Today’s New York Times carried the obituary of Dr. Lynn Smaha, former president of the American Heart Association, who died suddenly of a heart attack at age 63. I’m not in any way using this post to make light of Dr. Smaha’s death and I wish his family my heartfelt sympathies and deepest condolences. I can only imagine what a blow it must be to suddenly lose a spouse and father totally unexpectedly. (Click here for another obituary.)
My point in mentioning Dr. Smaha’s passing is to mention that he was a disciple of the lipid hypothesis of heart disease, a staunch advocate of the low-fat diet (although he started to modify his views and at least consider a Mediterranean type diet after the data came in from the Lyon Diet Heart Study) and an even stronger proponent of aerobic exercise. He was also a strong believer in physician’s practicing what they preach.

Excerpts from Heart doctors flunk own advice

By Maggie Fox, Reuters [11/07/99]

The advice is clear — do not smoke, eat plenty of fruits and vegetables, and keep fat intake low to avoid heart disease.

But even heart specialists who are supposed to preach this advice to every patient, every day, are failing to take their own medicine, Dr. Lynn Smaha, president of the American Heart Association, says.

He took his fellow heart specialists to task on Sunday for their bad habits and for their failure to stress to patients that heart disease, in many instances, is self-inflicted.

“There are those among us who do not follow proper diets, who do not engage in physical activity,” he told the opening session of the group’s annual meeting. “And if we do not do it ourselves, how then can we translate effective techniques to our patients?”

Another statement by Dr. Smaha:

“Cardiovascular disease accounts for more than 40% of U.S. deaths and affects both men and women,” says Lynn Smaha, MD, PhD, president of the American Heart Association. “Heart disease strikes men earlier, but the risk for women rises at menopause and continues to increase. Additionally, women are more likely to die from heart attacks.” Smaha says women often underestimate their risk of stroke as well.

“Many women don’t realize that stroke is just as serious for them as it is for men,” says Smaha. “Stroke claims the lives of over 90,000 women a year. In comparison, approximately 40,000 die of breast cancer.” Smaha says many of these deaths can be prevented.

“Strokes and heart attacks are often preventable, but American adults have a long way to go in changing their behavior,” says Smaha. “On average, 60% of us don’t get enough exercise, 55% are overweight, 45% have [LDL] cholesterol levels over 130, and 25% have high blood pressure.”

Dr. Smaha, I’m sure, followed his own advice, kept his weight down, ate a low-fat diet, did aerobic exercise, and made sure his cholesterol remained in check–in short he did everything he recommended to others to avoid heart disease, yet he succumbed to a heart attack. If cholesterol were the cause of heart disease, if a low-fat diet was truly ‘heart healthy,’ if aerobic exercise kept coronary arteries supple and plaque-free, then Dr. Smaha would surely still be with us today.
But he isn’t. And I don’t think that all the beliefs he had on the proper prevention of heart disease were valid. I do believe, though, that we should all reflect on this tragically early death and ask ourselves if we’re doing everything we can do for our own hearts. Although cancer is the disease we all seem to dread, statistically we’re much more likely to die of heart disease. And in one third of the cases of heart disease, the first symptom is sudden death, which, I suspect is what happened to Dr. Smaha.
I can tell you that of the many thousands of patients MD and I have taken care of first hand with low-carbohydrate diets not a single one has had a heart problem while under our care. We have treated, say, 10-15,000 patients over the years, most of whom were under our care for an average of two months. Multiplying two months times 10,000 patients gives 20,000 patient-months, which, statistically should have produced a number of heart attacks, especially considering that virtually all of these patients were middle aged and overweight and most had high blood pressure, elevated cholesterol, blood sugar problems, and all the rest of the disorders making up the Metabolic Syndrome. I’m not saying that the low-carb diet we treated these patients with kept them from having heart attacks, I’m simply remarking on the statistics.
I wonder if Dr. Smaha’s outcome would have been different had he followed a low-carb diet?


