Episode 94
Salmon isn't a Stent Food and Medicine
When Salmon Isn’t a Stent
Heart disease was four times more deadly than it is today. In those days, we had no statins, no stents, and no bypass surgery. Food was the only weapon doctors had.
Pharmacies in Rome and Greece even stocked extra virgin olive oil for patients with “hardening of the arteries.” Doctors sent people to pick up bottles, almost like prescriptions. Olive oil wasn’t curing clogged arteries, but it showed an early recognition that diet mattered.
Then scientists noticed something bigger. In certain Mediterranean villages, people lived longer with far less heart disease. It wasn’t genetic. Relatives who moved to cities and switched to Western diets developed heart disease much earlier.
Researchers didn’t stop there. They followed men in villages across Europe and the Mediterranean for decades. Some communities ate diets heavy in saturated fats. They developed clogged arteries and heart disease quickly. Other communities ate diets rich in fruits, vegetables, legumes, fish, nuts, and olive oil. They had much lower rates of heart disease. This pattern became the foundation of what we now call the Mediterranean Diet.
At that time, diet gave us hope. But today, we know that food alone is not enough.
Lyon Heart Study
The Lyon Diet Heart Study proved how powerful diet could be. Conducted just as statins came onto the market, it showed that patients with heart attacks who switched to a Mediterranean-style diet had a 70% lower risk of another cardiac event. That meant fewer heart attacks and fewer deaths.
Later, the PREDIMED trial confirmed these results. In high-risk adults, the Mediterranean Diet reduced major cardiovascular events by about 30%. That’s impressive, but it also raises a question: can people sustain it? Adherence usually means sticking with the diet about 70 percent of the time. That’s not perfect.
Here’s a personal example. I have hypercholesterolemia and a strong family history of heart disease. I follow the Mediterranean Diet carefully. But even with strong adherence, my LDL cholesterol never dropped below 180. With two drugs — Zetia and Crestor — my LDL is now in the 40s. Food helps. Medicine saves.
Atherosclerosis begins early in life
The PESA Heart Study showed why this matters. Researchers in Spain followed adults who felt perfectly healthy. Using advanced imaging, they found more than 60 percent already had plaque in their arteries. Atherosclerosis begins silently, and often decades before symptoms appear.
The JUPITER trial with rosuvastatin (Crestor) proved what medicine can do. Statins reduced cardiovascular events by 44 percent, and the study had to stop early because the benefit was so strong.
And then there’s Dean Ornish. His program is often called the “diet that reverses heart disease.” But it was never just a diet. His patients quit smoking, took statins, took blood pressure medications, and practiced yoga. Ornish proved that lifestyle matters — but it was food and medicine together that made the difference.
Barbara O'Neill and Cayenne Pepper
Meanwhile, scammers still sell false hope. Barbara O’Neill, banned from giving health advice in Australia, charges thousands for seminars where she claims cayenne pepper “opens arteries.” That’s pure fiction. Cayenne is a spice, not a stent. She also claims cholesterol guidelines only exist to enrich drug companies. Yet my three-month supply of Crestor costs $2.36, while she profits thousands. The real con is clear.
So here’s the truth: salmon is healthy, but it isn’t a stent. Olive oil helps, but it isn’t a statin. Food prevents disease. Medicine treats it. Together, food and medicine are unbeatable.
References
- de Lorgeril M, et al. Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation. 1999;99(6):779–785. (click here)
- Estruch R, Ros E, Salas-Salvadó J, Covas MI, Corella D, Arós F, Gómez-Gracia E, Ruiz-Gutiérrez V, Fiol M, Lapetra J, Lamuela-Raventos RM, Serra-Majem L, Pintó X, Basora J, Muñoz MA, Sorlí JV, Martínez JA, Fitó M, Gea A, Hernán MA, Martínez-González MA; PREDIMED Study Investigators. Primary Prevention of Cardiovascular Disease with a Mediterranean Diet Supplemented with Extra-Virgin Olive Oil or Nuts. N Engl J Med. 2018 Jun 21;378(25):e34. doi: 10.1056/NEJMoa1800389. Epub 2018 Jun 13. PMID: 29897866.
- Fernández-Friera L, et al. Prevalence, vascular distribution, and multiterritorial extent of subclinical atherosclerosis in a middle-aged cohort: the PESA study. Circulation. 2015;131:2104–2115. (click here)
- Ridker PM, et al. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N Engl J Med. 2008;359:2195–2207. (click here)
- Ornish D, et al. Intensive lifestyle changes for reversal of coronary heart disease. JAMA. 1998;280(23):2001–2007. (click here)
- Therapeutic Goods Administration, Australia. Prohibition order under section 42DV against Barbara O’Neill. 2019. (click here)
Transcript
>> Dr. Terry Simpson: Long before statins, long before stents, when
Speaker:heart disease was the number one killer, it was four
Speaker:times more deadly than it is today.
