Talk:Myocardial Infarction - Healthy Meals On A Budget

USA Death Rates decline

Is this statistic worth including in the article? I did not find death rates listed.

In the USA: The coronary heart disease death rate disease has decreased 38 percent in the 10 years ending 2013. Sources: http://www.nytimes.com/2015/06/21/health/saving-heart-attack-victims-stat.html?emc=edit_th_20150621&nl=todaysheadlines&nlid=58413496&_r=0

http://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_02.pdf

Thank you,--Jcardazzi (talk) 17:21, 21 June 2015 (UTC)jcardazzi

The CDC ref is good. What page is that info on? Doc James (talk · contribs · email) 19:46, 21 June 2015 (UTC)

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The NY Times article states: "From 2003 to 2013, the death rate from coronary heart disease fell about 38 percent" but I could not find the source. The CDC tables linked in the NY Times article are only the 2013 statistics

I did find: "From 2001 to 2011, the death rate from heart disease has fallen about 39 percent." source: American Heart Association Heart Disease and Stroke Statistics â€" At-a-Glance https://www.heart.org/idc/groups/ahamah-public/@wcm/@sop/@smd/documents/downloadable/ucm_470704.pdf "The source for the health statistics is the association’s 2015 Heart Disease and Stroke Statistics Update, which is compiled annually by the American Heart Association, the Centers for Disease Control and Prevention, the National Institutes of Health and other government sources."

In the 2015 Heart Disease & Stroke statistics Update: http://www.heart.org/HEARTORG/General/Heart-and-Stroke-Association-Statistics_UCM_319064_SubHomePage.jsp I could not find how the American heart Association derived "From 2001 to 2011, the death rate from heart disease has fallen about 39 percent." in the 500+page report. --Jcardazzi (talk) 23:49, 21 June 2015 (UTC)jcardazzi

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Okay AHA is good awell. Maybe the NY Times got the 38 / 39 bit wrong. Doc James (talk · contribs · email) 12:23, 22 June 2015 (UTC)

Actual ref says "From 2001 to 2011, death rates attributable to CVD declined 30.8%." [1] Doc James (talk · contribs · email) 13:02, 22 June 2015 (UTC)

Prevention

Asking about the inclusion of plant-based diets as a significant factor in the prevention of MI? A 20-year nutritional study done by Dr. Caldwell B. Esselstyn, Jr., a former internationally known surgeon, researcher and clinician at the Cleveland Clinic, explains in his book how myocardial infarction can be prevented, reversed, and even abolished. Dr. Esselstyn argues that conventional cardiology has failed patients by developing treatments that focus only on the symptoms of heart disease, not the cause. Dr. Esselstyn convincingly argues and produces convincing results that a plant-based, oil-free diet can not only prevent and stop the progression of heart disease, but also reverse its effects. http://dresselstyn.com/JFP_06307_Article1.pdf As stated in the National Center for Biotechnology Information “Nutritional Update for Physicians” (which includes its own comprehensive list of citations), “Research shows that plant-based diets are cost-effective, low-risk interventions that may lower body mass index, blood pressure, HbA1C, and cholesterol levels.” http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662288/ The American Journal of Clinical Nutrition concludes, “…substantial evidence indicates that plant-based diets including whole grains as the main form of carbohydrate, unsaturated fats as the predominate form of dietary fat, an abundance of fruit and vegetables, and adequate nâˆ'3 fatty acids can play an important role in preventing CVD. Such dietsâ€"which have other health benefits, including the prevention of other chronic diseasesâ€"deserve more emphasis in dietary recommendations.” http://ajcn.nutrition.org/content/78/3/544S.full Karyn Swaney (talk) 16:31, 3 December 2015 (UTC)

What the review says is fairly different than what the primary source says. This is not controversial "can play an important role in preventing CVD" Doc James (talk · contribs · email) 18:04, 3 December 2015 (UTC)

That would be my mistake in not thinking the text had to be word-for-word to the citation and that instead the results of the text could be easily demonstrated by the reading of the citation. This can be easily re-worded or cited, it is simply the factual bio of one of many doctors who have demonstrated the same conclusions and could even be omitted as specific only to this doctor. Thank you. Karyn Swaney (talk) 20:00, 3 December 2015 (UTC)

Doc James I can supply hundreds of articles that use the same terminology "substantial evidence", "research indicates"...not sure how many would be needed before sufficient. I can even include the citation for Dr. Esselstyn's book that clearly demonstrates the medical proof that unbiased medical professionals now easily accept as self-evident truth. Recent movie "Plant Pure Nation" also can be referenced and includes the contributions of many doctors with solid medical evidence of the effectiveness of a plant-based diet in reversing and preventing heart disease. Interested in your feedback. Thank you. Karyn Swaney (talk) 20:10, 3 December 2015 (UTC)

