Food for Thought Friday: Modern Medicine Rant

Pop Quiz:

The failure of institutions such as the American Diabetes Association, American Heart Association, and American Medical Association not just to acknowledge the undeniable efficacy of carbohydrate restriction for myriad chronic health complications, but also their failure to do what they should be doing—which is shouting it from the rooftops louder than any ol’ no-name blogger, and actively encouraging people to give it a try—is the result of which of the following:

A)  Stupidity

B)  Willful Ignorance

C)  Conspiracy

D)  Narcissism

E)  Malpractice 

F)  All of the above

Yeah. You can see where today’s rant is headed.

1.

I’m a pretty level-headed gal. (Or so I like to think.) I do my best to refrain from mudslinging, sensationalist headlines, and black-and-white thinking here on the blog. Perhaps it is naïve of me, but I don’t generally subscribe to conspiracy theories. Since I usually harbor no ill will against anyone (with exceptions, of course…we all have a few), it’s hard for me to believe that other people don’t feel the same way. The idea that someone would deliberately withhold helpful information from someone else, or actively steer them in the opposite direction—both of which may cause someone serious bodily harm, is difficult for me to comprehend. 

This is especially true when helpful—no, not just helpful, but potentially lifesaving—information is withheld in a medical or other healthcare setting. After all, doctors are supposed to help people, right? Sure, there are some bad apples who go into medicine solely to make money (or to appease their strict parents – “According to Jewish tradition, the fetus is not considered viable until it graduates from medical school” … *ba-dump-tsch!*), but again, me being the Pollyanna that I am, I’d like to think most physicians, nurses, dietitians and nutritionists go into their respective professions to help people get well if they become hurt, injured, or sick, or to help them stay well, if they’re already healthy. So, assuming this is true—that most healthcare professionals (which I’ll take to include the whole gamut—MDs, NDs, DCs, DOs, RNs, NPs, PAs, RDs, nutritionists, and village shamans) have their patients’ and clients’ best interests at heart, I say again:  it is darn near impossible for me to understand why some type of dietary and lifestyle modulations leaning in the direction of Paleo, Primal, low-carb, ketogenic, or general “ancestral health” are not presented as the very freaking first intervention, rather than what they are typically presented as: either a last resort after all the conventional methods have failed, or not even a last resort, but something healthcare professionals actively warn people against trying.

Twenty years ago, I could have understood this. (Maybe.) But now? When there is story after story, after story, after story (after story!) of people with “chronic and progressive” illnesses, morbid obesity, and who were on a slew of medications and darn near completely debilitated, who have experienced turnarounds that can legitimately be called miraculous?

Miraculous, that is, only to people who are completely ignorant of the no less than stunning metabolic turnarounds that can occur upon reducing dietary carbohydrate, controlling insulin levels, and going easy on the “vegetable oils.” Because, see, for those of us who do understand these effects, they’re not stunning. They’re not even the least bit surprising. They’re nothing more than the most basic human physiology and biochemistry. This is stuff it doesn’t take a medical degree to figure out. Regular ol’ non-doctor folks can figure this out just fine for themselves. A diabetic armed with nothing but a drugstore glucometer can figure out that if (s)he needs to avoid gigantic spikes in blood sugar (and, presumably, insulin), grains and dense starches are most likely off the menu.

Case in point: posted here, with permission from Steve Cooksey, the “Diabetes Warrior.” He’s said this more powerfully (and succinctly) than I can:

Disclaimer at the bottom of every page on https://t.co/VjWkYeLADG , if I can figure this out. @UncladLad pic.twitter.com/CqMJZADUwF

— Steve Cooksey (@diabeteswarrior) December 6, 2015

How many of these “anecdotes” have to accumulate before they reach a critical mass? I know personal stories are not data and never will be. But shouldn’t someone sit up and start taking notice? How many thousands of anecdotes have to pile up before they become “anecdata?”

As most of us know, there is a huge and growing-ever-huger body of scientific literature to support the efficacy of low-carb and Paleo diets. And this isn’t nebulous, black-magic, smoke & mirrors-type stuff that we don’t understand. We do understand the mechanisms. They make sense. In the light of the most basic, fundamental principles about how the human body works, they Just. Make. Sense.

So why is it that healthcare professionals have such a roadblock to understanding what any high school kid armed with a biochem textbook can see plain as day? After all, these people aren’t stupid. The dumbest person who gets to call him/herself an “MD” is still pretty damn intelligent. (Or maybe they’re just good at memorizing sh*t, which isn’t the same thing.) Why do logic and common sense completely fall apart when it comes to practicing medicine?

