I am a noninvasive clinical cardiologist.
I’m board-certified in internal medicine, cardiology, echocardiography, and nuclear cardiology.
For the last 13 years my practice has been at St. Luke’s Hospital in St. Louis but as of September 1, 2020 I have transitioned to Saint Louis University SLUcare. For what it’s worth I’ve been named to the Best Doctors in America list annually from 2009 to the present.
Most recently, I’ve transitioned into a hybrid position wherein I see patients in the office and in the hospital in St. Louis for two months in the spring and two months in the fall. For the remainder of the year, I’m in Encinitas, California where I do remote telehealth visits and read echocardiograms remotely. I see patients who live in all the states where I have a medical license, including North Carolina, Missouri, and California.
I’ve spent time in academic cardiology, done research and teaching, and published more than 100 research papers in major cardiology journals. Most of my research and writing has been in the area of echocardiography, a most amazing tool for visualizing the heart in all its glory. At Saint Louis University where all my medical training happened, I did the first transesophageal echocardiogram in St. Louis in 1988 and co-authorized an early textbook on that now indispensable tool for cardiac diagnosis.
I’ve been the Principal Investigator on many clinical research studies and I’ve received honoraria for speaking for multiple different drugs for Big Pharma. (I stopped doing that around the time I started this blog in 2013 and I don’t accept snacks, treats, dinners or lunches from pharmaceutical representatives)
All of these experiences have taught me to cultivate a healthy skepticism for medical and scientific information that has potential bias.
For 30 years I followed and counseled my patients on dietary guidelines that I assumed were solidly based in science.
I drank skim milk, ate low or no-fat yogurt, avoided butter like the plague and had egg-white omelets.
One afternoon I started to lecture my lunch companion (formerly known as the eternal fiancee’ of the skeptical cardiologist) on her decision to consume a croissant slathered with butter. When she challenged my supporting evidence I went on a quest to discover the scientific sources underpinning my recommendations.
My findings were, shall we say, eye-opening.
I now consume full fat milk, yogurt and cheese as much as I desire and my omelets contain egg yolks.
Although I emphasize consumption of plenty of fresh vegetables, I’m more concerned about low-quality carbs and hidden sugar in the foods I consume than about the fat.
The major focus of this blog is to look at what we truly know about diet and cardiovascular disease versus what we have been told.
Addendum: Over time I’ve obviously expanded the topics I bloviate on in a skeptical, critical way. Now, you will find discussions on statins, cardiac testing, good doctoring and new healthcare monitoring devices.
And occasionally I talk about things I love like travel, music, and literature.
Anthony C. Pearson, MD, FACC
This is a personal website, produced in my own time and solely reflecting my personal opinions. Statements on this site do not represent the views or policies of my employer, past or present, or any other organization with which I may be affiliated.
In particular, please note that nothing on this site represents the views or policies of Saint Louis University my current employer.
Also, do not consider anything I write as personal medical advice for your condition. Any decisions you make on your personal health care should be undertaken with the supervision, shared decision-making and care of your own personal physician.
Private emails can be sent to firstname.lastname@example.org
65 thoughts on “About”
Love your candid, honest, thoughtful (and thought-provoking) approach to matters medical. I nod in agreement to most of your posts but do not share your love of statins and am dubious over the obsessive desire to tinker with cholesterol levels. This paper :https://journals.lww.com/co-endocrinology/Fulltext/9900/Assessing_cardiovascular_disease__looking_beyond.21.aspx is a refreshing contra view to accepted doctrine. It should therefore appeal to your “skeptical” credentials but regardless I would love to read your take on it either way!
I do not have an obsession with cholesterol levels, just with lowering cardiovascular risk. Apo b and LDL-c are important targets in that quest when lowered by any of multiple therapeutics.
I get email updates from Malcolm Kendrick, the author of that paper, and I’m well aware of his thoughts in this area.