Please provide citations. Yogesh Khandke (talk) 02:28, 4 December 2015 (UTC)

Yes their is evidence for prevention. What we are disagreeing over is the claim of "reversing heart disease" Doc James (talk · contribs · email) 03:32, 4 December 2015 (UTC)

A clinically proven programme based on plant based diet, stress management and exercise that reverses heart diseases.[2] Yogesh Khandke (talk) 04:07, 4 December 2015 (UTC)

Not a useful source. Doc James (talk · contribs · email) 05:40, 4 December 2015 (UTC)

May I ask why? Yogesh Khandke (talk) 06:43, 4 December 2015 (UTC)

comment "My patients demonstrate much more dramatic cholesterol lowering since the advised dietary program is based on nutrient density," he explains, "and reversals from 20 to 40 percent per year are typical in my experience. I even have a patient who reversed his carotid blockage from 80 percent to undetectable in one year on carotid ultrasound." http://www.diseaseproof.com/archives/cardiovascular-disease-reversing-heart-disease-with-a-nutrient-dense-diet.html

Directory of sources:

http://www.dresselstyn.com/site/articles-studies/

“The low-fat, vegetarian diet devised by Dean Ornish, M.D. provided the first hard evidence that heart disease could be reversed -- that atherosclerotic plaques could regress -- with diet and lifestyle changes alone.” (6) “Similar results were found by Caldwell Esselstyn, M.D.” (7) http://www.huffingtonpost.com/joel-fuhrman-md/heart-health-prevent-and-reverse_b_783565.html Karyn Swaney (talk) 00:41, 5 December 2015 (UTC)

In the prevention section we already say "Recommendations include increasing the intake of wholegrain starch, reducing sugar intake (particularly of refined sugar), consuming five portions of fruit and vegetables daily, consuming two or more portions of fish per week, and consuming 4â€"5 portions of unsalted nuts, seeds, or legumes per week." Doc James (talk · contribs · email) 05:59, 4 December 2015 (UTC)

Doc James We both know that is not saying the same thing. We could potentially save millions of lives by including this factual data. Karyn Swaney (talk) 00:41, 5 December 2015 (UTC)

We strike with MEDRS recommendations for sources. Doc James (talk · contribs · email) 04:04, 5 December 2015 (UTC) â"Œâ"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"˜Doc James (1) I've asked MEDRS whether Dean Ornish's book is a reliable source. (2) Doesn't this conclusion "Modest regression of coronary artery stenoses after risk factor modification is associated with decreased size and severity of perfusion abnormalities on rest-dipyridamole PET images. Progression or regression of coronary artery disease can be followed noninvasively by dipyridamole PET reflecting the integrated flow capacity of the entire coronary arterial circula tion.(JAMA. 1995;274:894-901)" say in English that eating low-fat, plant-based, stress management and exercise caused reversal of heart disease. Please help in collecting and helping readers know it has been proven that it does. For you,: a medical professional it will be easier to find, access, interpret and post accurate information that would help mankind's horizon of free knowledge expand. Yogesh Khandke (talk) 05:54, 5 December 2015 (UTC)

A better source on Dean Ornish's views would be this in the Scientific American. However, mentioning either Ornish's dubious views, or the skeptical reaction to them, in this article would be undue in my view. We should just abide by WP:MEDRS and report what the best sources say. Alexbrn (talk) 08:39, 5 December 2015 (UTC)

"Ornish’s diet would probably be an improvement on the current American dietâ€"if people could actually follow it long-term." This from Melinda Wenner Moyer who wrote the above article, and that is what she says in response to Ornish's response that Scientific American has published. She also admits she lacks a clinicians expertise, not being one. She surely isn't Ornish's peer. I ask by what yardstick this article should be treated as a good source, Scientific American being lay press, without peer review. Please maintain consistency of standards. Yogesh Khandke (talk) 10:49, 5 December 2015 (UTC)

See WP:MEDPOP: Scientific American can be useful. That Ornish has some odd WP:FRINGE ideas could be supported by many non-heavyweight sources, because it's kind of obvious. However I'm not advocating using this Scientific American source. To repeat: "We should just abide by WP:MEDRS and report what the best sources say". Alexbrn (talk) 11:10, 5 December 2015 (UTC)