Okay, yes, doctors are pimped out influenced by the drug companies. Bought and paid for, in many cases. I know. I understand.

But still.

Facts are facts. Human metabolism is human metabolism. The liver is the liver; the pancreas is the pancreas. While certain things might be open to a great deal of widely varying interpretation, ultimately, facts are facts.

2.

Confession: I am a terrible nutritionist.

No, really, it’s true. I’m not just saying that. If any of you happened to have clicked on my “Services” tab in the last couple of months, you’ll have noticed that I’ve temporarily taken down my shingle. Closed up shop. (And at this point, I’m not sure about the “temporarily” part anymore.)

Why?

I suck at nutrition life.

Well, you might think from my blog posts that I kinda sorta have some vague idea of what I’m talking about. I believe I’m a good writer, and I think one of my strongest skills is in translating the scientific and medical gobbledygook into plain English so that we can all understand what are otherwise some pretty complex things about the human body. (Based on the feedback I get about the blog, this is what you, dear readers, enjoy about my writing. Plus, my sarcasm and wry wit. I love you, too!) But I can assure you that, regardless of whatever knowledge my more popular posts make it seem like I have, my career as a nutritionist giving one-on-one consultations has been a long string of failures, uninterrupted by even one success. So it seems that while I’m halfway decent at understanding the basics of human metabolism, and conveying that information to others in writing, when it comes to helping people apply that knowledge in their own lives in order to get the results they’re after, I am one step shy of totally incompetent.

Why am I telling you this? Why am I advertising the fact that I’m a complete failure as a nutritionist?

One thing you will always get from me is honesty. I tell you when things are going great, and I tell you when things are not going great. So in what is perhaps my biggest bit of honesty to date here on the blog (even bigger than this one), let me share with you the thought that immediately comes to mind when I get an initial email inquiry from a potential new client: “Oh, great, someone else I can fail.”

Is it me? Is it them? Is it Saturn rising in Aquarius? Probably all three. (No, just kidding about that last one. It’s the first two.) I am, in fact, going to reopen my practice soon, and I will be doing things very differently. I’ve met with some mentors to see how I can help people be more successful, and I’m looking forward to them and me feeling better about all this. 

But I digress. The reason I’m telling you all this ugly stuff about me is because the way I feel about my own career makes it impossible for me to understand how these doctors live with themselves. When healthcare practitioners have an endless slew of patients who never get better, who only get worse and worse, who need to take more and more drugs, and have ever-riskier surgical procedures, why do they never feel like failures? Do they just assume the patients are either not following “doctor’s orders,” are lazy and/or stupid, or that their illnesses really are SO TERRIBLE, and SO PERMANENT and irreversible, that it really doesn’t matter what a doctor says or does, because the patient is going to get worse and worse regardless?

Is that how these people can sleep at night? By absolving themselves of any and all responsibility in their patients' outcomes? Is it because they never engage in introspection, and wonder if maybe what all their sick-and-getting-sicker patients have in common is having them as their doctor? 

Okay, yes, some physicians have a “God complex,” and fully believe themselves infallible and above reproach in all ways. But not all doctors are giagantic jagoffs that arrogant. Why do so many of them never question their methods? Why do so few of them ever stop to wonder if maybe it’s them? Their methods that are failing? Their interventions that are useless (or worse, counter-productive)? I guess this where I’ve been going wrong as a nutritionist: when my clients don’t get results, I assume, every time, that it’s my fault. Rightly or wrongly, I take personal responsibility for it to the point that I've convinced myself I have no right to be a nutritionist at all. (It's all good, though. No llores por mi, Argentina. See the postscript at the end of this post.)

As for the doctors, I can’t imagine how demoralizing it must be to see patient after patient—someone’s father, someone’s mother, someone’s sister, someone’s son—get sicker and sicker, take more and more medication, and become more and more debilitated and unwell—often while doing exactly what they’re telling them to do. People follow their advice, yet become sicker and more debilitated. Does that sound like a fun, fulfilling, satisfying, uplifting profession to be engaged in day in and day out?  (No wonder they spend as much time as possible on the golf course!) It must be especially bad considering these people took an oath to “do no harm.” Granted, they probably don’t think they are doing harm—at least, not intentionally. But the total and utter lack of people getting better suggests that they’re not exactly doing a whole lot of good, either. 

But maybe they just try not to think about that. It’s much easier to bury their head in the sand, “shut up and color,” and a few other phrases that translate roughly to “ignore the awkward facts and go about your business in order to avoid crippling cognitive dissonance for as long as it takes to pay back your massive pile of medical school debt.”