He’s a bright fellow and interesting writer but I feel the bulk of the evidence informs my approach.
Hello,i have the alivecore kardia single lead device,I quite often get my ECG readings that don’t show any p waves at all,or sometime the p wave starts of and then disappears, or the other way round.I don’t have Afib just ectopics beats from time to time,and the report says normal sinus rhythm,should i be concerned?I read that not having p waves is not a good thing.Thanks.
Let me review your ECG recordings.
I am a retired Orthopaedic Surgeon, 83 yo (84 in 2 days). 7 months ago had first afib, lasted 2 days then resolved without treatment. 2 weeks later recurred but persisted. Cardiologist started me on Eliquis 5 mg BID and Sotalol 2.5 mg BID (my pre afib resting rate was normally in the low 40s so he did not want to slow it down too low). No underlying cardiac issues. Still felt terrible so had a cardioversion and have remained in NSR for nearly 7 months, with pulse in upper 30s to low 40s. Still on the Eliquis and Sotalol regimen.
Question: I have painful arthritis in my hands, back and knees. Prior to afib I would take an occasional (once every 2 to 3 weeks or less)Voltaen 75 mg. and felt much better for days at a time. Cardiologist now has reluctantly agreed to let me take it rarely but not change Eliquis regimen. Since I remain in NSR, is it risky for me to replace my AM Eliquis with the Voltaren on the rare occasion that I need the NSAID?
Doc, are you skeptical regarding supplementation against Atrial Fib? I am 70 and have been dealing with this condition for 22 years. I have taken Standard Process Cardio Plus and more recently their plant based magnesium and calcium supplements. My atrial fib has all but disappeared and the occasional episodes convert usually within 48 hours. My cardiologist has me on 225 mg of Propafenone which was
moderately helpful. She bumped it up to 300mg but didn’t help. Lowered back to 225 with supplements has been excellent. Thinking about 150 mg. Over exertion (exercise) seems to be the main trigger. Thanks for reading
Good review of home-based pulse oximetry- thanks. One additional factor that affects the normal range is the altitude where patients live. I am in Santa Fe, NM at 7,200 ft. and my normal range is 92-94% saturation. This has been confirmed by the FDA approved oximeters at our local hospital. Cheers.
what could you tell me about president trump’s real heart status
Just stumbled on your site. A breath of fresh air. Next September I will have been dealing with paroxysmal A-Fib for 50 of my 77 years. Many cardiologists in many town with many opinions. I have been able to cardiovert myself numerous times with a sports drink, a tranquilizer and bed. Also multiple electrical cardioversions highlighted by one during which I was merely asleep as opposed to sedated. (It took ten years before I could watch paddling on TV). It’s been quite a ride. Keep up the great work.
Well done on throwing tomatoes to the eggs study. It is also the first time ever someone raises the issue of which type of oil is used to fry eggs may matter more than yolk yes yolk no, and not for gourmet reasons. As a scientist myself, I really would hate to have to replace my daily omelette with cornflakes, lest my gold standard cholesterol readings will not survive kellogisation and I will not be able to claim my twice the standard population levels of HDL cholesterol any more. Maybe it is all down to the fact that I run 50miles a week but sure that constitutes personal leisure not of interest to researchers? And sure an n of 1 trial does not make a publication.
I am a 77 year old male runner, non smoker, non drinker (for last 7 years). 5 ft 5, 132 lbs, mostly Mediterranean diet (with notable lapses). Blood pressure 120-130/70 most of the time, cholesterol moderately high. I take no meds of any kind. My score said 19% chance based mostly on age. My cardiologist said take a statin, but I did not, but after reading your posts it seems sensible to do the ultrasound carotid and/or heart scan tests, mainly to get more evidence on whether to take the statin. Do you still recommend both tests or is the heart scan sufficient. Thanks, Mike
For 77 year old just the calcium
Looking forward to reading your blog! In this Information Age, a fair amount of skepticism is necessary!
