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The Dilemma Of The Way Modern Medicine Works

I just returned from LIVE-tweeting using hashtag #obesitymedicine at a truly amazing health conference in the fabulous City Of Brotherly Love, Philadelphia, Pennsylvania last week. I have had the privilege of attending every Spring for the past eight years getting to hang out with and befriend some of the top medical doctors in the world who are attempting to help patients who are overweight or obese lose weight. It’s called The American Society of Bariatric Physicians and it’s the only Continuing Medical Education (CME) event that I’m aware of presenting the latest science supporting low-carb, high-fat, ketogenic diets. The Nutrition & Metabolism Society Symposium that took place on Thursday, March 13, 2014 was a virtual who’s who in the world of low-carb science–Dr. Eric Westman, Dr. Stephen Phinney, Dr. Jeff Volek, Dr. Jay Wortman, Dr. Andreas Eenfeldt, and Dr. Eugene Fine. But one thing I noticed this year unlike other times I’ve attended is how the low-carb message is even starting to spill over into the obesity conference portion as well. The shift in thinking towards embracing dietary fat and carbohydrate restriction is happening in earnest amongst the world’s leading obesity specialists. I’m hopeful that changed lives will happen more and more in the coming years.

But for all the positivity of these developments in the world of obesity medicine specialists, there is still a lingering dilemma with the way modern medicine works. This point was clearly demonstrated to me in a recent e-mail I received from a reader who had a “very hard time” trying to find a low-carb doctor. This reader was able to locate a good doctor who agreed to be a consultant in his health decisions but initially left him to be “the final arbiter of any medical decisions,” something I’ve often talked about in my work. So he got some blood work done of key health markers he wanted to have run. Here’s what happened next:

On my follow-up appointment we started going over the tests and he was very impressed. I am 57 and I had great results in my A1c, CRP, and fasting blood sugar. My blood pressure was great and my carotid IMT was all clear. The only hang-up was the fact that something went wrong with my NMR Lipoprofile cholesterol test. He said the lab messed it up and they would have to run another sample. However, he did assure me that the NMR was unnecessary considering all the other numbers on my panel.

When the second NMR test results came back, they were awful. The LDL particles were shocking and my doctor told me he needed to prescribe me a statin medication. When I brought up all the other good numbers on my panel and my clear carotid artery scan, I told him that I didn’t understand why he changed his tune about my state of health from being fine to now suddenly needing drug therapy. Is atherosclerosis something that will happen in a week and kill me? Why don’t we have time to figure WHY I have this symptom?

My doctor tells me I must have familial hypercholesterolemia, the genetic form of high cholesterol. A cardiologist friend of his says at CT Heart Scan would not be helpful because I am so old there’s obviously calcium buildup in my arteries and thus the results would be useless. It had to have been the cardiologist who got my doctor to change his tune on putting me on Lipitor. I debated with him for a long time inquiring about the evidence he had that this would help me since I’ve never had heart disease. When we finished talking, I explained that I didn’t want to take a statin.

After I told him this, my doctor sighed and looked up at me stating that if it was him, he probably wouldn’t take the statin drug either. Then he shifted his attention to his computer screen and said something that he probably didn’t mean to say in front of me. “With health markers like yours, nobody would ever win a malpractice suit against me just because you aren’t taking a statin.”

Needless to say, that shocked me. He didn’t really disagree with me not wanting to take a medication I didn’t want to take. But he knew that if he didn’t follow the ‘standard of care’ that requires him to prescribe a statin, then he would be putting himself at risk.

And this is where we are with modern medicine. Stuck between a rock and a hard place and I don’t blame physicians for wanting to do a little CYA to protect themselves. As we shared in Cholesterol Clarity, patients certainly need to take back control of their own health and play the games that your doctor has to play in order to remain compliant with his protocols. If that means allowing him to write a prescription for a statin drug for your “high” cholesterol, then let him do it. Just because he writes the prescription doesn’t mean you as a patient are required to fill it. That allows him to fulfill his obligation as your doctor and he’s no longer liable if something were to happen to you.

