Doc's Opinion

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Doc's Opinion is a a website containing articles and blog about health, nutrition, healthy lifestyle and disease prevention.

07/11/2025

In 2012, I wrote about low-carb diets and heart disease. It felt like rebellion.
Thirteen years later, the data — and my perspective — have changed.
Here’s what time, patients, and a little humility have taught me.

Exploring how carbohydrate restriction reshaped our understanding of heart disease, metabolism, and the quiet revolution in modern cardiology.

29/10/2025

For the patient, there is no such thing as a “routine” procedure.

Behind every familiar rhythm in medicine lies a moment of surrender — and a trust we should never take for granted.

My new essay explores what happens on both sides of the drape.

A cardiologist reflects on what “routine” really means in medicine—and how trust and vulnerability define every procedure, from cath lab to endoscopy suite.

21/10/2025

What happens when a U.S. president with malignant narcissism is “treated”?
This story imagines the experiment no one should ever attempt — a psychological thriller about power, empathy, and the danger of curing what keeps evil contained.

How to Manufacture a Soul

14/10/2025

You can’t survive medicine by feeling everything — but you can’t honor it by feeling nothing.

This essay is for everyone who carries the weight of patient care — doctors, nurses, therapists, anyone who’s ever stayed past their shift because they still cared.

A reflection on the quiet cost of compassion — and how doctors learn to stay human in a profession that tests the heart as much as the mind.

04/10/2025

I’m writing a series called Inside the Artery: 13 Steps of Atherosclerosis — a deep, visual journey through how atherosclerosis truly begins and evolves inside the arterial wall.

Step by step, it tells the story from the first microscopic cracks in the endothelium to the birth of complex, unstable plaques.

The first eight episodes are now live — tracing the path from endothelial dysfunction and lipoprotein entry, through inflammation, foam cells, smooth muscle migration, and now, the formation of the necrotic core — the turning point between stable and unstable plaque.

A new series on how heart disease really happens — and how to stop it before it starts

02/10/2025

Harry Truman never looked like destiny.

Yet in April 1945, after just 82 days as vice president, he was told: “The President is dead. You are now in charge.

Within weeks he would learn of the Manhattan Project. Within months, he would decide whether to unleash a weapon unlike any the world had ever seen.

This is Episode 10 in The Heart of Power series — the story of an ordinary man whose steady heart carried the nuclear age into being.

Harry Truman and the atomic bomb: how an ordinary man’s heart endured extraordinary stress at the dawn of the nuclear age.

25/09/2025

Clinical trials speak in averages. Patients want to know what will happen to them. That gap is medicine’s oldest problem — and it’s not going away.

Medicine speaks in averages, but patients live in the singular. This essay examines how risk scores, thresholds, and statistics inform care — and why they often fail to account for the individual.

22/09/2025

This is something different. For the first time, I’ve written a Letter from Reykjavík that isn’t about medicine.

It’s about the summer of 1972, when my small hometown became the center of the world. Bobby Fischer and Boris Spassky brought the Cold War to Reykjavík — not with bombs, but with bishops and pawns.

I was twelve years old, with a bicycle and a cheap Kodak Instamatic, trying to slip close enough to glimpse history.

This is Part I of a four-part series: Letter from Reykjavík — A Boy, a Bicycle, and the Center of the World.
This is something different. For the first time, I’ve written a Letter from Reykjavík that isn’t about medicine.

It’s about the summer of 1972, when my small hometown became the center of the world. Bobby Fischer and Boris Spassky brought the Cold War to Reykjavík — not with bombs, but with bishops and pawns.

I was twelve years old, with a bicycle and a cheap Kodak Instamatic, trying to slip close enough to glimpse history.

This is Part I of a four-part series: Letter from Reykjavík — A Boy, a Bicycle, and the Center of the World.

Reykjavík in July 1972 — endless light, Cold War shadows, and a boy chasing history.