(1)Please provide WP:MEDRS quality sources that call Ornish's programme or results dubious or fringe. (2) Scientific American has published Ornish's rebuttal including his description of Moyer's attacks as ad hominem, Moyer says she doesn't have the necessary expertise (3) A JAMA (journal) study is quoted above and you bring a controversial article in a lay journal in reply. This needs explanation. Yogesh Khandke (talk) 11:19, 5 December 2015 (UTC)

You mean to say that JAMA that has the third highest Impact factor in its category as "non-heavyweight", and think a lay publication is heavyweight? Yogesh Khandke (talk) 11:23, 5 December 2015 (UTC)

You don't need a WP:MEDRS-quality source to frame a fringe view, but something which shows WP:PARITY. Ornish's recent pronouncements have been taken down by pieces such as this. The JAMA article mentioned is a twenty year old primary source, so no good for our purposes. Alexbrn (talk) 12:02, 5 December 2015 (UTC)

(1) First you ought to use neutral language, there isn't any need for language like "have been taken down by pieces". (2)Don't bring blogs into this discussion, we need MEDRS quality sources like the JAMA study that has been quoted above. Yogesh Khandke (talk) 12:33, 5 December 2015 (UTC)

I am a medical professional, but being new to Wikipedia makes it hard to read and understand some of the discussion about sources and MEDRS, am learning. I never initially suggested using Ornish specifically, Dr. Esselstyn's research is wider-known and more scientifically sourced, multiple publications cited in one of the links I left above. The only reason I initially thought it would be good to be specific (Esselstyn) is because I didn't want people thinking they could eat lettuce and carrots and be healthy...the heart disease reversal diet is admittedly more specific than that, so I included the sentence I initially entered (about Esselstyn) - to allow people who wanted to improve their health know where to start - safely and responsibly. The facts are becoming very widely known (recent Washington DC plant-based conference drew over 500 doctors) and I agree that getting accurate, current, medical info posted is our responsibility as medical professionals to the people desp erately searching for a truthful source to help them manage their disease. I appreciate all the help and guidance from all as I learn terms, acceptable sources, etc. Karyn Swaney (talk) 15:09, 7 December 2015 (UTC)

I am just seeing the line "The dietary pattern with the greatest support is the Mediterranean diet" which is not in line with the current science on what dietary pattern provides the best results for MI prevention. I am hoping something can get posted soon that tells people the truth.Karyn Swaney (talk) 04:11, 8 December 2015 (UTC)

What MEDRS-compliant ref(s) do you have to back up the claim that the Mediterranean diet is not the diet with the most support? Please be specific! TylerDurden8823 (talk) 04:52, 8 December 2015 (UTC)

I put up several sources above of strong evidence of heart disease reversal with WFPB diets. I am not saying there is not proof supporting Mediterranean diets as better than most, but am only aware of evidence of actual heart disease reversal with WFPB diet.

http://www.huffingtonpost.com/joel-fuhrman-md/heart-health-prevent-and-reverse_b_783565.html

http://ajcn.nutrition.org/content/78/3/544S.full

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662288/

http://www.pcrm.org/health/heart/treat-and-prevent-atherosclerosis

And though this page http://www.dresselstyn.com/site/articles-studies/ may be re-posting of the articles, the source of publication is listed with the reposted article, so not sure why this wouldn’t qualify as containing secondary sources, as easily can use the publication listed.

The word vegan should not be used in discussions of health management, but anyways:

http://drjaygordon.com/in-the-news/the-president-of-the-american-college-of-cardiology-goes-vegan.html

I do not claim to have half the knowledge The President of the American College of Cardiology does, but if his (and a growing group of cardiologists) interpretation of the available data makes them feel strongly that WFPB should be recommended to their patients, that is a might convincing fact in itself. Karyn Swaney (talk) 07:32, 8 December 2015 (UTC)

â"Œâ"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"€â"˜ There are no reliable sources there supporting the idea that diet can "reverse" heart disease. This appears to be a WP:FRINGE view based on skimpy evidence, and touted by people like Ornish and Esselstyn whose chief objective seems to be large volumes of book sales etc. This is an extraordinary claim and would need a super-strong source, not the Huffington Post or some fringey journal. I think we may however note this idea as a popular misconception promoted by some prominent altmed types and not supported by good medical evidence. The Science-based medicine site has published some posts on this topic[3][4] and per W P:PARITY would be a usable counter-source. Alexbrn (talk) 07:43, 8 December 2015 (UTC)

So are we saying that: Preventive Cardiology, The Am J of Cardiology, Cleveland Clinic, The Journal of Family Practice, Experimental and Clinical Cardiology are not good sources, as all are listed in this .