Speaker:Part of that is because we had no real treatments. No
Speaker:statins, no stents, no bypass
Speaker:surgery. And so food was the best
Speaker:medicine we had. In the
Speaker:pharmacies of Rome and Greece, they even kept
Speaker:extra virgin cold pressed olive oil on the
Speaker:shelves for patients with what they called hardening of the
Speaker:arteries. Doctors would send people down to pick
Speaker:up a bottle almost like it was a prescription.
Speaker:And then research began to notice something else.
Speaker:In certain parts of the world, small towns
Speaker:and villages around the Mediterranean, for example,
Speaker:people seemed to live longer with far
Speaker:less heart disease. It wasn't genetics,
Speaker:because their cousins who moved into the cities
Speaker:eating a westernized diet developed heart
Speaker:disease much earlier. Those scientists didn't
Speaker:stop there. They followed not just
Speaker:Mediterranean villages, but other small
Speaker:villages around the world where people ate
Speaker:traditional foods, often those same patterns
Speaker:for generations. From Finland to Japan,
Speaker:they tracked adult men for decades
Speaker:and saw a striking difference. In places
Speaker:where diets were rich in saturated fats, arteries
Speaker:clogged early, and heart disease was common in
Speaker:places where diets look like what we now call the Mediterranean
Speaker:diet. High in fruits, vegetables, olive oil, legumes, and
Speaker:fish, heart disease was rare
Speaker:at the time. Diet was our only
Speaker:weapon. It gave us a clue and it
Speaker:gave us hope. I know this
Speaker:literature well, and while you won't often hear it
Speaker:promoted on social media because saying eat this
Speaker:way doesn't sell a lot of supplements, the
Speaker:evidence is solid. Eating this
Speaker:way decreases your risk. But it
Speaker:is nothing like the therapy we have
Speaker:today. Food is important. It's
Speaker:empowering. It's the thing you as a patient
Speaker:can do every day to change your health.
Speaker:And we cannot ignore it, because here's one.
Speaker:Bad diet filled with ultra processed food and
Speaker:saturated fat accelerates
Speaker:atherosclerosis, drives heart disease, and raises
Speaker:the risk of cancers. And that's
Speaker:what today's episode is about.
Speaker:Why it's not food as medicine, but food
Speaker:and medicine together. And why
Speaker:salmon is. No matter how good it tastes,
Speaker:salmon is in a stent.
Speaker:Today we're going to make sense of the madness of diet and
Speaker:heart disease.
Speaker:I am your Chief Medical Explanationist, Dr. Terry Simpson,
Speaker:and this is Fork U Fork University,
Speaker:where we bust a few myths, make sense of the madness,
Speaker:and teach you a little bit about food and medicine.
Speaker:The Mediterranean diet, if you've been following my podcast for a
Speaker:while, isn't one single thing. It is not
Speaker:from one single area. It's a pattern Lots of
Speaker:fruits, vegetables, legumes, nuts, olive oil, whole grains,
Speaker:fish, little red meat, modest dairy
Speaker:and wine in exceeding moderation.
Speaker:It's not a fad, it's based on real
Speaker:populations. And we have decades of data showing it
Speaker:improved cardiovascular outcomes.
Speaker:One of the most famous studies was the Lyon Heart Study.
Speaker:This randomized secondary prevention trial took
Speaker:patients who already had their first heart attack and
Speaker:randomized either to the Mediterranean style
Speaker:diet or or what the French called
Speaker:a prudent cardiac diet.
