Why healthy can make us fat


Brian Wansink, author of Mindless Eating: Why we eat more than we think (see yesterday's Heart Scan Blog post), also has a Blog. Despite the bland advice offered on much of the Prevention Magazine and website, Wansink's Food Think Blog is a winner.

In a recent post, Wansink quotes a report from Science Daily that described a study he recently published in the Journal of Consumer Research. Wansink's study describes how just applying the label "healthy" to fast food choices increased consumers' calorie intake:


"When we see a fast-food restaurant like Subway advertising its low-calorie sandwiches, we think, 'It's OK: I can eat a sandwich there and then have a high-calorie dessert,' when, in fact, some Subway sandwiches contain more calories than a Big Mac."

In one study, Chandon and Wansink had consumers guess how many calories are in sandwiches from two restaurants. They estimated that sandwiches contain 35% fewer calories when they come from restaurants claiming to be healthy than when they are from restaurants not making this claim.

The result of this calorie underestimation? Consumers then chose beverages, side dishes, and desserts containing up to 131% more calories when the main course was positioned as "healthy" compared to when it was not--even though, in the study, the "healthy" main course already contained 50% more calories than the "unhealthy" one.

"These studies help explain why the success of fast-food restaurants serving lower-calorie foods has not led to the expected reduction in total calorie intake and in obesity rates," the authors write.


Interesting. In fact, I've had many patients say that they eat at Subway or similar chains and choose the "healthy" options. "That's got to be better than a cheeseburger and fries!" Perhaps not. (Of course, you can't leave Subway or other fast food operation feasting on wheat products.)

Wansink can be counted on for some truly fascinating observations into many behaviors that are subconscious but explain at least part of the reason why we're so fat. Though his Blog has a relatively short history of posts, there's lots of great commentary.

Pierre Chandon and Brian Wansink. "The Biasing Health Halos of Fast Food Restaurant Health Claims: Lower Calorie Estimates and Higher Side-Dish Consumption Intentions" Journal of Consumer Research, October 2007.

Outsmarting the enemy


"Everyone--every single one of us--eats how much we eat largely because of what's around us. We overeat not because of hunger but because of family and friends, packages and plates, names and numbers, labels and lights, colors and candles, shapes and smells, distractions and distances, cupboards and containers. This list is almost as endless as it's invisible.

Invisible?

Most of us are blissfully unaware of what influences how much we eat . . . We all think we're too smart to be tricked by packages, lighting, or plates. We might acknowledge that others could be tricked, but not us. That is what makes mindless eating so dangerous. We are almost never aware that it is happening to us."



So opens Brian Wansink's book, Mindless Eating: Why we eat more than we think.

Wansink studies consumer behavior at Cornell University. He's the guy who scrutinizes in excruciating detail why we eat what we do, what factors determine what we eat like food color and smell, the company we keep, product packaging. He works without food industry funding, though there are plenty of researchers who do this sort of research funded by the likes of Kraft, Nabisco, and Kellogg's.

His book is packed full of the conclusions he and his team have come to over the years studying our buying and eating habits. While this information could (and is) be easily used by the food industry to coerce us to eat more and more, understanding many of the concepts Wansink talks about can also open your eyes to their clever tactics.

He especially details how our internal satiety signals fail us when external cues are present that easily trip us up. He talks about one experiment he ran in which soup bowls were rigged with concealed rubber tubes in the bottom that continually replenished the soup as the person consumed it. Thus, with the bowl continually refilled, the eater had no idea how much he or she had consumed. When the quantity of soup eaten from the endless bowl was compared to people eating from standard bowls, there was as much as a three-fold increase in the quantity and calories eaten.

Just be aware that, while Wansink is an expert in consumer eating behavior, he is not necessarily an expert in nutrition. Just as a card shark can show you lots of clever tricks to hoodwink your opponent, he might not be the best person to teach you how to play bridge.

For a great hint at some of the interesting and all-too-human observations Wansink makes, the online Prevention Magazine posted a brief video:

http://link.brightcove.com/services/link/bcpid1155399889/bclid1171884988/bctid1113465050

We might not be able to stop Big Food from selling garbage foods, but we can at least be armed with insight into how we are subconsciously coerced into eating more.