Statements can also say comment "There is evidence to suggest that WFPB diet can have major impact on managing and improving CV disease and decreasing MI risk. The current President of the American College of Cardiology Dr. Kim A. Williams feels the data is strong enough to recommend a WFPB diet to his patients, but acknowledges that more extensive clinical trials are necessary." (as cited above)Karyn Swaney (talk) 16:06, 8 December 2015 (UTC)

Sorry, the reference you give there is to Esselstyn's commercial site, which is not a good source. Are you proposing something from a good source and if so what specifically? Alexbrn (talk) 16:11, 8 December 2015 (UTC)

Are you not clicking on it? He cites where those papers were published! Karyn Swaney (talk) 16:14, 8 December 2015 (UTC)

I tried one and it was some junk journal and the article was written by - Esselstyn himself. I gave up then. If you find anything of worth, please indicate. Alexbrn (talk) 16:36, 8 December 2015 (UTC)

They are published articles so the bottom line is you are saying all those listed sources are not valid. What is increasingly 'skimpy" is the meat and dairy propaganda, which is why I say the paragraph I do above, which is well-evidenced and cited. (added word comment to highlight). There is no argument that what I say above is factually correct and easily evidenced, as doesn't even draw an absolute set-in-stone conclusion, but not when we discredit extremely notable physicians and call them bias for trying to get word out because they know truth about what really helps their patients. People are dying, and those who have read the trials know how to best help them, so that is all I am suggesting, give patients the opportunity to decide for themselves and include the evidence.Karyn Swaney (talk) 17:05, 8 December 2015 (UTC)

No I checked one and it was poor enough I looked no further. Look, if you want stuff in the article the onus is on you to find good WP:MEDRS sources. Then we can reflect them. It is nt our job to give medical advice, but to reflect accepted knowledge, which is subtly different. Alexbrn (talk) 17:11, 8 December 2015 (UTC)

"Physicians should consider recommending a plant-based diet to all their patients, especially those with high blood pressure, diabetes, cardiovascular disease, or obesity." Karyn Swaney (talk) 17:13, 8 December 2015 (UTC)

For those who have read the studies it is already accepted knowledge, now we who know truth are trying to demonstrate it to those who still have not updated their own knowledge. I am not looking for medical advice, I have done the research. I am hoping others do the same so we can let people know their options and help them live a better life with less disease. Thanks.Karyn Swaney (talk) 17:21, 8 December 2015 (UTC)

break

It presents a case study, one of the weakest types of source according to WP:MEDRS. The words you quote don't strike me as hugely contentious (and note they do not mention "reversing" heart disease). But we need strong WP:MEDRS for sourcing such statements. Are there any? Alexbrn (talk) 17:24, 8 December 2015 (UTC)

I feel like I am posting the same things over and over - my statement above does NOT say that.

sorry for repetition but my actual words are not being debated: "There is evidence to suggest that WFPB diet can have major impact on managing and improving CV disease and decreasing MI risk. The current President of the American College of Cardiology Dr. Kim A. Williams feels the data is strong enough to recommend a WFPB diet to his patients, but acknowledges that more extensive clinical trials are necessary."Karyn Swaney (talk) 17:32, 8 December 2015 (UTC)

Again, source? If we're going to make statements like this we need more than what one dude "feels". Alexbrn (talk) 17:47, 8 December 2015 (UTC)

"One dude" is one of the most powerful physicians in the USA, and many sources are in the texts above but continue to be called invalid even though it is easily demo'd that many MDs agree and are "prescribing" WFPB diets.

http://health.usnews.com/health-news/blogs/eat-run/2015/09/02/absence-of-meat-makes-the-heart-grow-stronger

http://www.forksoverknives.com/why-i-abandoned-traditional-cardiology-to-become-the-healthy-heart-doc/

http://ajcn.nutrition.org/content/78/3/544S.full

http://www.jeffnovick.com/RD/Articles/Entries/2013/12/5_The_Specturm_Of_Health__The_Evidence_For_A_Whole_Food_Plant_Base_Diet_-_Pt_1.html

http://www.hindawi.com/journals/cric/2015/978906/

http://www.pcrm.org/health/medNews/plant-based-diet-reverses-angina

http://business.inquirer.net/167214/genes-load-the-gun-lifestyle-pulls-the-trigger

Karyn Swaney (talk) 17:58, 8 December 2015 (UTC)