Speaker:And here's the timing. This study took place just as
Speaker:statins were coming onto the market. So while doctors were
Speaker:beginning to prescribe cholesterol lowering drugs,
Speaker:Lyon showed that diet itself could also
Speaker:have a dramatic effect. And the results were
Speaker:stunning. Over about four years, the Mediterranean
Speaker:diet group had a 70% reduction in recurrent
Speaker:heart attacks or recurrent cardiac
Speaker:events. This wasn't just better
Speaker:cholesterol numbers, it was fewer heart attacks
Speaker:and fewer deaths. It was a combination of lower
Speaker:cholesterol and less inflammation. But let's be clear,
Speaker:those patients were highly motivated and this was
Speaker:carefully constructed study. They weren't just
Speaker:eating salmon once a week. Their entire
Speaker:dietary pattern changed. And you can
Speaker:imagine Lyon, France changing
Speaker:from butter to olive oil wasn't always
Speaker:an easy sell. Later,
Speaker:in larger studies, like what we call the predimed
Speaker:trial in Spain, confirmed the benefits in
Speaker:high risk but otherwise healthy individuals. The Mediterranean
Speaker:diet lowered rates of heart attacks, strokes and cardiovascular
Speaker:deaths by 30%. That's
Speaker:impressive. It proves food matters, but it's
Speaker:not magic. While those relative
Speaker:risk reductions are large, the absolute numbers are
Speaker:still smaller than what we see with medications in high risk
Speaker:groups. And here's the can you
Speaker:sustain it? When we talk about dietary adherence,
Speaker:we usually mean people are able to stick with it 70% of the
Speaker:time or more. That's good. It's not
Speaker:perfect because we're not perfect. I'll give you a
Speaker:personal example. I follow the Mediterranean diet with
Speaker:pretty strong adherence. But I also have
Speaker:hypercholesterolemia with a strong family
Speaker:history of heart disease. Even with my diet, I could
Speaker:not get my low density lipoprotein, my
Speaker:LDL or below 180. But with
Speaker:two drugs, Xedia and Crestor, my
Speaker:LDL is now in the 40s. That's the difference.
Speaker:The Mediterranean diet is powerful, but for some of us,
Speaker:especially those with genetic risk, food
Speaker:alone isn't enough.
Speaker:Let's talk about the PISA Heart Study, which stands for
Speaker:progression of early subclinical
Speaker:Atherosclerosis. It adds another layer of our
Speaker:understanding. This was a long term project
Speaker:launched in 2010 by the Spanish national
Speaker:center for Cardiovascular Research and Santander
Speaker:Bank. They followed middle aged adults who
Speaker:felt perfectly healthy. Using advanced imaging,
Speaker:researchers found that more than 60%
Speaker:already had measurable plaque in at least
Speaker:one artery. The lesson
Speaker:Atherosclerosis begins silently.
Speaker:Decades before symptoms, it tracks
Speaker:directly with APOB and LDL cholesterol. The
Speaker:Mediterranean diet can slow that progression and
Speaker:statins can dramatically reduce it. But by
Speaker:the time you're waiting for the stent, the disease has
Speaker:been smoldering for years. When you
Speaker:see these young men on the Internet
Speaker:claiming that they can eat whatever they want because they're
Speaker:metabolically healthy, they are slowly
Speaker:layering atherosclerotic plaque down
Speaker:into all of their arteries and you won't manifest it
Speaker:for years to come. Now let's compare that to
Speaker:medicine, and we're going to start using what's called the Jupiter
Speaker:trial, which looked at Rosuvastatin Crestor, the
Speaker:medicine I take, and it looked in people with
Speaker:normal LDL cholesterol but elevated
Speaker:C reactive protein, which is a marker of inflammation.
Speaker:The trial had to be stopped early because the benefit
Speaker:was so strong. Rosuvastatin reduced major
Speaker:cardiovascular events by 40.
Speaker:And unlike a diet study where adherence is hit or miss,
Speaker:all you had to do was take a pill.
Speaker:So while the Mediterranean diet lowered events by 30%,
Speaker:statins cut that nearly in half. And it did it
Speaker:in people who didn't even have high
Speaker:cholesterol. And then there's the
Speaker:Dean Ornish program. You probably heard people say that
Speaker:the Ornish diet reversed heart disease, but here's
Speaker:the nuance. It wasn't just a diet.
Speaker:Yes, it was very restrictive, very low fat,
Speaker:vegetarian style diet. But participants also
Speaker:quit smoking, took statins, took blood pressure pills
Speaker:and did something I love yoga. So was
Speaker:it the food? Some of it, sure. Was it the medicine?
Speaker:Absolutely. Was it the stress reduction and lifestyle
Speaker:change? Without a doubt, Ornish deserves
Speaker:credit for showing that lifestyle matters. But let's not
Speaker:pretend his diet alone
Speaker:unclogged arteries. It was food and
Speaker:medicine, not food as
Speaker:medicine.
Speaker:Which brings me to the scam portion of my
Speaker:podcast, because I have to have that.
Speaker:Barbara o' Neill from Australia has no medical
Speaker:education and has been banned from giving health advice
Speaker:in her country and yet travels around the world
Speaker:charging thousands of dollars for her seminars.
Speaker:One of the things she claims is that cayenne pepper can open your
Speaker:arteries and stop a heart attack in its tracks.
Speaker:This is complete fiction.
Speaker:There is zero evidence that cayenne pepper
Speaker:prevents treats or Reverses heart attacks. None.
