “a stitch in time saves nine” turns into “a penguin ate my underwear” by the time it reaches the end. Health advice today travels along a chain of individuals and organizations, each with a very pointed agenda and their own incompetencies.
Scientists, as you are so skilled at observing, frequently fall in love with their theories and ignore compelling evidence to the contrary. Funding agencies like the grain industry or the pharmaceutical industry have a clear agenda when hiring researchers to perform a study. Public universities in agricultural areas are often very careful not to conduct research that casts an unfavorable light on grains or certain farming practices for fear that industry lobbyists will bring pressure on the politicians who fund their institution. As a former journalist, you’re well acquainted with the news media’s reluctance to deviate too far from mainstream nutritional dogma. It’s shocking how politics, deception, ego, and greed permeate every link in the health and nutrition chain.
Fat Head: What was the biggest surprise for you during your research?
Angelucci: The biggest surprise was just how wrong nutritional “experts” are. The general public doesn’t have the time or the inclination to closely follow scientific research, so we trust these so-called experts to summarize for us the content and implications from key studies as they are released. Reading nutritionist’s reports and then comparing their interpretation to the original studies showed me very quickly that the nutritional experts are very good at adding 1 plus 1 and getting 3.
For example, the experts read a very narrowly focused study that shows, unsurprisingly, that whole grain rice is slightly less likely to induce Type 2 diabetes than refined rice, but instead of reporting that whole grain rice causes Type 2 diabetes but refined rice does so more readily, these geniuses advise that we all need to eat plenty of whole grains so that we avoid Type 2 diabetes. This sort of twisted logic, coupled with an inability to cry “foul!” when a blatantly flawed study crosses their desks, is rampant among nutritional experts today and was the most surprising, and infuriating, thing I learned.
Fat Head: There are a lot of good books out there on how a better diet can produce better health. What made you decide to write your own? What unique or different information did you want to add to the mix?
Angelucci: Rather than focusing on “how to lose weight” or “how to have buns of steel,” I’ve tried to fill a niche that nobody else has addressed: how to have the best chance at avoiding the diseases that steal our quality of life as we age. Losing weight certainly has its benefits, but too many people, even practitioners, overlook the fact that excess weight is not a disease, it’s a symptom of a greater problem.
I wrote Don’t Die Early for people who want to be healthier but who don’t want to put their lives on hold to critically examine dozens of books, hundreds of research reports, and a seemingly endless parade of blogs and web sites. I wanted to create the one book that bridges the gap between wanting to be healthier and knowing how to go about it. Not in some vague, generic, unsubstantiated way, but in specific, measurable ways that anyone can understand and apply, no matter their age or condition.
Fat Head: In the first part of the book, you tackle what you call The Major Players: heart disease, diabetes and inflammation. Why did you pick those three over, say, cancer or Alzheimer’s?
Angelucci: By virtually every analysis, heart disease is the #1 killer today. This, and the fact that heart disease is the T-Rex in my rearview mirror, affords heart disease a prominent place in any discussion of preventive health. The other two major players, diabetes and inflammation, are at the root of virtually every disease we face as we age. I use the term “diabetes,” but it’s really about effective glucose control. Even if a person is never compromised enough to be diagnosed as diabetic, decades of poorly controlled glucose levels give rise to heart disease, neurological damage, dramatically increased risk of cancer, and a laundry list of other maladies. Inflammation, and by inclusion autoimmune disease, has such far-reaching implications throughout the body that inflammation has been called by some “the root of all diseases.”
We tend to think about diseases like coronary artery disease, Adult Onset Type 1 Diabetes, irritable bowel syndrome, peripheral neuropathy, MS, asthma, rheumatoid arthritis and so many others as completely distinct diseases, but ultimately they’re all a product of runaway inflammation within the body. Effectively controlling blood glucose and avoiding inflammation, while devoting as much attention to heart disease as our individual condition warrants, dramatically reduces our chances of a disease-laden adulthood.
Fat Head: You emphasize over and over in Don’t Die Early that it’s important to get some specific tests done, even if you have to order them for yourself. Why is that? Why can’t we just rely on our doctors to monitor our health?
Angelucci: It’s true that Don’t Die Early advises partnering with a prevention-minded physician but the unfortunate reality is that many physicians are not prevention-minded. Instead, they wait until diseases appear and apply whatever FDA-approved medication or procedure is designed to treat the symptoms of that disease. Also, physicians are often constrained by insurance company guidelines that restrict how often certain tests can be run, or if they’re covered at all.
If you’re a 45-year old man with a family history of heart disease who wants to know, not speculate, whether you’ve got coronary artery disease, a closed-minded physician shouldn’t stand in the way of a $49 non-invasive scan. If you want to test your lipids using the most current technology, your physician or insurance company shouldn’t be a barrier to an $85 test just because they still embrace a failed 30-year old HDL/LDL model of lipid health.