Feedback accepted, instead of "feels" - "After the current President of the American College of Cardiology Dr. Kim A. Williams reviewed the data and saw his own health measurements improve after changing his diet, now recommends a WFPB diet to his patients, yet acknowledges that more extensive clinical trials of the impact of WFPB diets are necessary." - or something such as? Karyn Swaney (talk) 18:19, 8 December 2015 (UTC)

http://wellandgood.com/2014/12/29/meet-the-new-york-doctor-who-prescribes-vegan-diets/

http://www.montefiore.org/cardiacwellnessprogram

http://www.losaltosonline.com/special-sections2/sections/your-health/48685-

http://health.usnews.com/health-news/blogs/eat-run/2015/01/28/plant-based-diets-a-prescription-for-optimal-health

http://nutritionstudies.org/reversing-heart-disease-diet/

Karyn Swaney (talk) 18:36, 8 December 2015 (UTC)

Right, so nothing reliable. I think we're done here. Alexbrn (talk) 18:38, 8 December 2015 (UTC)

Wow...any medical pro who would discount opportunity to present clinically significant info? Wiki medical editing is clearly not the place for me, I pursue current data, maybe someday we can agree to reflect that without bias.Karyn Swaney (talk) 18:49, 8 December 2015 (UTC)

I just looked at Dr. Esselstyn's Wiki page, and am seeing that even though some of the most powerful doctors in the country support and cite his research, and is backed in other clinical trials, Wikipedia editors have chosen the word "skimpy." I find this very surprising. Even our more-comprehensive studies on vegetarians should be able to suggest these claims are much more than just "skimpy" ideas to "sell a book". I find that assertion appalling in the absence of any proof that he is wrong or shady. I am not interested in bashing other doctors. Take care.

Comprehensive lifestyle changes may be able to bring about regression of even severe coronary atherosclerosis after only 1 year, without use of lipid-lowering drugs.

http://www.sciencedirect.com/science/article/pii/014067369091656U

Results: After a mean of 10.6 years…vegetarians had a 24% reduction in mortality from ischaemic heart disease.

http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=550912&fileId=S136898009800007

Pending answers to these questions, a plant-based low-carbohydrate diet high in vegetable proteins and oils may be an effective option in treating those with dyslipidemia for whom both weight loss and lower LDL-C concentrations are treatment goals.

http://archinte.jamanetwork.com/article.aspx?articleid=415074&resultClick=3

http://healthletter.mayoclinic.com/editorial/editorial.cfm/i/397/t/The%20risks%20of%20not%20going%20meatless/

Karyn Swaney (talk) 19:53, 8 December 2015 (UTC)

Three primary sources and an editorial, none of which is a WP:MEDRS. Please read WP:MEDRS (and maybe WP:WHYMEDRS for background) - we need good secondary sources for this kind of major biomedical information. Alexbrn (talk) 20:00, 8 December 2015 (UTC)

That is kind of funny, because for this last post I clicked on a bunch of sites that are currently cited by Wiki editors and used their data. Am also seeing sources from pages I have cited now being called unacceptable, i.e. The Am J of Cardiology and others. I do think we are done here.Karyn Swaney (talk) 20:09, 8 December 2015 (UTC)

I don't understand your point. The Am J of Cardiology is a journal. It will contain articles (sources) that are both reliable and unreliable per WP:MEDRS. So far nobody has suggested a reliable one. This is all explained in WP:MEDRS and WP:WHYMEDRS. Please do read them. Alexbrn (talk) 20:17, 8 December 2015 (UTC)

Saying that doctors are reproducing primary data in their own practice and not all of that was 'primary' spurces. Also saying "strong research suggests" which it clearly does. Truth can't stay hidden forever, no worries. We will see the edit soon, one one or another. Karyn Swaney (talk) 20:38, 8 December 2015 (UTC)

The people on here seem to lack interest in collaboration or science, only in refuting sources without acknowledging a readily apparent truth and assisting with their knowledge to be able to factually include clinically significant data. As said, the bashing of others who are well-respected and have saved many lives by offering a simple and self-evident truth is appalling. To use words such as 'skimpy' when the research is so widely supported - it is insulting. I was looking for another way to bring real help, offer a real solution, based on widely-scientifically supported data. This is clearly not the forum to do that, wasting time arguing such simplistic ideas (food as medicine?) and simple biology (our lean scientifically towards herbivore physiology) with 'peers' rather than collaboration, support (as I may have been a new user but these are NOT new ideas) and the true desire to be objective and factual. No thanks.Karyn Swaney (talk) 17:48, 9 January 2016 (UTC)

Saturated fat is unassociated with heart disease? The Chowdhury paper.