Test Of Scanner Saves A Doctor's Life


















Read the story online at http://www.courant.com/news/health/hc-luckydoc.artsep10,0,7572510.story?coll=hc_features_promo

I personally hate these stories, the ones that turn heart scans into drama by describing how someone had a heart scan, then turned out to have so much coronary plaque that they had to have bypass surgery.

But I point this one out because the story is related in an interesting way. It highlights the utter ignorance that operates in heart disease detection.

The story highlights how a 50-year-old, 5 ft 8, 150 lb slender, exercising neurologist underwent a CT coronary angiogram in a newly installed device in a Hartford, Connecticut hospital (not a heart scan) that detected entirely unsuspected severe and diffuse coronary disease. You know the rest: abnormal stress test, heart catheterization, bypass surgery of the hapless doctor-now-patient, followed by grateful patient saying things like "This machine saved my life."

It probably is true. You've seen these stories before. I've witnessed these sorts of headline-makers for the past decade. I remain surprised that it still happens.

The doctor is not some ignorant, uninformed man who can't even fill out his income tax forms. Yet how does a man like this walk around with life-threatening disease and not know it? Why does it still make headlines?

Anyway, despite all my jawing about heart scans and early heart disease detection, many physicians and the public remain in the stone age of heart disease. Even though this neurologist's story made headlines, the many other people who 1) identified their heart disease earlier with a simple heart scan, then 2) took action to put a stop to it, do not make headlines. But that's the way to go.

Why isn't the rest of the story being told? Why was this man's heart disease uncovered only in its late phases? Hartford, Connecticut is not some backwater. I've been there. It's a major city with large hospitals and a University Medical Center. But a professional with presumed knowledge of health and his doctor(s) allowed this to happen?

In other words, this is not a story of success, but of failure--failure to identify coronary disease years earlier when preventive action would have prevented bypass. But that's not such a compelling headline, is it?

As an aside, I'll bet you that this man has lipoprotein(a), a severe small LDL pattern, and severe deficiency of vitamin D. Correct these and it's unlikely he'll need bypass again. But that's kind of boring, isn't it?

The great food industry deception

I'd forgotten what a powerful report Peter Jennings and ABC News produced about the enormous deception perpetrated by the food industry and its effects on health until Dr. Joe Mercola posted the YouTube clips from the report on Mercola.com.

(This is not meant to be an endorsement of everything Dr. Mercola has to say. He says lots of things; I agree with only a fraction of it. But this is a gem.)

Although made in 2004, the report remains every bit as relevant today as it was then. It concerns me deeply that, despite reports like this being broadcast to Americans, the obesity epidemic continues unabated. In fact, it's worse just in the short three years since then.

Be aware of what the food industry is up to. They intensively market high profit margin foods to us--and especially our children--to increase sales. As Jennings points out, the U.S. government (USDA) is, for a variety of reasons both good and bad, complicit with this massive deception. While many media reports continue to focus on lack of exercise as the root cause for the obesity epidemic, it is really the active and purposeful selling of processed junk foods to Americans that is principally to blame.

By the way, how many of these foods proudly boast the American Heart Association Check Mark of approval?



Part 1





Part 2




Part 3




Part 4




Part 5

Dr. Joseph Prendergast and l-arginine

In response to a discussion started by Track Your Plaque Member, Rich, on the Member Forum, I tracked down Dr. Joseph Prendergast, who had posted a video on his unique experiences, both personal and professional, with l-arginine.

Dr. Prendergast describes some of this in a brief webcast. Here, I quote Rich:

“This 90-second video by a Palo Alto physician (internal/endocrine, diabetes specialist) will totally blow your mind.

http://enews.endocrinemetabolic.com/2007/08/16-12-years.html

You will see in the link below that he reversed his personal atherosclerotic disease, diagnosed in abdominal aorta at age 37—completely reversed. He's now much older."

http://www.endocrinemetabolic.com/about/press/larginine.pdf



I contacted Dr. Prendergast to find out more.

Dr. Joseph Predergast is founder of the Endocrine Metabolic Medical Center in Palo Alto, California, focused on providing care for people with diabetes. In addition to the website, he provides Blogs and newsletters, though most of his conversation is about diabetes issues. Dr. Predergast’s website is located at http://www.endocrinemetabolic.com.

I asked Dr. Prendergast several questions about his l-arginine experience. His brief answers are below.



1) What dose of l-arginine have you employed in your patients and why this dose?