The problem here is most patients aren’t empowered like this reader and simply obey the orders given to them by their doctors. They have abdicated responsibility for their own health to physicians, dietitians, and other health professionals and forgot that they are the ones who have the final say about what direction to take in their health. That’s not to say we shouldn’t respect the training and experience these medical and nutritional health professional have to share. But a knee-jerk reaction to put patients on a low-fat diet with healthy whole grains and medication after medication as the first line of defense is what’s wrong with modern medicine as I see it.

The good news is we have plenty of medical doctors, dietitians, and other medical health professionals who say enough is enough and are doing what they can to educate their patients on the nutritional aspect of improving disease and overall health. Finding a professional like this is critical and there are some amazing resources available online at your disposal to locate someone you can trust: LowCarbDoctors.blogspot.com, FindObesityTreatment.org, PrimalDocs.com, PaleoPhysiciansNetwork.com.

Interestingly, as I was writing this blog post today, I heard from an Illinois-based internist with 42 years of experience practicing medicine. He discovered low-carb in 2012 after reading books by Gary Taubes and Dr. Stephen Phinney and Dr. Jeff Volek where he learned about me (I wrote the last chapter of The Art And Science Of Low Carbohydrate Living). He personally uses about 30 grams a day of carbohydrate and has seen the benefit in himself enough to use it with patients. Here’s what he shared with me in his e-mail:

Very few of my patients who come to see me for whatever health concern will leave my office without a serious discussion of nutrition. For about two out of three of my patients, that discussion is critical in determining whether the patient gets better or not. I hope to use your personal story and history with my patients so they can find hope and inspiration in their own journey.

My greatest frustration is the amazing difficulty some of my medical colleagues have with even considering a new paradigm like a low-carb, high-fat diet. While I think they are far from being stupid, it is obvious they are discouragingly ignorant. More than anything else they are extremely defensive in response to making nutritional changes to improve health to a degree I would not have anticipated. In my medical training we were taught to analyze the validity of what we were shared with patients and to revise those ideas which failed to meet the criteria of good science. In fact, healthy skepticism for the ideas of others that differ from our own is vital to any real progress.

How refreshing! This gives me hope that the dogmatism in modern medicine is shifting and I’m seeing it more and more with younger physicians who are coming up through medical training with their eyes wide open to the reality of the impact nutrition plays on health (listen to my interview about this with medical school students Peter Wei and Alex Chamessian in Episode 727 of “The Livin’ La Vida Low-Carb Show”). It can seem bleak, but there is light on the horizon. Unfortunately, far too many doctors will continue to feel stymied by the “standard of care” rules that control what they can and cannot do. A new breed of doctors is emerging and it’s only a matter of time until this becomes the norm. It might take a decade or two or three to happen, but it will happen.

  • chelsea prather

    Yes, there is a light on the horizon. I think the key is to encourage healthcare providers to start to experiment with their own nutrition to recognize the power of food (and fat). If they don’t have a personal connection, they will most likely pass it off as a fad. I know that once I made that switch personally and realized that nutrition guides health, the “rock and the hard place” pains me even more and has lit a fire underneath me to help others learn how to break the cycle of chronic illness.

    • LLVLCBlog

      It’s interesting you share this, Chelsea. At that medical conference I attended, the ones that embrace low-carb the most passionately are the ones who were healed in their health by it. I stated I wish every doctor had to deal with the disease they’re trying to treat their patients for.

      • chelsea prather

        Great point. I know that certain doctors are more likely to order larger doses of pain medicine for problems that they have experienced personally (i.e. kidney stones). I don’t think it’s necessary for providers to distance themselves so much and rely on rigid protocols backed by skewed studies. We’re humans treating humans, after all :)

  • Janknitz

    My daughter will be applying to medical schools next year, and I’m a bit saddened about the medical education she will recieve. Everything is done now by “evidence-based” protocols, but they no longer emphasize critical thinking skills and younger doctors are taught not to question the “evidence” when more and more it’s influenced by outside factors instead of true evidence.

    Even when a doctor sees right in front of him that a so-called “evidence-based” protocol is not working, they stick to the script under the guise of standard of care. And they are very suspicious and dismissive of patients who think for themselves.

    My father-in-law was a doctor but one who definitely marched to his own beat. And patients flocked to him and loved him for it. I only hope my daughter will think outside the box like her grandpa did.