Dear Kristin

One of my fab readers, who appreciates her privacy, sent me an email yesterday on the topic of my last post. It occurs to me (and this reader told me she would be receptive to a response in post format), that the whole point of having a platform is that it gives an opportunity to pool information and provide potential advice to those of us we may not know personally, but with whom we likely share many common experiences.

Below, I've described the reader's situation - and my response. Of course, I am NOT a medical professional so any sort of medical response would be irresponsible. Moreover, I have (thankfully) limited exposure to the issue at hand. But that doesn't mean I don't have opinions! I sense your feedback would be quite welcome - in the event that any of you has encountered a similar challenge. So on with Kristin's version of an advice column...

The High-Level Scenario:

• The reader's husband, in his late 50s, recently had a heart attack (one artery with blockages, 3 stents).
• She describes his pre-heart attack diet as "not SAD (i.e. standard American diet) but not perfect". He's quite active, fyi.
• He's gone on statins, though that's not his doctor's preferred approach. He is in the process of adapting to a very low-fat, vegetarian diet of the Ornish variety because the doctor's preference would be to lower blood lipid levels by diet vs medication. FYI - the Ornish approach encourages approximately 10% fat...
• Having said this, the patient will remain on statins for a year, per medical advice, given the specifics of his experience.
• The reader is particularly concerned that the combo of statins plus a very low fat diet might have eventual cognitive impacts. Dementia does not run in his family.
• The reader is thoughtfully avoiding inundating her husband with many conflicting pieces of information at a time when he's adapting to a new landscape.
• The reader is in favour of a more "Primal" diet approach (i.e. the kind of diet I have been eating since January).
• She's concerned that genetic testing would no longer be useful because the undesired outcome (that one tests genetically to avoid) has already occurred.

Kristin's Take:

For starters, Lovely Reader, I am thrilled that your husband is recovering from his health set-back! This is excellent news and it should be celebrated at length, IMO :-) Secondly, I want to acknowledge that a serious health concern affects both partners in a long-standing relationship. On some meta level, you have had a health crisis too. Your life has been dramatically altered by this unexpected occurrence. You may feel the need to change your own lifestyle to support your husband, even if you wouldn't have otherwise, and that may have impacts you can't predict (or aren't looking forward to). You're already confronting a contradiction between your own views on diet and health and what your husband has been integrating from his health care team. I have confidence that, as this scenario becomes more knowable and "normal", this may be easier to navigate but, in the meanwhile, I think it's important to own your approach to eating while also respecting your husband's path forward. It seems you have a great partnership so that should be doable, if potentially tricky at first.

I imagine that, if I'd just had a heart attack of this magnitude, I'd be pretty fucking afraid. I mean, I'm fearful of far less frightening things! And I'd probably react reflexively at first: I would shout from the rooftops that I would never do X again (or Y). I would probably follow my doctor's advice to the T (additional research having not yet been done, cuz I wouldn't have been expecting a heart attack!) And I think that's a reasonable response when recovering from such an experience.

However, over time, I'd either come to really respect my doctor's advice, or wonder if there are better approaches for me, based on my own personal biochemistry and the many other factors that make me "me". Your husband may come to this conclusion too - or he may be on the road to long-term low-fat living. (Who knows, he may adapt to it fantastically.) That's his choice.

In this instance, I actually think that genetic testing would be really useful. Some people have high blood-lipids but do not possess the gene variant associated with late-onset dementia (APOE4). I don't know to what extent non-APOE4 carriers are susceptible to dementia when put on statins and a long-term low fat diet. There's probably some useful (and even more very sketch) info out there, so no time like the present to find out what exactly is going on with his specific genes - and the nature of the high-cholesterol he might have.

I also don't know to what extent your husband's heart attack was caused by high-cholesterol and I wouldn't in a zillion years hazard a guess. Having said this, I've heard that it's often triglycerides (as much as LDL) that predict heart attacks and there's some evidence out there to suggest that cutting down on processed foods and sugar can lower triglyceride levels precipitously in some individuals. Your husband's doctors may be able to provide all of the answers to his questions - or you may choose to do additional testing of the vaguely "alternative/integrative" variety to come to your own conclusions.

One thing I will say: when people don't eat fat, they eat sugar. And eating sugar under these circumstances may compound the heart challenge in the long run (never mind the impacts of healthy fat). I do believe that fat protects the brain and that evidence supports this. Whether the risk of dementia due to low-fat diet is higher than the likelihood of a future heart attack is a complicated question and determining the answer is likely going to take time and research.

It's possible that statins will be less-often prescribed in the next few years. Moreover, given your husband's doctor's disinclination to prescribe them, it's possible he may not stay on them for long enough to have any impact in the long-run. I wouldn't really worry about them in the short-term but I'd do all the research and consider how my own blood lipid composition relates to the studies that are out there.

No question though, my bias is against the low-fat vegetarian diet. If research and evidence were to definitively support that my own body would be better-off for eating this way, I'd likely bite the bullet. But I don't think the evidence points this way for most people and I would NEVER do it on spec. (Even the pre-"healthy fat/low sugar diet-obsessed" Kristin ate lots of fat, if much of it unhealthy.)  On the basis of my reading - and pointedly, my own experience - I believe that most bodies need healthy fat (maybe not in volumes the likes of which I eat, but probably more than 10 per cent) and they generally benefit from animal protein (a readily bioavailable source for those who may struggle with metabolic syndrome, which is implicated in heart attacks for some).

So I hear your concern about the Ornish diet over time. The thing is, though, that through considered research, that which happens organically, you can work together to determine whether your husband's specific issue would be best ameliorated by the low-fat plan currently suggested by the doctor. I mean, if she's a good doctor, she's likely going to engage with your questions and the information you bring to her. Her perspective may change over time. Follow her advice, by all means, unless you determine that there's another approach that would work better for your husband, given who he is (genetically, biochemically, emotionally, mentally etc.) He's infinitely more than the heart attack he's just experienced, and my advice would be that he should live, very exuberantly, with that in mind. xoxoxo

Readers with life-experience: Please chime in! Feel free to disagree with me (politely, preferably :-)). I'd love for our reader to gain info from those who know the score.