The dose is 3 - 6 grams as suggested by the Stanford Cardiovascular Research Department Chairman John Cooke. http://med.stanford.edu/profiles/John_Cooke/

2) I gather that you have preference for specific preparations of l-arginine. Can you say why some preparations seem superior to others in your experience?

I started with pharmaceutical l-arginine from the pharmacy. I gradually began to add components that would augment the power of the l-arginine and have gone through 12–15 different products. I have completely reversed my own very severe atherosclerosis discovered at age 37 and there has been less than 0.05% cardiovascular disease in my endocrine practice in almost 17 years. Both my exams were evaluated with CT technology. I am now using ProArgi9 Plus that includes several anti-aging components and will likely never switch. http://www.synergyworldwide.com/synergycorp/home.aspx

3) Are you employing any other unique practices in your patients to reduce cardiovascular events?

Withdrawing as many prescription drugs as possible.




Interesting. Of course, I also advocate l-arginine as a facilitator of atherosclerotic plaque regression, though I am not as ebullient about its use as Dr. Prendergast.

Instead, I see l-arginine as a method that yields forced normalization of “endothelial dysfunction,” the abnormal constriction and other effects that develop when abnormal lipoproteins and unhealthy food by-products are present in the circulation. Endothelial dysfunction is an inevitable accompaniment of plaque.

However, unlike Dr. Predergast’s experience, despite our use of doses higher than he uses, I have never seen plaque regression just using l-arginine alone. Nonetheless, it’s good to hear that others are seeing at least some positive effects.

By the way, we have also had some positive posts on our Forum about the ProArgi9 product he uses.

Dr. Dwight Lundell on omega-3s and CLA



An interview with Dr. Dwight Lundell, cardiac surgeon and author of the new book, "The Cure for Heart Disease."


Dr. Lundell comes to us with a unique pedigree. He is a cardiothoracic surgeon practicing in the Phoenix, Arizona, area. Despite having performed thousands of coronary bypass operations, including numerous "off-pump" procedures earning him a place in the Beating Heart Hall of Fame and a listing in Phoenix Magazine’s Top Doctors for 10 years, more recently Dr. Lundell has turned his attentions away from traditional surgical treatment and towards prevention of heart disease and.

In particular, Dr. Lundell is a vocal advocate for omega-3 fatty acids from fish oil and conjugated linoleic acid, or CLA.

When I heard about Dr. Lundell’s unique perspectives, I asked him if he’d like to tell us a little more about his ideas. Here follows a brief interview with Dr. Lundell.



You’re a vocal advocate of the role of omega-3 fatty acids from fish oil in heart disease prevention. Can you tell us how you use it?

In my book, I recommend 3 g of fish oil daily. This would normally yield about 1000 mg of EPA and DHA depending on the concentration of the supplement. This is approximately the dose that reduced sudden cardiac death by 50%, and all cause death, by 25% in patients with previous heart attack.

In patients with signs of chronic inflammation such as heart disease, obesity, arthritis, metabolic syndrome or depression or in those patients with elevation of CRP, I would recommend higher doses, 2000 to 3000 mg per day of EPA and DHA. The FDA has approved up to 3400 mg for treating patients with severely elevated triglycerides.

I personally take a 2000 mg EPA and DHA per day because I have calcium in my coronary arteries.




Of course, in the Track Your Plaque program we track coronary calcium scores. Do you track any measures of atherosclerosis in your patients to chart progression or regression?

Carotid ultrasound with measurement of IMT [intimal-medial thickness] has been shown to be a good surrogate marker for coronary disease, as has vascular reactivity in the arm. CT scanning with calcium scoring is a direct marker of coronary disease. CT does not differentiate between stable or unstable plaque but there is no good noninvasive way of doing this.

The dramatic value of CT scan calcium scoring is to demonstrate to people that they actually do have coronary disease and to motivate them to make the necessary lifestyle and nutritional changes to reduce it. CT scan with calcium scoring is a direct way to measure the progression or regression of coronary artery disease. If there is a choice between a direct measurement and indirect measurement, always choose the direct method.

Every patient treated with CLA in my clinic, experienced significant reductions in C-reactive protein. These patients were also on a weight-loss program, so I can't prove whether it was the CLA or the weight-loss that improved their inflammatory markers. In the animal model for arteriosclerosis, CLA has a dramatic effect of reducing and preventing plaque. This has not yet been proven in humans.