21/09/2025

Six episodes are now out!

I’m writing a series called Inside the Artery: 13 Steps of Atherosclerosis. Step by step, it tells the story of how atherosclerosis develops inside the artery wall — from the very first changes in the endothelium to advanced plaque.

The first six episodes are now published, covering the journey from the earliest triggers through foam cell formation.

A new series on how heart disease really happens — and how to stop it before it starts

18/09/2025

For most of the twentieth century, medicine wasn’t a conversation — it was a command.
Doctors spoke, patients obeyed, and trust was the silent air between them.

That order has collapsed.

This is the story of how medicine lost its authority — and what it means to practice in an age where trust must be earned, one conversation at a time.

Public trust in doctors has collapsed. From scandals to COVID, here’s how medicine lost its authority—and how trust might be rebuilt.

15/09/2025

As a child, I pressed my nose against the window of an old clock shop in Reykjavík, convinced the ticking machines were whispering the secrets of time.
Medicine later taught me that our bodies have clocks of their own — circadian rhythms, telomeres, even molecular timers of aging. What happens when they fall out of sync?

Read my latest Letter from Reykjavik

How our inner clocks shape health, aging, and meaning.

11/09/2025

We can now silence hunger.
The question is — what happens when appetite itself becomes a condition to medicate?

From miracle drug to moral dilemma? The hidden costs of silencing hunger with GLP-1s like Wegovy and Ozempic.

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About Doc’s Opinin

Doc’s Opinion is written and edited by Axel F. Sigurdsson MD, Ph.D., FACC.

Dr. Sigurdsson is a cardiologist at the Department of Cardiology at The Landspitali University Hospital in Reykjavik Iceland. He also practices cardiology at Hjartamidstodin (The Heart Center) which is a private heart clinic in the Reykjavik area. He is a Fellow of the American College of Cardiology (ACC), The Icelandic Society of Cardiology and the Swedish Society of Cardiology. He is a past president of the Icelandic Cardiac Society.

Dr. Sigurdsson is also a licensed aeromedical examiner. He has held the position of Medical Director of Icelandair since 2005.

Axel F. Sigurdsson MD, PhD

I studied medicine at the University of Iceland between 1978-1984. Upon receiving my medical license, I went to Sweden at the beginning of 1988 for further education and training.

I spent the next eight years at the Sahlgrenska/Östra University Hospital in Gothenburg, Sweden, specializing in internal medicine and cardiology.

In October 1993, I defended my doctoral thesis at the University of Gothenburg, termed “Neurohormonal Activation in Patients with Acute Myocardial Infarction or Chronic Congestive Heart Failure – With Special Reference to Treatment with Angiotensin Converting Enzyme Inhibitors”

In 1995-1996 I was a clinical fellow at the Royal Jubilee Hospital in Victoria BC, Canada. The primary purpose of my fellowship was training in interventional cardiology, mainly coronary angiography and percutaneous coronary interventions (PCI’s).

I have published more than 100 scientific abstracts, articles, and book chapters in international journals and textbooks.

Since 1996 I have worked as a clinical cardiologist at the Landspitali University Hospitalin Reykjavik Iceland as well as practicing internal medicine and cardiology at Hjartamidstodin (The Heart Center) in Kopavogur, Iceland.📷

I was born in Vestmannaeyjar, a volcanic island close to the south coast of Iceland on August 21, 1959.

Doc’s Opinion

I started writing Doc’s Opinion in the spring of 2012.

My aim is to write informative high quality articles based on medical science. Evidence based medicine is at the core of my writing.

My goal has always been to write articles that can be read and appreciated by health professionals as well as the general public. Of course, this is a difficult challenge because the gap between the medical literature and what ordinary people can read and understand may sometimes be difficult to overpass.

The main purpose of this website is to provide up to date information on preventive medicine, healthy lifestyle, and nutrition, and to provide reliable and practical information about different medical conditions. Although heart disease plays a central role, I also focus on many other areas of medicine.