  1. Dr. Eades,
    Your post on Dr. Smaha was touching and hearfelt, in my opinion–and you also touched on a point I feel strongly about, too.
    One of the great questions I’ve always struggled with goes like this: All physicians are scientists, no? I’m assuming you were all trained to interpret evidence presented in journals for what it is–pure fact. (Not to worry, by the way, I’m a huge fan of yours, so don’t panic) My question is this–how can so many doctors not see what doctors like you, your wife, Dr. Robert Atkins, Dr. Diane Schwarzbein, etc. see so clearly? Why is the wrong information continually peddled? (Here is where my beef is, by the way): When doctors talk, people listen; when a doctor is in a position of power as the late Dr. Smaha was, it carries huge weight–people listen closely and it affects supply and demand–I’m griping only because I feel that it’s slowly becoming harder and harder to follow a low carbohydrate diet that is full of choices–for instance, I’m noticing my HOOD low carb chocolate milk is gone from the supermarket shelves along with my HOOD orange drink–something I enjoyed many a morning along with my bacon and eggs.
    Your article is excellent because it brings to light the power of people’s opinions and how they follow what comes from “enlightened” sources–I just wish the evidence would be more widely understood and out there–it sure would alleviate the difficulty of trying to live low carb.
    Thanks for listening to my rant.
    Adam Wilk

  2. >I wonder if Dr. Smaha’s outcome would have been different had he followed a low-carb diet?
    Probably not. It’s my understanding that Dr. Samha’s father died from an MI while in his early 50’s. We sometimes forget that diet, exercise and medicine can only go so far to compensate for bad genes.

  3. I agree that diet, exercise and medicine can only go so far to compensate for bad genes, but I believe the right diet, exercise and medicine can go a lot further. I have always liked the idea that says that genes load the gun but lifestyle pulls the trigger.

  4. is there any information on Dr. Smaha’s father’s lifestyle? probably excess carbs and not much exercise… If so, it could be possible that a low carb diet could have helped.

  5. I agree with Adam, when the doctor speaks, the patient listens. My dad will continue to stay on cholesterol meds and eat a low fat diet because his doctor and dietitian say so. Both of my dad?s parents died of cerebral hemorrhage, his dad at 62, his mom at 70. We can speculate that high carbs may have been the culprit, years ago no one checked cholesterol and triclyceride levels. My dad is nearing 70, so far his two older sisters have outlived their parents, but both have had heart issues, one having bypass surgery. The statins may have helped in all of their cases, but what is interesting the youngest of my dad?s siblings (there are 4 children including my dad) is now 62, an avid bicycle rider and basketball player, he has lifted weights, takes no meds and his cholesterol and triclyerides are fine. I did inherit the cholesterol issues, as well as diabetes from my mom?s side. I have controlled all through the high protein diet and lifting weights, no meds, and I plan to keep it that way. Will my family listen to me? No, I am not a doctor.

  6. I know someone who started low carb because a vacation was coming up and she needed fast weight loss to get into her clothes. Her doctor gave her permission to only do it for a month. Well, that month goes by and she’s lost some weight and when her cholesterol is checked (it was always high), it had come down some. Since her cholesterol was better and she liked the diet, the doctor let her stay on it a bit longer. Each blood test only got better, she lost 70 pounds and is having no trouble maintaining, and she’s been able to get off every drug she was on except the high dose niacin. When she tried to go off that her cholesterol went up again. Her doctor now wants her on low carb for life and has become a believer because of his patient’s results.
    So yeah, family history has some to do with it, but a low carb diet has helped get her cholesterol down when a low fat diet did nothing to help.

  7. Regarding mrfreddy’s comment, I believe Dr. Smaha’s father was an Iowa farmer. So much for self-serving speculation (“probably…not much exercise”)!

  8. My dad ran four miles a day, along with pushups and situps every morning. Yes, heart disease was hereditary (his mother had heart problems as well as his father). And yes, he did grow up on an Iowa farm, which anyone who met him would have known. And yes, it is extremely ironic that a cardiologist died of a heart attack.
    I know that we all like to say “If only he had done this, if only that…” But the reality is, he didn’t. And nothing we argue now is going to reverse time and situation. I see your point entirely, and I’m sure there are many plausible solutions that may work for others and help them live longer. But he believed so hard in what he did, and he believed so hard in helping people that to say “Well, maybe he was just wrong” is a little superfluous.
    In actuality, while a change in his diet so on and so forth may have helped him live longer (how many months?), he had already had a minor heart attack roughly six months earlier, we discovered that day. No one knew. His arteries were the size of pinholes because of it, and it was a miracle that he had lived as happy and healthy as he did until then.
    I offer my most heartfelt condolences for your family’s loss.

Leave a Reply

Your email address will not be published. Required fields are marked *