Speaker:Cayenne is a spice. It makes chili taste better.
Speaker:It might make your nose run, but it will not
Speaker:reopen blocked coronary arteries.
Speaker:My God, if it did, we would be using it in
Speaker:every hospital in the nation. She claims that the cholesterol
Speaker:guidelines were lowered just to make money for drug companies.
Speaker:Really? Because my three month supply of
Speaker:rosubastatin cost me $2.36.
Speaker:Meanwhile, Barbara O' Neill charges thousands for her seminars.
Speaker:Tell me again who's profiting here? And
Speaker:here's the kicker. She denies that APOB and LDL
Speaker:cholesterol are the primary drivers of atherosclerosis,
Speaker:which every major cardiologist society in the world, from
Speaker:the American Heart association to the European Society of
Speaker:Cardiology, agrees that APOB is
Speaker:the causal agent of atherosclerosis.
Speaker:Barbara o' Neill's denial isn't science, it's
Speaker:salesmanship. And Barbara o' Neill belongs in the same
Speaker:category as the shirtless salesman hawking mango
Speaker:flavored salt packets. She isn't offering help.
Speaker:She's selling false hope dressed up as empowerment
Speaker:and charging dearly to do it.
Speaker:Now let's make this real. If you're in the middle of a heart attack,
Speaker:grilled salmon is not going to open your artery either. That's what
Speaker:stents and bypass surgery do. Food
Speaker:prevents disease greatly, but not
Speaker:completely. Medicine and procedures treat it
Speaker:and can help sometimes reverse it. The tragedy is when
Speaker:people confuse the two. Thinking olive oil replaces a
Speaker:statin or nuts replace a stent. They don't.
Speaker:The Mediterranean diet is the most evidence based
Speaker:eating program we have for cardiovascular and many other
Speaker:types of health. It reduces events, improves survival
Speaker:and it tastes good. But it does not replace
Speaker:medicine. The Lyon and Predimed studies
Speaker:show us that food can lower risk by 30 to 70%.
Speaker:The Pisa study showed us that plaque forms silently long
Speaker:before symptoms. The Jupiter study showed us that statin
Speaker:lowers events by nearly half. And Ornish showed us that
Speaker:lifestyle works, but only with medicine alongside
Speaker:it. And when a heart attack hits, only
Speaker:stent and surgeries save lives.
Speaker:The truth is simple. Food is the foundation.
Speaker:Medicine is the reinforcement. Together
Speaker:they're unbeatable.
Speaker:This has been episode three of Food is in a Prescription
Speaker:Pad. Next time, when beans aren't metformin. How
Speaker:legumes lower blood sugar and not like medicine.
Speaker:I'm Dr. Terry Simpson, your chief medical explanationist.
Speaker:Remember, salmon is delicious, but it is
Speaker:not a stem. Forku is
Speaker:produced by producer Girl Productions and
Speaker:it is advertised out through the world and all
Speaker:things audio from Simpler Media and my good friend the paw
Speaker:God, Mr. Evo Terra. For references and
Speaker:more, please visit your doctor's orders and
Speaker:forku.com and don't forget to
Speaker:check out my newsletter on Substack, where I dive into
Speaker:deeper times with these topics. And here's the
Speaker:disclaimer. I am a board certified physician,
Speaker:but I am not your physician. This
Speaker:podcast is for education, not for personal
Speaker:medical advice. Please talk to your Western trained
Speaker:board certified doctor and a dietitian before making any
Speaker:changes that will affect your health or your diet. Because
Speaker:we want you to be around because we have a lot more
Speaker:episodes to go.
Speaker:All right, everybody, have a good week.
Speaker:Enjoy your salmon. I like mine baked.
Speaker:Hey, Evo, you know these people who think if
Speaker:you put enough olive oil on a salad, you'll avoid a
Speaker:statin or stent? That's like thinking sunscreen
Speaker:protects you after you've been burned. Food helps prevent the
Speaker:fire, but medicine turns that out. And as for cayenne
Speaker:pepper, that's seasoning, not surgery. Anyone
Speaker:charging thousands otherwise is a scam artist. I'm going
Speaker:to stick with the salmon. Maybe I'll put some cayenne pepper and olive oil on
Speaker:it. And my $2.36 statin.
Speaker:Anyway, hey, buddy, I'm kind of wondering what food
Speaker:you're up to these days because, hey, we got about
Speaker:900 more episodes of fork you to go before, uh,
Speaker:you know, we have to get a stent.
Speaker:Wait, wait, wait, wait, wait. You put crestor
Speaker:on your salmon? Man,
Speaker:physicians are
Speaker:weird,
Speaker:Sam.