I am keen to hear more of what you have to say
Greetings! I just found your blog and have trotted about in it. Entertaining, enjoyable, and an exhilarating balance to the powers of pseudoscience!
Thanks for taking the time,
Pat Van Antwerpen
Glad you are appreciating it.
Hi Dr. P, I bought the Kardia stand alone in May then decided to get the band in July. The reason being that when I felt “flutters” or lightheaded I usually didn’t have my stand alone right there with me and by the time I got it it was to late. Which got very frustrating trying to catch those little buggers! So for that very reason I got the watch band. I am using it with a second generation Apple Watch. The set up was quite easy as I followed the instructions on the app. I do wish it came with thorough instructions in the box though. The recordings seem to be very accurate. I did have to figure out the “sweet spot” on my wrist for it to be able to read. I have small wrist and even with the small band I have to play around with it to get it in the right spot, not on a bone.
So with that I have been able to catch PVC’s, PAC’s, SVT, A-Fib with rapid ventricular response, possible 2:1 a-flutter. I have strips of all the events and would be willing to email all of them to you. As well as the smart monitoring results.
A little history, I am a Cardiac RN. I have worked at UAB with Dr. John Kirkland (I know I’m showing my age?) I worked in CVOR as well as CVICU. I am currently home schooling my two youngest boys, and believe me the hospital is way easier ?.
That is exciting! I’d be interested in looking at them. I’ve been meaning to write an update on the Kardia Band and this should help stimulate me. Send to email@example.com
Actually, try firstname.lastname@example.org
I knew Dr Kirkland and his family; I’m from Birmingham, grew up in the internal medicine community at UAB, now a health psychologist. You are lucky to have worked with him.
I am enjoying this blog and your thread, as I find the opposing views of cardiologists in how to treat a fib so recalcitrant that I end up having to figure things out for myself.
Dr. Anthony. Do you know of any board certified cardiologists in the NY metro area who share your views on patient cardiac care?
Problem of non-symtomatic patient. It turns out I’ve had severe aortic valve regurgitation for at least five years, probably much longer. Now 78 and turns out getting the most mild of hints of limits to exercise, at extremes such as a minute of fast sprinting getting out of breath with hints of nausea. .
I learned that TAVR (Transarterial Aortic Valve Repair) has only been approved for stenosis, not regurgitation. Never told this as I was waiting for approval just received a few years ago. Now I’m faced with some surgery, which bothers me because I have Mild Cognitive impairment and fear the depression of a long recovery including the chance of post perfusion cognitive loss.
But, if I wait until symptomatic, then the harm to the LV can’t be fixed, so I have to jump one way or the other while I’m still enjoying being active.
Do I have it pretty straight for a layman?
Pretty straight. If you are still running and sprinting at 78 , however, it will be hard to make you feel better.
In this situation, your cardiologist should be monitoring the size (LVEDV) and function (EF) of your left ventricle to decide on timing of surgery.
TAVR not approved for AI yet but some day may be.
Let me introduce myself, I’m a Non-Invasive cardiologist in Venezuela and spend half of my duty time trying to diagnose with my límitesd skills in ecocardiography. Your attitude, reflected in your blog intro, is the way I dream to reach in my humble practice.
What papers do you recommend in order to use as the gold standard for practical reasons, as the main guide for diastolic evaluation?
Thanks for your time and it would a honnor for me to have your answer, with my admiration.
P.D: sorry for my english.
Thanks for your excellent, well reasoned, and good humored site! I too was offered a “Leading Physician of the World” opportunity, and while I was not remotely interested in signing up for it I wanted to see what better informed folks thought about it. I came across your post and had to keep reading. Your incisive perspective is a pleasure to read. You can always spot where a scientist is in his or her development; the most mature and experienced are most open to being wrong. Thanks again.