I find it amusing that saturated fat is being described as being unassociated with an increase in risk of myocardial infarction, based on the Chowdhury paper. This paper has had major criticism leveled against it. See descriptions:

http://www.hsph.harvard.edu/nutritionsource/2014/03/19/dietary-fat-and-heart-disease-study-is-seriously-misleading/

http://plantpositive.com/blog/2014/3/23/recent-articles-by-drs-chowdhury-and-dinicolantonio.html

http://nutritionfacts.org/video/the-saturated-fat-studies-set-up-to-fail/

I also find it amusing that dietary cholesterol is being described as unassociated with serum cholesterol, but that's another issue.

Lifestyle section "Cholesterol Skeptic" Bias

Lifestyle section in this article contained a biased link to a widely discredited (but very popular in yellow journalism, and paleo fad diet circles) meta-analysis which claims to contradict scientific consensus on saturated fat. I added the rebuttal and noted the current scientific consensus, the lipid hypothesis which contains a controversy section with the same meta-analysis and rebuttal (neither the controversial meta-analysis NOR the refutation really belong on this page OR that one, but if the meta-analysis link is going to be here the refutation needs to be as well).

If you doubt the scientific consensus, the page on the Saturated fat and cardiovascular disease controversy is already well written and covers the "controversy" well. IMO any rejection of scientific and medical consensus should really be kept there, rather than spread across Wikipedia (Cholesterol skepticism, not unlike the similar anti-vaccination position, is not credible and poses a public health risk when it results in misinformation).

I also clarified the point about Cholesterol, regarding hyper-responders, and included a link (if anybody has a better link or can go into more detail for readers, that might be good). People shouldn't be getting health advice from wikipedia to begin with, but this page still needs to contain responsible information. As with vaccines, listen to your doctor and you'll do fine. Wkuahngo (talk) 19:34, 8 January 2016 (UTC)

This ref is a strong source [5]. We do not refute it with a power point presentation.[6] We can balance it with other sources. We also have this BMJ review that says the same [7] Doc James (talk · contribs · email) 23:08, 8 January 2016 (UTC)

The clear bias this section still shows against the scientific consensus on this matter makes Wikipedia appear unreliable for medical information (I'm sure that's not what any of us want). The scientific consensus (as always) could be mistaken, but it's not our job to decide that and downgrade it by use of biased wording to what appears to be a minority opinion, or one held by only a few people. The "alternative POV" (the actual consensus) that was added back in is extremely weak by comparison to the real minority view following it, and the apparent result is the same as giving equal time in school classrooms to evolution and "intelligent design", when the two are by no means equal in terms of evidence or general acceptance in the scientific community. Two flawed and widely criticized meta-analyses (note that the linked criticism of that original source was also removed) are not enough to overturn scientific and government consensus, which is the lipid hypothesis. It is the s cientific consensus, and not the supposed controversy that belongs on this page. If somebody wants to provide evidence for his or her personal opinions on the topic, that should be done where it belongs: in the article on the Saturated fat and cardiovascular disease controversy. This section should note that there is controversy and link to the full article on the topic for people to read if they are interested in that debate. In regard to dietary cholesterol and hyper/hypo responders (which is a different issue, distinct from saturated fat intake and serum cholesterol), if anybody doesn't like the source I linked to, please replace it with a superior one. Here's an option: http://www.ncbi.nlm.nih.gov/pubmed/3328488 Although some government recommendations now do not suggest limiting cholesterol for the general population (saturated fat limits already keep dietary cholesterol low for most people), it's still recognized as important for people at high risk (which are the people most likely to be reading this article). Maybe some day more research will come out and show some confounding factors that prove the minority view right and overturn current consensus (maybe evolution will be proven false too?), but assuming that doesn't happen because the consensus is right after all, let's not let Wikipedia be a contributor to somebody ignoring his or her doctor's advice on saturated fat and cholesterol and dying an early death because of it. Wkuahngo (talk) 04:28, 14 January 2016 (UTC)

So you are saying that the BMJ[8] and Annals of Internal Medicine[9] two of the worlds most respected journals are horribly biased?

