Let Them Eat Cake

A cardiologist challenges the conventional wisdom about diet, exercise, and heart health.

Let Them Eat Cake

Coffee and cigarettes; pleasure and disease; blog manifesto.

What unpleasant things do you do for the sake of your health? Doing these things takes some pleasure out of life, so it seems worthwhile to ask how much healthier you become.

Two Heart Attacks, Two of Life's Pleasures Lost

Mr. B., previously a lifelong smoker, had a heart attack shortly after turning fifty. At his wife's insistence he has quit smoking. He reports that he constantly craves cigarettes, dreaming of smoking almost every night.

Mr. G., a former colleague's father, was a coffee lover. He had a heart attack in his seventies. He read a pamphlet saying that you should avoid caffeine after a heart attack, and never drank coffee again. Instead he started drinking Postum, a coffee substitute.

At first glance these stories seem similar, stories of people making a sacrifice for the sake of better health.

Prolonging Life or Suffering Pointlessly?

Quitting smoking prolongs life in nearly everyone. It reduces your risk of having a heart attack; in people who have already had a heart attack, it reduces your risk of having another one. This effect is large, easily measurable, and repeatedly demonstrated. You could argue that it is the most thoroughly proven public health recommendation ever made; if not, it's close.

On the other hand, there is essentially no evidence to show that avoiding caffeine improves health after a heart attack. In the past some people suggested that drinking caffeine might cause a heart rhythm abnormality called ventricular ectopy (VE), which is associated with bad outcomes after heart attack. Eventually someone got around to doing a study to see if this was true, and it failed to find any effect of caffeine on VE in people who had heart attacks. The American College of Cardiology (ACC) last weighed in on this question in 1996, stating that it was safe to drink several cups of coffee a day even immediately after a heart attack.

However, before this study was done, some sources recommended avoiding caffeine after heart attacks, a recommendation that found its way to Mr. G.

"Better safe than sorry" v. "Postum Tastes Gross"

imageThere is some merit to making health recommendations as soon as there's any concern for possible danger. Once we have some suspicion that something (e.g. coffee or cigarettes) might cause harm, perhaps you should avoid it until clinical trial data becomes available. It's sad that Mr. G. gave up coffee, but what about the people who heeded early warnings about cigarettes? Probably thousands of people avoided premature death from quitting smoking before the benefits of quitting became clear. In comparison, Mr. G.'s suffering seems trivial.

Except for one detail: By the time Mr. G. had his heart attack, the pamphlet was obsolete. The study showing that caffeine did not increase VE had already been published; the ACC had already declared coffee to be safe for him. He gave up coffee not out of caution, but because his news was old.

Thesis Statement for This Blog

This blog is dedicated to Mr. G., and to everyone else who is doing something that they don't enjoy for the sake of their health. We will look at things we do that:

1) Make life less enjoyable, yet
2) Have only minimal evidence of health benefit

coffee cupThis blog will revisit old warnings and examine new ones. It will investigate how health recommendations are made, and what they mean. We will meet the recommenders. We will ask these people uncomfortable questions to see if it might make you more comfortable.

This blog will not warn you of possible new health threats. Plenty of sources will take care of this for us--those people can tell you when avoid life's pleasures. Here you can learn about when it's safe to go back to enjoying life.

Rob Siegel is a cardiology fellow at the Albert Einstein College of Medicine. He treats patients and investigates the interaction between lifestyle, obesity, and heart health.

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