A List of Some of my Published Scientific Papers

Evidence, Not Evangelism, for Dietary Recommendations

Relationship of C-reactive protein reduction to cardiovascular event reduction following treatment with canakinumab: A secondary analysis from the CANTOS randomised controlled trial

Effect of interleukin-1β inhibition with canakinumab on incident lung cancer in patients with atherosclerosis: Exploratory results from a randomised, double-blind, placebo-controlled trial

The cardiovascular risk reduction benefits of a low-carbohydrate diet outweigh the potential increase in LDL-cholesterol

Outcome of myocardial revascularisation in patients fifty years old and younger.

Angiotensin Receptor Neprilysin Inhibition Compared With Enalapril on the Risk of Clinical Progression in Surviving Patients With Heart Failure.

Benefits of Statins in Healthy Elderly Subjects What Is the Number Needed to Treat?

Comparison of 30-Day and 5-Year Outcomes of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients Aged

Prevalence of Abnormal Electrocardiographic Patterns in Icelandic Soccer Players and Relationship with Echocardiographic Findings.

Dual angiotensin receptor and neprilysin inhibition as an alternative to angiotensin-converting enzyme inhibition in patients with chronic systolic heart failure: rationale for and design of the Prospective comparison of ARNI with ACEI to Determine Impact on Global Mortality

Screening for risk factors of sudden cardiac death in young athletes

Diagnostic accuracy of 64-slice multidetector CT for detection of in-stent restenosis in an unselected, consecutive patient population

A comparison of all coronary angiographies (CA) performed in 2008 in Iceland and Sweden

Angiographic in-stent restenosis is not related to the inflammatory markers hs-CRP and MPO

Diagnostic accuracy of 64-MSCT for detection of in-stent restenosis

Clinical In-Stent Restenosis is related to stent length and diameter but not to diabetes in an unselected cohort

The effect of physical training in chronic heart failure

Effects of a 5-Lipoxygenase–Activating Protein Inhibitor on Biomarkers Associated With Risk of Myocardial Infarction: A Randomized Trial

Early neurohormonal effects of trandolapril in patients with left ventricular dysfunction and a recent acute myocardial infarction: A double-blind, randomized, placebo-controlled multicentre study

Effects of 3 analgesic regimens on the perception of pain after removal of femoral artery sheaths

Results of percutaneous coronary interventions in Iceland during 1987-1998.

In-hospital heart failure – epidemiology, prognosis and treatment

The role of neurohormonal activation in chronic HF and postmyocardial infarction

Neurohormonal activation and congestive heart failure: today’s experience with ACE inhibitors and rationale for their use

Prevention of Congestive Heart Failure by ACE Inhibition in Patients with Acute Myocardial Infarction

ACE inhibitors in patients with minimal or asymptomatic left ventricular dysfunction

Neurohormonal activation in patients with mild or moderately severe congestive heart failure and effects of ramipril. The Ramipril Trial Study Group

Is neurohumoral activation a major determinant of the response to ACE inhibition in left ventricular dysfunction and heart failure?

Left Ventricular Remodelling, Neurohormonal Activation and Early Treatment with Enalapril (CONSENSUS II) Following Myocardial Infarction

Response of plasma neuropeptide Y and noradrenaline to dynamic exercise and ramipril treatment in patients with congestive heart failure

Effects of ramipril on the neurohormonal response to exercise in patients with mild or moderate congestive heart failure

Short- and long-term neurohormonal activation following myocardial infarction

Neurohormonal effects of early treatment with enalapril after acute myocardial infarction and the impact on left ventricular remodelling

Enalaprilat in acute myocardial infarction: Tolerability and effects on the reninangiotensin system

Anti-arrhythmia agents after myocardial infarction should be used with caution

The Etiology of Bacterial Cellulitis as Determined by Fine-Needle Aspiration