Instead you wish to replace these 2014 and 2015 reviews with a 1987 paper[10] Doc James (talk · contribs · email) 05:34, 14 January 2016 (UTC)

Doc James, you are putting words in my mouth, and I don't feel like you are reading what I have written in good faith (you have three times now misrepresented what I have said). The dietary cholesterol issue is completely separate from the dietary saturated fat issue: the fact that you seem not to understand that while continuing to edit this article is concerning. I have said this twice, and twice you ignored it. Dietary cholesterol recommendations are more legitimately controversial, and government recommendations vary, dietary saturated fat is not controversial in the scientific or medical community. Also, in terms of date (even if I were replacing those recent studies, which I was not) recent is not inherently better, due to research bias favoring doing studies attempting to contradict mainstream opinion, since more confirmation of established consensus is not really beneficial to the researcher. It's not like people didn't know how to do research 30 years ago. The more i mportant issue is that those meta analyses are of poor quality, have been debunked (have you read criticism of them?) and the wording of the lifestyle section on this wikipedia page indicates clear bias of the writer of the page in favor of those two limited studies over the overwhelming scientific consensus. The lipid hypothesis is consensus. This should not even be a discussion; any contrary minority opinions and the controversial and flawed studies that support them can be found on the Saturated fat and cardiovascular disease controversy page. "Medical, scientific, heart-health, governmental and intergovernmental, and professional authorities, such as the World Health Organization, the American Dietetic Association, the Dietitians of Canada, the British Dietetic Association, American Heart Association, the British Heart Foundation, the World Heart Federation, the British National Health Service, the United States Food and Drug Administration, and the European Food Safety Authorit y advise that saturated fat is a risk factor for cardiovascular disease (CVD), and recommend dietary limits on saturated fats as one means of reducing that risk." It is important to challenge long held assumptions in science, but this is not the place for it (the article on the controversy is). I encourage you to re-evaluate your opinions on this topic, and talk with some actual cardiologists to challenge your own assumptions on the matter (if you have, you may have had the exceptionally bad luck of meeting one rare 'quack' among the bunch, in which case please seek a second opinion). I think it's great what you have done for Wikipedia, but I also understand that means you have more pull here, and if you want to write a biased article propping up these few recent controversial and deeply flawed studies as equal or greater in weight to the overwhelming governmental and non-governmental consensus on the topic regarding the risk of saturated fat on heart disease there is nothing I can do to stop you (I have neither the time nor resources to wage a war here). I fear the only way this page will ever be fixed is if you change your mind on this commitment you have to this opinion, but based on how you have misrepresented me so far and your seeming unwillingness to consider criticism of those studies I feel like it may be impossible for me to convince you no matter what I present. Please do a little soul searching, and please talk to experts you trust on the topic and consider the possible harm this fringe advice might do to people seeking knowledge here outside of the full context of the criticism available of those controversial studies. I sincerely hope that you will do the right thing here. Real human lives are on the line when bad information is disseminated like this and represented as equally credible to medical consensus. You're surely not a bad person, you have just been misinformed on this issue somehow, and have misunderstood how consensus works and why two limited meta-analyses don't overturn it. Wkuahngo (talk) 10:28, 14 January 2016 (UTC)

You could try to get the BMJ and Annals to retract these two meta analysis. Within the hierarchy of evidence expert opinion is lower than systematic review and meta analysis. What we tend to do here is set both those types of evidence. Doc James (talk · contribs · email) 11:12, 14 January 2016 (UTC)

That's blatantly false, at least in terms of new research. Do you not understand research bias on controversial issues like this? It took six years for Andrew Wakefield's fraudulent research on the link between MMR vaccines and autism to be retracted. Had Wikipedia been around and you in charge then, can we assume you would have been consistent in proudly declaring that vaccines likely cause autism on the Wikipedia page based on that study (despite no mainstream health authorities agreeing with that claim)? And how many children have died because of this bad information? In another section you rejected the claim that predominately plant based diets can actually reverse (rather than just help prevent which is clearly true) heart disease because it isn't consensus, and is based on more limited and controversial research: that would seem more appropriate, and will help prevent people from attempting to self-medicate with diet change alone without the help of a doctor. But here y ou do the opposite, in trivializing the overwhelming consensus in favor of limited and controversial research that supports your personal opinions. There are wealths of meta analyses supporting the conclusion that saturated fat intake increases cardiovascular risk, but you reject them because they're older than these newer studies, despite them being more credible and supported by mainstream opinion: they have stood the test of time, and these newer analyses have not. Just have an open enough mind to read the criticisms of these studies and talk to some cardiologists. If you care about human health, you will allow this section to be reworded to better reflect consensus and direct people who question this to the controversy page where the issue of these meta-analyses is better explained (with criticism) so they can decide for themselves without your biases restricting their access to this information or making it seem less credible. Just as if somebody is fully informed and chooses n ot to vaccinate his or her children and they die of disease as a result, if somebody is fully informed and chooses to eat butter and full fat meat over vegetable oil and lean meats/fish/vegetable resulting in fatal heart attack or stroke, so be it (it's unfortunate, but that's personal choice). We have a duty to provide the most reliable and unbiased information possible so people can decide for themselves, and this article fails to do so with its obvious bias against mainstream scientific and medical consensus on this topic. Wkuahngo (talk) 20:20, 14 January 2016 (UTC)

