Edition: 2014-05-15
FAQs:
Why is my doctor hostile about my diet?
Why does my doctor never ask about my diet?
Why can't I get a real lipid or thyroid test from my doctor?Consensus medicine is the product of Western Civilization, which many of you are now beginning to realize has been in an unhealthy metabolism (full-time glycemic) for all of recorded history and then some. To the extent that consensus medicine is even aware of low carb (much less ketogenic metabolism), it considers it an uninteresting fringe topic, a place where people like diabetics and epileptics used to live only because they had no access to insulin and anti-convulsive meds. And, to seal the deal, low-carb cultures, unlike even osteopaths and chiropractors, have no med schools that might represent a formal dissenting view.
In 12 years of pre-med, med and residency, your MD got between
2 and 4 semester hours on the role of diet in health, and all of that small smattering was based on science confounded by the culture's full-time glycemic diet. The role of nutrition in health is not even a topic in med school Boards. Knowledge of it is not even required to become an MD.
Med School Lesson 1: diet doesn't matter.How could 80% of my caseload (almost all the chronic stuff) have a root cause in something that was a med school footnote?
It's really unsurprising that consensus medicine ignores diet. In addition to the dismissive attention paid to it by med schools, what they were taught is incorrect, so the consensus diet they parrot is in fact negatively correlated with health.
Med School Lesson 2: so don't bother to read papers on nutrition...
and they don't. The original Wheat Belly book has 295 footnotes, mostly cites from the medical lit, and your MD is exceedingly unlikely to have read any of them, even though they are dead-on regarding wheat, carbs and diet generally.
It doesn't help that too many nutrition papers (not those cited in WB) are little better than junk food - hopelessly confounded, almost never isolating for low-carb/grain-free/healthy-fat, and heavily influenced by their funding sources. Most food-fright-of-the-week headlines turn out to be based on such worthless and/or agenda-driven papers.
Med School Lesson 3: prescribe a preparationAs an MD in training
pointed out on the WBB, the med school focus is on pharmacology - prescribing drugs. Drug companies have excess influence in courseware, and on the "standard of care" (SoC) - the approved treatments for conditions, not to mention undue influence on the PDR. Naturally, the solution usually requires that the patient buy a drug, even when changing aisles at the supermarket would have the same result. Post-graduate visits by cute pharma sales reps, free dinners and free trips, reinforce the message. There are just enough drugs that are actually useful that this state of affairs seems credible to the credulous.
Med School Lesson 4: liabilityThe SoC is safe (for the MD). No MD is going to lose a malpractice case by following the dogma. In cancer, the SoC is usually fatal, and often has no material effect on lifespan, but no oncologist gets sued over it. When you suggest deviating from the SoC, the MD's inner lawyer goes to red alert, and the MD may not even realize it. Treat your glioma with a restricted calorie keto diet, hyperbaric therapy and exogenous ketones? Panic attack just due to liability.
Aside: this WFF article is about MDs. Any health care provider with a lesser rank than MD is dramatically less likely to deviate from dogma. MDs have a longer leash, particularly when their off-schedule or radical approach has demonstrable positive results. PAs, NPs, RNs, LPNs, dieticians and counselors of all kinds take a severe career risk in stepping outside the box, so set your expectations accordingly.
Med School Lesson 5: MD = matriculated dietyIf the student isn't careful, formal medical education can afflict them with godlike psychology, later exacerbated by the tendency of patients to assume they have the power of life and death. The deeper into this trap the MD falls, the less open they are to being mistaken, and especially to being challenged by ordinary mortals (patients).
Post Grad Lesson 0: what that student loan impliesThe young doctor is entirely unprepared to confront a situation that implies that much of their medical education, not even paid off yet, was very wide of the mark.
Similarly, the mature physician is not prepared to deal with an implication that much of their career has been in error, with needlessly tragic outcomes for many prior clients.
Post Grad Lesson 1: follow the moneyMost of an MD's income doesn't come directly from patients. It comes from insurance providers, who may refuse to cover non-standard therapies.
Preventative and pre-emptive treatment is often also not in-plan (in large part because little preventative advice has been effective, and as we see with WB, effective dietary advice is pretty simple and doesn't require 12 years of training). The various medical specialties have consequently allowed themselves herded into a posture of fix on failure.
Yes, a dietary revolt by the general public is going to dramatically reduce the demand for MDs, but most of those MDs haven't seen that far ahead, and that's not what's on their minds when you bring up diet.
Post Grad Lesson 2: Fix on FailureAs Dr. Davis has said several times on his blog, consensus medicine has allowed itself to get painted into an acute care corner. It tries (and all too often fails) to fix things only after they've spun out of control. Prevention is not on the menu, both because it's not compensated by insurance, and also because the consensus guidance offered is not correlated with healthy outcomes.