When some of these professionals see patients who say…

• “Doc, y’know, I stopped eating wheat a few months ago and I’ve lost 40 pounds.”
• “I stopped eating dairy, and my IBS is gone.”
• “After 3 years of failing to conceive a child, I gave up and decided to focus instead on cleaning up my diet. I tried that Paleo thing, and to my surprise, I’m 2 months along now!”
• “Doc, I’ve started the Atkins diet, and I think I might need to lower my insulin dose, or maybe quit taking it altogether, because when I test my blood sugar now, sometimes it's actually going a little too low.” 

Your A1c went from 10.2 to 5.3?
TELL ME HOW, TELL ME HOW,
TELL ME HOW!!!

…They shouldn’t just nod and smile patronizingly. THEY SHOULD BE THE ONES THE MOST INTERESTED in how it happened, because they are the ones in the best position to help others. Instead of dismissing it as “just one of those weird things that happens now and then,” they should be saying, “HOLY COW! I have a hundred other patients just like you: obese, diabetic, arthritic, infertile, with acne, and chronic fatigue. HOW THE HECK DID YOU ACCOMPLISH WHAT YOU’VE ACCOMPLISHED? TELL ME EVERY SINGLE DETAIL, SO I CAN TELL EVERYONE ELSE. In fact, let me arrange a talk, so you can speak to them yourself. Bring some “before” pictures if you have any. I’ll print out your labwork so we can show everyone how far you’ve come. Better yet, I’ll invite some of my colleagues, so they can learn, too!”

3.

Okay. That was a nice jaunt through fantasy land, wasn’t it? Back to reality. Obviously, one of the larger reasons doctors have a hard time believing these “miraculous” transformations is because, sure, they’re rare. Those of us who are immersed in the LCHF/Paleo/Primal/WAPF worlds have a distorted view of healthcare and nutrition. You and I might think this is all “normal” and totally second nature. It’s easy to think this, when every blog, website, journal article, and Twitter feed we read keeps us surrounded in our comfy bubble of real food. But in the larger world out there, this stuff is almost unheard of. The vast majority of healthcare professionals and dieting disciples are still preaching the virtues of healthywholegrains and condemning arterycloggingsaturatedfat to the ninth circle of hell. The main message coming through about weight loss and better health is still to “eat less and move more,” despite decades upon decades of this advice having been proven over and over to be a total failure. 

And when patients follow this advice—and take a slew of “blockbuster” pharmaceutical drugs—yet continue to get sicker, I guess maybe it is logical for doctors to conclude that heart disease, type-2 diabetes, rheumatoid arthritis, multiple sclerosis, and more, really are progressive and irreversible. After all, they almost never see it reversed. (And on the rare occasion they do see this, it’s because someone did something absolutely nuts, like eliminate grains and corn oil from their diet, but everyone knows grains and vegetable oils are good for us, so there’s no way there’s a connection there.) So either those conditions really are death sentences, or maybe the patients are just lying. All of them. Liars, liars, pants-on-fire. Maybe that heart disease patient is not using margarine instead of butter, like the doctor suggested. Maybe that type-2 diabetic is not eating a bowl of fat-free, high-fiber whole grain cereal with skim milk, as the dietitian and “certified diabetes educator” recommended. No one ever gets better because no one actually does what the professionals tell them to do. No one really wants to change their diet. Everyone just wants a pill. A quick fix. Every single patient. They want to take medication. They want to inject themselves with insulin three times a day. That obese, diabetic patient with coronary heart disease is obviously not following the recommended "heart healthy diet," because if he was, he wouldn't be obese, diabetic, and have heart disease anymore.

Are the ties between the pharmaceutical industry and the medical profession really that strong? Has “Big Pharma” really managed to convince doctors—who, despite the jokes we make and the insults we hurl, really do spend years studying human anatomy, physiology, and biochemistry—that illnesses and dis-eases that are caused by dietary and lifestyle factors cannot be treated and reversed via the same? Then again, unfortunately, it’s probably not well advertised in medical textbooks that Alzheimer’s disease is type-3 diabetes, or that mitochondrial dysfunction and oxidative stress are huge players in Parkinson’s disease, or that insulin has a far greater effect on blood pressure than sodium from salty foods does.

All I know is, this has got to stop. The lack of attention given to ancestral health and evolutionary biology in medical schools and across the entire healthcare profession is a travesty. (You can listen to Sir Robb Wolf spout a beautiful rant about this on this podcast if you are so inclined, or read the transcript here. It’s a long show, but the pertinent part is short, and occurs between the 15 and 20 minute marks. [The transcript also includes the time hacks, so you can scroll down to it if you’re pressed for time.] If you don’t know how RW got into all this Paleo stuff in the first place, listen from the beginning. [And yes, I just knighted him.])