Normally, when people lose weight 20% or more of the loss is lean body mass (muscle) this lowers the metabolic rate and frustrates further weight-loss. My patient, from teenagers to retirees, lost no lean body mass and continued to have satisfactory weight-loss when CLA was used as part of the plan.



In reading your book, your use of conjugated linoleic acid (CLA) as a principal ingredient struck me. Can you elaborate on why you choose to have your patients take CLA?

My enthusiasm for CLA is based on:

1) Safety?this is of paramount importance. Animal toxicity studies have been done, as well as multiple parameters measured in human studies, both of these are well reviewed recently in the American Journal of Clinical Nutrition (2004:79(suppl)1132s). CLA, a naturally-occurring substance, is not toxic or harmful to animals or humans. The only negative report is by Riserus in Circulation (2002), where he found an elevated c- reactive protein; however, he used a preparation that is not commercially available and not found in nature as a single isomer.

2) Effectiveness?also critically important. A recent meta-analysis [a reanalysis of compiled data] in the American Journal of Clinical Nutrition (2007; 85:1203-1211) demonstrated the effectiveness of CLA in causing loss of body fat in humans. The study also reconfirmed the safety of CLA.

Since we now know that atherosclerosis is an inflammatory disorder, any strategy that reduces low-grade inflammation without significant side effects would seem to be beneficial in the treatment and prevention of atherosclerosis. CLA not only has antioxidant properties, but it modulates inflammatory cascade at multiple points. CLA reduces PGE2 (in much the same way as omega-3) CLA also has been shown to reduce IL-2, tumor necrosis factor-alpha and Cox–2. It reduces platelet deposition and macrophage accumulation in plaques. It also has some beneficial effect in the PPAR [peroxisome proliferator-activated receptors, important for lipid and inflammatory-mediator metabolism] area.

Part of the effect of CLA may be because it reduces fat mass and thus the amount of pro-inflammatory cytokines produced by fat cells.

I reiterate and fully admit that CLA has not been shown to have any effect on atherosclerosis in human beings. However, the results in the standard animal models for atherosclerosis (rabbits, hamsters,APO-E knockout mice) are very dramatic.

From all I know, it appears that the effective dose for weight loss and the animal studies in atherosclerosis would be equal to about 3 g of CLA per day. The anti-inflammatory properties of CLA seem to work better in the presence of adequate blood levels of omega-3.



I’m curious how and why a busy cardiothoracic surgeon would transform his practice so dramatically. Was there a specific event that triggered your change?

The transition from a very busy surgical practice to writing and speaking about the prevention of coronary disease has not been particularly easy, but it has been very interesting. I can't really point to any specific epiphany, it was a general feeling of frustration that we were not making any progress in curing heart disease, which is what I thought I was doing when I began my medical career.

Of course, I enjoyed the technical advances, the dramatic life-saving things that you do and I did on a daily basis. American medicine is spectacularly good at managing crises and spectacularly horrible at preventing those crises.

The lipid hypothesis is old and tired, even the most aggressive statin therapy reduces risk of heart attack by about 30% in a relatively small subset of people. It's interesting that we're now looking at statins as an anti-inflammatory agent.


Thanks, Dr. Lundell. We look forward to future conversations as your experience with CLA and heart disease prevention and reversal develops!


More about Dr. Lundell's book, The Cure for Heart Disease can be found at http://www.thecureforheartdisease.net.


Note: We are planning a full Special Report on CLA for the Track Your Plaque website in future.

High-tech heart attack proofing


I was reminiscing the other day about what I was taught about heart disease in medical school some 20 years ago.

In the 1980s, the world was still (and remains) fascinated with this (then) novel "solution" to heart disease called coronary bypass surgery. As medical students, we all fought for a chance to watch a bypass operation being performed. And there was lots of opportunity. I was a medical student at St. Louis University School of Medicine, a center that boasted of a busy thoracic surgery service, performing up to 10 bypass operations every day.

Back then, coronary angioplasty was just a twinkle in Andreas Gruentzig's eye, still contemplating whether it was possible to put an inflatable device in the blockages of coronary arteries to re-establish blood flow. Risk detection for heart disease consisted of EKGs, screening for symptoms, detection of heart failure, and tests that are long forgotten in the dust bin of medical curiosities, tests like systolic-time intervals, phonocardiography (using amplified sound to detect abnormal heart sounds), and detailed physical examination. Treatment for heart attack involved nitroglycerin and extended bedrest. Bypass surgery would come after you recovered.