Let's hit that point again: medical professionals aren't highly enthused about prevention, both because it doesn't pay well, but perhaps principally because the outcomes have not been encouraging. Hint, docs - it's not because we don't follow the advice - it's because the advice is incorrect.
Post Grad Lesson 3: I have no map for that territoryWhen I asked my GP (now retired) to order up proper lipid testing (that actually measures small LDL) and proper thyroid testing (that actually directly measures thyroid function, and not pituitary reaction), he admitted that he had never written such an order, and wouldn't know how to read the results.
Post Grad Lesson 4: union loyaltyIt's 1850. You propose to your MD that perhaps bad humours, treated by bloodletting with leeches, or emetics, might not be an effective way to treat your chronic indigestion. Another red alert. You are asking the doc to defect from the fraternity, and join the rebellion. Is the doctor disposed to do that? They aren't all rogue gems like William R. Davis; not even a significant minority of them.
Post Grad Lesson 5: webmd.comAny physician with an established practice now has to deal, daily, hourly, appointment-to-appointment, with patients overflowing with insights, advice, "facts" and self-diagnoses from the internet, much of it flat out incorrect. This has rapidly conditioned them that patients bearing new/contrary information are mistaken until proven otherwise by overwhelming evidence, which probably hasn't happened yet for your doc, who confidently predicts that you won't be the exception.
Post Grad Lesson 6: shock of the newAs I said on
WBB:
Another aspect of this is that the problem is extraordinary. I can’t think of a precedent for this sort of thing. So in addition to the particulars of medicine vs. nutrition, we have the perfectly normal rational skeptical response of “extraordinary claims require extraordinary proof”.
OK, here are 295 cites. Connect the dots yourself.
Skeptic MD: “I don’t have time for that.”
OK, it’s been done for you in this book.
Skeptic MD: “That’s a popular best seller, with recipes! Surely you don’t expect me to take that seriously (especially when I have a vague subconscious unease about the wider implications).”
Post Grad Lesson 7: the overlooked itself has changed, and so whatEven if consensus medicine had paid more attention to diet, and thwarted the USDA's suicidal shift to low carb (1977-1992), would it have reacted to:
- the relatively sudden rise of semi-dwarf hybrid wheat (1960-1985),
- high fructose corn syrup (1975-1985),
- high Omega 6 PUFA processed seed oils and
- the only
recently banned trans-fats?
Not only do these "foods" present novel issues in diet, they also, by way of being high yield and cheap, have pandemically infested the majority of prepared foods over the last 30 years.
The history of medical societies is dominated by resistance to change, even when they are paying attention, and in the case of diet, they aren't.
Post Grad Lesson 8: Too Much Too SoonLCHF can't be correct, because that would imply ...In the specific case of Low Carb High Fat diets (LCHF, and the WB recommendations are very low carb, borderline keto), getting your doctor to accept the benefits of LC also implies accepting that HF is at least not harmful. You're asking them to toss overboard multiple major features of the consensus diet (namely: 60% of calories from carbs, low fat is "good" and high fat is "bad").
This dot connects itself to another:
heart disease dogma is also upside down. Fat isn't the problem; carbs are -
de novo lipogenesis , the conversion of the rapidly-digested carbohydrate of wheat, amylopectin A, into triglyceride-containing particles like very low-density lipoproteins, or VLDL. This is the real cause, and Small LDL-P (NMR LDL), the crucial measure, is almost never measured. Instead they poison you with statins, that artificially distort symbolic "cholesterol" numbers that don't matter, and screw up your CoQ10, which massively does matter.
If they further take the time to figure out that WB is borderline keto (Nutritional Ketosis), they are quite apt to confound that with DKA (Diabetic KetoAcidosis), which is only a hazard to advanced diabetics who produce almost no insulin. This is quite a bit to swallow for someone taught the inverse, and that none of it really mattered to begin with.
Look at the trend chart for any of the leading chronic conditions, Type 2 diabetes being perhaps the most disturbing - not just
high, not just
rising, but
accelerating. You'd think that Conventional Medicine would be in a panic about this, and willing to consider quite radical theories on what the cause is, and actually try some different approaches.
Nope.
And big pharma merely sees it as an attractive revenue stream.
Summary
This is a really awful moment in history to be a classically trained MD. In addition to what a low-carb diet implies about a huge black hole in their training, they are straining under the yoke of universal health care rationing and its cookie-cutter standards of care (which care nothing for actual outcomes).
All of the above does not excuse knee-jerk resistance, denialism and general freak-out when you raise the topic of diet with your doc, but may at least explain it, and prepare you for the likelihood of encountering it.