I very much appreciate your approach to medicine and patient care. I’m a 57 year old with family history of heart disease. I live in Texas. Can you suggest cardiologists in my state that are also data driven and look a little more deeply than most?
I have an elevated hs-CRP and want to find out what I should do.
I don’t have personal experience with any cardiologists in Texas.
My last post was just retweeted by John Erwin in Temple, TX at Baylor there who seems to have a great interest in preventive cardiology. You can get an idea of his interests and personality by reading his prolific tweets at @heartotxheartmd.
Beyond personal connections I find it very hard to make MD recommendations.
I would definitely be looking for board certification in cardiology.
I’m 57 with family history of heart disease. No immediate issues (other than elevated hs-CRP) but would like to find a cardiologist for assessment. Would like someone like yourself who is data driven but looks beyond guidelines “handed down”. I’m in Texas – do you know of any like minded cardiologists I could seek out?
Enjoying your blog and learning from it as well (even better, it’s confirming some of my prejudic…er, I mean, well constructed thoughts).
Ive been an RN for decades and now find myself with heart temper tantrums called a fib. It is so refreshing to read your info, restores my faith in honest medicine. Thanks for doing what you do?
Thanks for your blog, Dr. Pearson. Having just had an afib episode (only the second; the first was more than ten years ago). It converted within an hour of beginning a cardizem IV, but there’s been a long-term reaction/damage seemingly caused by a single experimental dose of Rythmol. As a result, I’ve begun reading up on the subject again. It’s refreshing to find a cardiologist who writes based on science rather than “conventional wisdom.”
Oops, just saw the typo. Second sentence should read “I just had….”
During the late 1980’s, Dr. Dean Ornish and Dr. Caldwell Esselstyn began reversing atherosclerosis, and more importantly greatly decreased the number of reoccurring cardiac events in participants who adhered to a plant-based diet and often other lifestyle modifications.32 33 34 35 More recently Dr. Esselstyn has replicated his initial findings in around 200 participants over the period of a decade, with publication pending results showing a phenomenal success rate of a 99.5% reduction in reoccurring cardiovascular events [reviewed previously].
Dietary cholesterol and fat that leads to obesity, heart disease and diabetes among other chronic diseases, can only be found in animal based foods such as All meat (not just red) and all dairy, and eggs. There is research and cases that prove this, as well as a growing number of cardiologists and cardiothoracic surgeons who have experienced this themselves are are treating patients with this approach. So how does a cardiologist like yourself, ignore and promote a lifestyle that promotes the use of animal based products?
Merrilee, I appreciate your comments and questions and wish you success on your documentary. I have no problem with people eating a plant-based diet. Personally, I follow Michael Pollan’s “Eat food, mostly plants, not too much”.
However, there is no good science supporting the concept that “dietary cholesterol and fat” …”leads to obesity, heart disease and diabetes.
In fact if you will look at some of my other posts you will find my summary of these topics, discussed and referenced in detail.
You could start with
1. My discussion of the bad science behind Dr. Esselstyn’s “study”.
2. My discussion of the fact that dietary cholesterol is no longer considered a nutrient of concern for atherosclerosis and that cardiologists are moving away from obsessing about fat or saturated fat in the diet as a cause of heart disease.
3. My discussion of the Pritikin diet . In the comments I discuss the poor science behind Ornish’s studies as support for very low or vegetarian diets.
So, as you can see, I don’t ignore this research, in fact I have studied it in detail in order that I could present the best possible advice to my patients with respect to diet.
I just found your blog today — you sound more like us than we do. Even your tone is almost as sarcastic as ours. But wellness is even more of a scam than the stuff you are describing, so it’s easier for us to diss ‘the Aetnas, Cignas, and United Healthcares of the world for convincing companies they need to force their employees to get screened every year, and that the answer to all of life’s problems is to eat more broccoli.
Anthony. We have two events in the US in 2016. I’m involved in the planning. Want to join us?
