Overwhelming evidence shows that a diet low in total fat and saturated fat can lower levels of lipids in the blood. However, dietary counseling is frequently still not a routine part of the treatment for hyperlipidemia, particularly for patients who have or who are at high risk for coronary artery disease. The reasons are numerous. A second obstacle is the advent of managed-care medicine, in which physicians tend to order fewer special services, such as dietary counseling, and spend less time with patients. Third, there is a general perception that dietary therapy doesn't work, or at a minimum, that its effects are too small to be worth the effort.
Many patients are comfortable with the focus on drugs.
After all, it's much easier to swallow a pill than to change behavior, particularly a behavior like eating, which is biologically fundamental and socially important. To ignore the importance of diet and living patterns is certainly a mistake, says Sidney Smith, Jr., MD, chief of cardiology at the University of North Carolina at Chapel Hill. Dean Ornish, MD, a staunch supporter of behavior-oriented therapy as a primary treatment for coronary artery disease and founder of the nonprofit Preventive Medicine Research Institute in Sausalito, California, agrees with Smith's assertion. According to Ornish, drug and surgical treatments do not remedy the underlying cause of coronary artery disease. However, he believes that patients deserve to be informed about the benefits and risks of diet and stress-reduction strategies as compared with other treatments.