 Why don't more doctors practice preventive cardiology? Available time is a reason frequently cited by physicians, but if you probe a little deeper, yes they complain about not having enough time to give their patients dietary advice. But the number one reason, given, was their perception that patients fear being deprived of all the junk they're eating. Can you imagine a doctor saying, yeah, I'd like to tell my patients to stop smoking, but I know how much they love it? Changes in diet to reduce cholesterol levels are often assumed to result in reductions in quality of life. Do we get to live longer, or is it just going to feel longer? But contrary to popular belief, this study found no apparent reduction, but rather an improvement in some measures of quality of life and patient satisfaction using medical nutrition therapy as opposed to drugs for high cholesterol. Whereas people taking cholesterol-lowering drugs don't feel any different, this study found that those using dietary changes reported significantly better health and satisfaction and better life in general, more positive feelings and fewer negative. In the family heart study, for example, those placed on a cholesterol-lowering diet showed significantly greater improvements in depression as well as a reduction in aggressive hostility. Another barrier to preventive cardiology is that doctors don't realize how powerful dietary changes can be. The importance of diet for patients' health remains underestimated by doctors. Even the new drug-centered cholesterol guidelines emphasize that lifestyle modification should be the foundation for the reduction for atherosclerotic cardiovascular disease risk, yet more than half of physicians may skip over lifestyle change, completely jump straight to their prescription pad, doubting that cholesterol goals can be reached with lifestyle changes alone. According to the director of the famous Framingham Heart Study, the best way to manage coronary artery disease is to lower patients' LDL cholesterol and other atherosclerosis-causing particles. You can achieve this with diet plus drugs, but if you can do it with a vegetarian diet, it works even better. In the Framingham Heart Study, those running in the Boston Marathon achieved the goal of getting their total to good cholesterol ratio under 4, but the vegetarians did even better. And if you go all out putting people on a very high fiber, whole food, vegetable food, and nut diet, you can get a 25% drop in the bad to good cholesterol ratio within one week, a 33% drop in LDL. That's the cholesterol reduction equivalent to a therapeutic dose of a cholesterol-lowering statin drug.