Best, Dr. Jeff
We’ve already got a nice lineup. Jeff
Hi Dr Pearson. I was researching healthy eating due to a diagnosis of type 2 diabetes and I find it confusing that Dr. Kim Williams (president American College of Cardiology) can have such a, seemingly, diametrically opposed point of view to your own when looking at the same scientific evidence. Am I missing something? I would like to have your take on this if you have time. Many thanks.https://www.youtube.com/watch?v=yW7ljppz5JQ
Yes, Kim Williams is a vegan and yes, he’s is the president of the ACC but that doesn’t mean that the ACC recommends a vegan diet or that we should believe his advice. Williams likes to cite his drop in LDL cholesterol when he changed his diet but what we don’t know is what this change in diet will have on his risk of atherosclerosis. He has become convinced of the great benefits of vegan diets based on his own anecdotal experience and this does not make for good science. I can cite my own anecdotal experience of having my good cholesterol go up 50% when my diet changed from low fat to low carb but I don’t think this should be a basis for population recommendations.
Keep in mind, Kim Williams, as a vegan believes you should not eat fish. This goes against every thing we have learned in the last 20 years.
He also mentions in this video that he is in favor of restricting all fat. That would include olive oil which is clearly beneficial in reducing coronary disease.
He clearly has developed a bias that the vegan diet is better and is attempting to evangelize this by cherry picking scientific studies.
As a diabetic, you are much better off consuming a low carb diet.
I came across your blog while reading your review of The Widowmaker. I am looking forward to reading many of your older posts!
Thanks for writing this blog.
Hoping you will some day soon address the issue of catheter ablation for atrial fibrillation–assuming you have some opinions about it.
I will second Alexa’s motion and move to add a discussion of Flutter versus Fibrillation, also assuming you have some opinions, considering that you are a non-invasive, non-interventional guy …:-)
There has been a recent Study on catheter ablation for A-fib.
The result was…’Disappointing’. 🙁
– I don’t think it would be kind to make any comparisons to ORBITA.
I hope to summarize my views on the CABANA study and AF ablation in general in an upcoming post. The primary study results were disappointing to most EP doctors (the ones who do ablation).
WHY is mainstream cardiology not preaching the same gospel? Australian Heart Foundation is still stuck on tasteless low fat dairy products.
I am a dairy farmer’s daughter with good FH,, practising as GP . I have always eaten a bit of butter, and adore a bit of cheese, ignoring the advice. I will have more, waistline premitting.
Husband’s cardiologist still saying ‘no cheese, no butter’ because of his IHD but we both opt for full fat yoghurt.
It tastes better.
My post today talks more about this paradox.
“mainstream cardiology” is gradually coming around to the truth but its difficult adjusting the bearings of such a large , fully loaded ship.
If you husband likes fried mushrooms… you can hide a ginormous amount of butter in them.!
Another oddity DownHere, is the number of Doctors – including the odd Cardio – who either know nothing about CAC scores or who denigrate them as ‘useless’ quackery !.
A good friend of Senior Vintage (with FH) took himself off statins 6 months ago.
He hasn’t had any adverse Events…and feels “better”.
Another (GP) friend has all-but stopped prescribing statins. Funny, his practice hasn’t suffered any ‘reduction in numbers’… 😉
I’ll be interviewing a new Cardiologist in a few days and I fully expect the usual Australian Guidelines et al. to be trotted out. I almost feel sorry for him, if he does, – my response will be ‘Full & Frank’. !
After a – now failed – CABG x5 18 months ago, I’m in no mood to put up with willfully ignorant Specialists .
Alexa, Any excuse is a Good Excuse to eat a natural, bio-available source of vitamin K2 (Brie) A 500 gram half-wheel only survives a few days in my refrigerator, – no matter where it hides!
So I can eat brie now with virtual cardiac impunity? After so many decades of indoctrination about the evils of consuming dairy fat, my brain simply cannot seem to adjust to the latest research. Brie? Butter?