In other words, NONE of the tools we now use in the Track Your Plaque program for heart disease control and reversal were available just twenty years ago. There was no lipoprotein testing, no CT heart scans. Nobody recognized the power of omega-3 fatty acids (although epidemiologic observations were just beginning to suggest that eating fish might be the source of reduced risk for heart attack and cardiovascular death). Vitamin D? Why, that's in your milk so your babies don't get rickets.

So much of what we do today was not available then, nor were they even in the crystal ball of forward-looking people. I certainly had no idea whatsoever that I'd be talking and obsessing today about reversal of heart disease based on what I saw and learned back then.

Things have certainly come a long way and all for the better. The problem is that much of the world is stuck in 1985 and haven't yet heard that coronary disease is a manageable and reversible process. They've been sidetracked by the fiction propagated by the likes of Dr. Dean Ornish, the nonsense of low-fat diets aided and abetted by the food manufacturing industry and the USDA, the extravagant claims of some practitioners and the supplement industry. They haven't yet stumbled on the real-life experiences that are chronicled here in this Blog and the accompanying Track Your Plaque website.

Our program has been criticized for being too "high-tech," involving too many sophisticated measures like small LDL, lipoprotein(a) treatment, vitamin D blood levels. But when you see a woman reduce her heart scan score 63%, or a school principal's score plummet 51%, then that's reward in itself.

It's all about plaque

Just to keep my finger on the pulse of what is being said in the world of heart disease by the media, I subscribe to many publications.

Conversations abound about cholesterol, low-fat diets, now low-carb diets, not smoking, inflammation, etc. No doubt, these all have some importance in the conversation.

But the great majority of discussions fail to identify the one truly crucial factor to identify and track: coronary atherosclerotic plaque.

Sugar for breakfast

We were reviewing Stuart's diet because of his persistent small LDL, low HDL, modestly elevated triglycerides, and blood sugar of 107 mg/dl.

"I've changed my diet, doc. No kidding. We never fry our foods. No butter, no goodies. I don't know what else I can possibly do."

"Okay. Let's review your diet. What did you have for breakfast?"

"Orange juice, a big glass. Gotta get my potassium. Then cereal like Cheerios or Shredded Wheat, sometimes Kashi or Raisin Bran, always in skim milk. Gotta have my one slice of toast, no butter. I'll put some fruit preserves on it. You know, real fruit. Only whole wheat bread, never white. On Sundays, we always go out for pancakes, but now we order only whole wheat."

Many of us have gotten into a peculiar habit: Having what amounts to pure sugar for breakfast. Perhaps there's a little fiber thrown in with it, but many people indulge in breakfasts that are sugar and plenty of it. That's precisely what Stuart is doing: A breakfast that, while it doesn't contain a huge amount of sugar outside of the orange juice, is promptly converted to sugar. If we were to check his blood sugar just after his standard breakfast, it would rise substantially.

This pattern has become deeply ingrained into the American psyche. Some people will act like I've suggested we overthrow the government when I suggest that breakfast cereals need to be eliminated from their lives. We all share memories of Tony the Tiger, the leprechaun on Lucky Charms ("They're magically delicious!), reading the brightly colored boxes often including games and prizes. Breakfast cereals seem as American as apple pie. But the wheat and corn content ensures a big rise in blood sugar, the sort that create small LDL, low HDL, etc.--all the patterns Stuart is showing--and make us fat.

Orange juice? Too much sugar all at once. Get your potassium from whole vegetables and fruits, not from orange juice. (Bananas are another problem source of potassium for similar reasons despite being a whole fruit.)

Toast? Any diabetic who monitors their blood sugar after meals will tell you: Even one slice of bread, ANY bread, skyrockets blood sugar. Add the fruit preserves made with sugar syrup and it's doubly worse.

Pancakes? Even if made with plenty of fiber, blood sugars go absolutely berserk after a meal like this, especially if maple syrup is added.

In other words, the seemingly healthy breakfast Stuart eats guarantees that he fails to control all his patterns that contribute to his coronary plaque growth.

After I pointed out Stuart's dietary faux pas, he asked, "Then what the heck can I eat?"