Fortunately, more and more laypeople are discovering this stuff for themselves. Unlike my mother, they are not content to just follow doctor’s orders while they continue to spiral deeper into a bottomless pit of declining health and disappearing vitality. They are taking matters into their own hands, and are experiencing improved health that should, but does not, leave doctors, dietitians, and nutritionists completely astounded. (The link there is classic. If you have some time, scroll through the comments and see the American Diabetes Association get its *ss handed to itself, courtesy of type-1s [and a few type 2s] chiming in about stellar blood glucose control achieved by doing the opposite of the traditional ADA dietary advice.) People are experiencing wonderful feats of healing and undergoing incredible transformations in their overall cardio-metabolic health not by following doctors' orders, but by ignoring them. In many cases, people are regaining their health and vitality not because of a doctor's advice, but in spite of it.

There is hope!

Fortunately as well, there are doctors and dietitians who get it. The list grows longer every day, but the ones that come to mind immediately include Theodore Naiman, Rakesh “Rocky” Patel, Jeff Gerber, Jason Fung, David Ludwig, William Davis, Sarah Hallberg, Michael Eades, Aseem Malhotra, Malcolm Kendrick, Andreas Eenfeldt, Georgia Ede, David Perlmutter, Stephen Phinney, Eric Westman, Jeff Volek, Franziska Spritzler, Miriam Kalamian, and Beth Zupec-Kania. (I was going to post links to each of their sites, but you can find them easily enough on your own.) And the reason these practitioners are well-versed in low-carb, Paleo/Primal, and ketogenic diets is because they did do the introspection I've talked about here. Whether it was because they, themselves had become ill or overweight, and the conventional advice failed to yield the expected results, or something finally made them stop and examine why so few -- if any -- of their patients ever got better, they started questioning their standard operating procedures. (Maybe, like me, they got tired of feeling like failures in their profession. They're intelligent people. They're dedicated and hardworking people. They're good doctors. So why was no one ever getting better? Fortunately for the multiple thousands of people they have now collectively helped, they were also humble and inquisitive enough to realize that something just wasn't right. If only all healthcare and nutrition professionals were imbued with these same qualities, eh? )

As I often do, I’ll leave you with a link to a post similar to this one, but written by someone who is far more succinct than I am capable of: It’s all MY FAULT! (by Tess Kissack Howell.)

Read part 2 of this rant here!

P.S. Yes, I know darn well that lots of people do want the medication. The quick fix bullsh*t temporary solution. I understand that doctors are presented day in and day out with people who are not going to quit their Mountain Dew habit, or give up their cereal and blueberry muffin breakfast. Okay, fine. But there are plenty of other people, who, if presented with advice that might actually work, instead of the same old bullcrap eat less, move more nonsense that has failed them time and again, then maybe, just maybe, they'd be more open to making some changes.

P.P.S. About the state of my nutrition practice: don’t feel bad about me putting things on hold. Can I and will I be doing things differently when I reopen? Yes. Do I think these changes will help my clients get better results? Yes. But I am also going to stop holding myself personally accountable for whether someone else loses weight. (Or feels more energy, or whatever else.) While I can guide someone as much as I can, and help them tweak & change things as necessary, ultimately, all I can really do is provide the most accurate information I can. I’ve realized that one-on-one consultations aren’t my strong suit. That’s not a character flaw, just the simple truth. I’m not cut out for them. It takes a certain temperament and personality type to be a “cheerleader” and a good hand-holder, and I don't have it. No biggie. It seems I can serve people better through sticking to my strengths: writing, and maybe teaching. (I like giving talks in the community, and I’d like to get into teaching at a community college or something. Maybe some “lifelong learning” classes, where it’s not a formal degree program, and I could just walk people through some basic anatomy & physiology, basic stuff about digestion and fuel partitioning…and drop a bunch of knowledge bombs along the way.) My point is, while I initially felt like a gigantic failure, I’ve come to terms with things. I can best participate in this industry while capitalizing on my strengths.

Remember: Amy Berger, MS, CNS, NTP, is not a physician and Tuit Nutrition, LLC, is not a medical practice. The information contained on this site is not intended to diagnose, treat, cure, or prevent any medical condition. Links in this post and all others may direct you to amazon.com, where I will receive a small amount of the purchase price of any items you buy through my affiliate links.