Any high-fat cheese?
Definitely you can eat brie! Butter, too. The indoctrination again full fat cheese was never based on good scientific evidence. I’m presuming you read this
I hadn’t, but have now read your post from 2014, “In defense of real cheese.” It’s going to take a long time to adjust my thinking; the brainwashing went deep, and I still feel guilty consuming food like butter and brie. But I’m delighted to have just discovered your invaluable website. Thanks so much for all the critically important information.
The brainwashing of 30 years has gone deep into the American subconscious.
Thanks for your kind words!
It’s amazing how the brainwashing takes r(o)ot. The same thing with margarine vs butter. For years we were told that margarine is heart healthy. Fortunately, I never believed that and stuck with butter. If it gets repeated often and loudly enough it must be true!
Dr. Pearson, you should have more of a presence on FB and Twitter and list that here on your website. It’s a great way to direct people to your site. 🙂
I have a slight presence on FB and Twitter. Very slight. I’ll investigate ways to list that here.
I just read your post on being nominated for a “The Leading Physicians of the World”. Thanks so much for looking into it and sharing what you found! I got an email on linked in today and was very suspicious too (what do these people know about what i am doing?? I don’t even have that much on linked in!). Glad to know how it works and its real purpose!! 🙂
As promised I visited your blog today. It was easy to access & navigate. I’m on the same page as you re: dietary fat but we differ on quantity. Also, I’m all for taking “goodies” from pharma reps – I can be “bought off” w/lunches, dinners etc BUT I can’t convince them to call on retired diagnostic imaging reps.
I’ll work on shaving a few pounds off my formidable frame before I see you again. I’m sure you have some insights at the site that will help w/calories.
Anthony, a friend of mine from Dublin directed me. I would enjoy your feedback.
Apparently Roger Ebert likes it a lot.(http://www.rogerebert.com/reviews/the-widowmaker-2015)
Nice site Dr. Pearson. I am a family doc in Colorado focused on CV risk and prevention
I took a look at your site. Looks great for Denverites! I was not aware of the Widowmaker movie and will check it out.
I accessed your blog today through a link included in your comment on Dr. Sigurdsson’s blog. Having read your posts about saturated fat, I see you are not yet familiar with the omega-6 hazard, as I term it.
I learned the hard way what excessive omega-6 linoleic acid can do to one’s health. http://www.berkeleydailyplanet.com/issue/2014-10-03/article/42529?headline=Perils-of-Peanuts–David-Brown-Kalispell-MT
I contacted the FDA and learned that regulations forbid the listing of grams of monounsaturated and polyunsaturated fats on food labels. In Canada, grams or omega-3s and 6s are listed on Canola oil containers.
I’d really like to know which oil-rich foods are high in omega-6 linoleic acid. For example, the turkey I’m cooking contains 3 grams of saturated fat and 10 grams of total fat per serving. Turkeys generally have a high omega-6 content because of what they are fed.
Humans also have a high omega-6 content these days because it’s in the food supply. http://www.news.ucsb.edu/2014/014386/hold-mayo
I hope that you will give Lysulin a try. Lysulin is an all natural nutritional supplement that targets and can halt protein glycation, the cause of insulin resistance, diabetes and its complications. See my website for a bibliography to substantaite this: http://www.jburd.com. Clinical studies prove that it works! I was the founder of DexCom. Thanks, John
We have the tools to wipe type 2 diabetes off the planet, like polio. Type 2 diabetes is a diet disease. A keto diet with some fasting, moderate exercise and Lysulin can reverse type 2 diabetes. Join me in my war on diabetes – a war that we can win, with no investment in R&D, just a change to the ridiculous government diet reccomendation of a high carb, low fat diet. Thank, John
That’s unbelievably ignorant. A keto diet can reverse diabetes? Site your proof.