"There's actually lots of good choices: Eggs (preferably free-range, if available, or the 'omega-3' enriched) or Egg Beaters; oat products, but true oat products like slow-cooked oatmeal, or the best of all, oat bran, used as a hot cereal; ground flaxseed as a hot cereal with added fruit, berries, nuts; a handful of raw almonds, walnuts, pecans; some cheese, preferably traditional fermented cheese and not processed; low-fat cottage cheese; low-fat yogurt that you flavor yourself with berries and nuts; raw seeds like sunflower and pumpkin.

"Try and save some of your dinner foods for breakfast. For instance, save some green peppers and onions from your salad and put it in your scrambled eggs along with some olive oil. Save some of the chicken and add it to your breakfast. Save some of the cooked vegetables and have them as they are. You'll be surprised how filling dinner foods can be when eaten for breakfast."

It's not that tough. But Stuart and many other people need to break the hold that the food manufacturers have created. If you're hoping to seize hold of your heart scan score, get rid of the sugar foods in your morning, even the ones cleverly disguised as healthy.

The Low-Carb Man

If ever there was an enthusiastic disciple of deceased Dr. Robert Atkins of Atkins' Diet fame, it's Mr. Jimmy Moore.








Jimmy tells the story of how he was transformed by the Atkins' approach, losing 180 lbs in the course of one year. He continues to develop this conversation, in many ways elaborating on the conversation in more sophisticated ways than even Atkins did in his lifetime.

Though we've agreed to disagree on some points of nutrition, Jimmy and I had a recent discussion about heart disease, the mis-guided ways of conventional cardiac care,and the evils of processed carbohydrates. We do differ on the role of saturated fat in heart disease and health, but beyond that difference I was impressed (reading his Blog and listening to his many webcasts) with his level of understanding of the issues. Jimmy is not some over-enthusiastic dieter. He has a grasp of the issues that exceeds that of 99% of my colleagues.

If you are interested in reading our discussion or just perusing a really fun, informative Blog/website, go to LivinLaVidaLowCarb.com. The interview is posted at:

http://livinlavidalocarb.blogspot.com/2007/08/davis-wanna-cut-plaque-in-your-arteries.html


See Jimmy Moore's before and after pictures at http://livinlavidalocarb.blogspot.com/2005/07/my-before-pictures.html. He's quite an entertaining read.
Medical education in the days of Big Pharma

Medical education in the days of Big Pharma

I received this detailed email from an unexpected source: a 3rd-year medical student.

In her email, Theresa describes her frustrations in what she is witnessing for the first time, proceeding through her training and getting exposed to the realities of medical life.

Medical training, particularly clinical training from the 3rd and 4th years of medical school, onwards through internship, residency, and fellowship training, consists largely of bullying, "pimping" (meaning rapid-fire grilling of questions at trainees), and sleep deprivation. It is an extended hazing period meant to demoralize and inculcate the trainee into following the lead of superiors. Buck the system and you're . . . out. Imagine you've just sunk $190,000 and 8 years of college into getting to your internship. You are not going to chance being thrown out on principle. So you just swallow your pride, go along with the game, and echo all the answers they want you to repeat.

While Theresa laments the sad state of modern American pharmaceutical- and procedure-obsessed medicine, she provides me with hope that some young people training to practice medicine today will carve out their own paths, not the one laid for them by the pharmaceutical industry, nor fall for the temptation of higher-paying procedural specialties like orthopedics and cardiology. I am impressed with her ability to see this so early in her career.


Dr. Davis,

I am a 3rd year medical student at ________ University. I came across
your blog today, and I'm very glad I did. I appreciate the value of your time,
so I want to be as succinct as possible while still getting across what I'm
really thinking and feeling:

From what I gathered exploring your blog for a while this afternoon, the
wellness strategies you incorporate into your practice are some of the exact
things I want to do with my future patients. Personally, I strongly believe in
staying healthy by eating right, staying active, etc. For instance, I don't eat
grains or much in the way of starches and sugars. So I love the fact that you
are helping your patients make these powerful and foundational changes in their
lives.

As I'm sure was your experience, a full appreciation of nutrition and lifestyle
as a first-line health strategy is not something that was taught to me in
medical school. I came to school with this deep conviction already in my heart
and mind, and now, on my 3rd year rotations, I am still conflicted and at a loss
as to how I'm going to be able to practice medicine the way I want to, which is
to incorporate these all-important principles into the care of my patients.