Ah was Wakefields paper a systematic review and meta analysis? Doc James (talk · contribs · email) 07:43, 15 January 2016 (UTC)

I believe it was the only available study on that specifically, at the time. I don't know why you're obsessed with meta-analyses, since they are less reliable than well designed studies due to the greater tendency to reflect biases (from publication bias to selection bias), and the lack of well established scientific or statistical methodology for them makes matters worse. There is an excellent article on Meta-analysis here, including the problems inherent in the methodology (which should make it particularly suspect when a meta-analysis seems to come up with such an extreme conclusion in opposition to consensus). This is a good summary of the issue which you should read if you are interested in being intellectually honest and ethical as a health practitioner in giving this potentially dangerous advice (which I hope you are, and that your biases aren't strong enough to prevent you from considering that these studies you like might be flawed, and the conclusions you have drawn from them unwarranted): http://www.hsph.harvard.edu/magazine-features/is-butter-really-back/ A short excerpt which makes the point about these meta-analyses: "Willett had taken a similarly strong stand against a meta-analysis published in the Journal of the American Medical Association (JAMA) in 2012, which reported that overweight people were 6 percent less likely to die than those of normal weight. Willett says the analysis did not properly account for factors like the tendency of frail elderly people to lose weight (not healthy), smokers to be skinny (also not healthy), and people with serious diseases to lose weight before they die. Willett also noted that the National Cancer Institute, partly in response to the JAMA paper, later sponsored a pooled analysis on the same subject. A pooled analysis, in which scientists gather raw data directly from the source rather than using data summaries from published papers, is more time-consuming and expensive than a meta-analysis, but the results can be more meaningful. The study, published in the New England Journal of Medicine, said that being overweight was indeed deleterious. According to Willett, it got almost no press. Similarly, an international collaboration of investigators had examined the relationship between type of fat and coronary heart diseaseâ€"the same topic of the recent meta-analysisâ€"by combining the original data from large cohort studies (more studies than in the recent Annals meta-analysis). Because they had access to the original data collected on individuals, the researchers were able to compare calories from saturated fat with the same number of calories from carbohydrates (which showed no difference in risk) and from polyunsaturated fat (which showed lower risk). They, too, received virtually no media attention." The analysis referred to in the last paragraph would be a better source. As shown in that article, with quotes, the authors of the Annals study (flawed though it is) even disagree with the conclusions you are drawing from it. You fail to understand the source material and its limitations, and you do so at risk to the health of those who may read this article and be confused away from sound mainstream health advice. Replacing saturated fat with polyunsaturated fats (all other things being equal) is good. But in Willet's words: "People don't just remove saturated fat from their diets. They replace it with something else, says Walter Willett, chair of the HSPH Department of Nutrition. Exchanging a hot buttered cheesesteak for a half-dozen donuts does not help your heart; swapping it for grilled salmon with greens and olive oil does." When controlled for processed sugar and other heart damaging foods we find polyunsaturated fat is more health promoting than saturated fat, but the source matters and you can't just replace it with junk food. The bottom line was that the issue is more complicating than just replacing fats. Mozaffarian has some good quotes about foc using on foods rather than nutrients. If you will read the article and the quotes from the authors of the Annals study with an open mind to the possibility you may have misunderstood something or misrepresented the issue here, surely you will change your mind and make the right decision to allow this article to be edited to better reflect both what is consensus and the complexity of this topic in terms of dietary recommendations. Wkuahngo (talk) 04:08, 18 January 2016 (UTC)

Added another review that found a small benefit. Doc James (talk · contribs · email) 23:56, 19 January 2016 (UTC)

Research section

I have deleted a "research" section mentioning several random projects on the basis that this section appeared to be biased and incomplete. For example the first project mentioned was a phase I stem cell infusion trial that showed a "small but significant improvement" in an echocardiographic endpoint (only survival or event-free survival are meaningful clinical endpoints in MI research). There are literally thousands of research projects ongoing around the world and it is nearly impossible to give a brief overview of research in this area; if such a section is included it would need likely need to speak more generally about research methodologies important in the field (prospective cohort studies, case-control studies based on large databases, and randomized clinical trials) with a few classic examples.

External links modified

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Primary PCI for STEMI

doi:10.1161/CIR.0000000000000336 JFW | T@lk 16:38, 16 March 2016 (UTC)

Lancet seminar

doi:10.1016/S0140-6736(16)30677-8 JFW | T@lk 08:23, 2 September 2016 (UTC)