What I've come to understand about the medical field today is that the
information that exists is primarily subsidized by the pharmaceutical industry,
and dictated to medical professionals as "evidence-based" treatment guidelines
and recommendations by organizations with sincere and official sounding names
like American Heart Association and American Cancer Society. Add to that the
pressure of potential malpractice litigation and the complexities of the
insurance reimbursement game, and it seems to me like what you get is a bunch of
diagnostic and medication management algorithms that any half-trained monkey
could follow. In his sleep. Which I guess would be alright if at least they
weren't algorithms based on misguided, self-serving, profit-seeking Big Pharma,
Food Inc, insurance conglomerates, and agri-politics (I think I just made that
word up.)

A lot of well-intentioned physicians are just parroting the party
line, as their patients dutifully and gratefully chomp down their statins and
diabetes drugs and blood pressure pills. And I'm sorry, but "diabetes
education" programs with curriculum put together by drug companies? How is that
even legal? Massive corporations raking in massive profits that are dependent
on uncontrolled blood sugars telling people how to best control their blood
sugars?!

Anyway, forgive my rant. What I'm getting at is this: How can I practice
medicine, with the freedom to educate/coach/treat my patients with diet and
lifestyle changes to mitigate/reverse their chronic health conditions? Without
feeling like I automatically have to first and foremost prescribe the litany of
drugs dictated by "evidence-based" guidelines? Without excessive fear of
litigation or loss of credibility among my peers? Without having to lie through
my teeth to my patients, and tell them that eating low-fat and heart-healthy
whole grains is the best way (implication also being the only scientifically
proven way) to control their diabetes, lower their cholesterol, etc, etc, etc?

I want my patients to have the full benefit of honest nutrition and lifestyle
information, and medications and surgery as necessary. I'm afraid that there
isn't room for this kind of holistic emphasis in the medical profession today.
Are there residencies that include this kind of training or at least respect
these "unconventional" philosophies? Are there clinics or practice groups that
would allow me to practice with this emphasis, or is there a bias against docs
who do not necessarily conform to the party position? Will I have no other
option but to go it alone under the auspices of my own shingle? How do you
handle these kinds of issues in your professional life?

Sincerely,
Theresa M.


A ray of hope! Perhaps Theresa is just the first among many more medical students who refuse to submit to the brainwashing practices of the pharmaceutical industry, the same mind manipulation that has hopelessly turned most of my colleagues into their unwitting puppets.

I'll be interested in watching how Theresa's experience unfolds. I've asked her to keep us informed every so often.

Comments (43) -

  • Sassy

    10/29/2010 8:16:32 PM |

    I would love to see your answers to her questions.

  • Tara BRIDGES

    10/29/2010 8:24:51 PM |

    Welcome to my world... only as a dietitian it is WAY worse.  Trust me.

    Not only do we have to deal with bogus "evidence-based guidelines," the loss of respect of colleagues, and risk of losing our license... We have to do it all with less than a quarter of the salary that the average physician makes and much, much less respect.

    I'm so frustrated in this field, but I'm at a loss as to what to do...

  • Tommy

    10/29/2010 8:28:25 PM |

    Timely. I was just arguing (discussing) with my cardiologist about coming off my statin (40 mg). I never had a cholesterol problem and still don't, even though I had an MI. I point to niacin and he points to Zocor. I tell him about studies and he claims I'm reading the wrong studies and that it is his job to know these things. He claims the zocor isn't for my cholesterol it is to control inflammation. I again point to studies that dispute statins ability to do that and  again suggest niacin. Again, he says he knows better. She is right...it is a sad state of affairs.

  • Jonathan

    10/29/2010 8:49:12 PM |

    @Tommy
    Maybe your doc needs to watch Tom's latest post.
    http://www.fathead-movie.com/index.php/2010/10/28/video-of-the-big-fat-fiasco-speech/

    And maybe your doc doesn't need to be your doc anymore.

  • Lucy

    10/29/2010 9:54:30 PM |

    Wow-Thank you Theresa. We need more like you!

  • Lori Miller

    10/30/2010 1:28:42 AM |

    Theresa, I'm not a health care provider, just someone who leads an independent life and writes a humble blog on solving one's own health problems, so take this FWIW.

    How do you think for yourself and do things your way? Study the Socratic method. Go by results. Look at how conclusions were arrived at, and weak links in the chain. Don't hang around with people who are dishonest or have stopped thinking for themselves. Always admit your mistakes instead of justifying them.

    If colleagues disapprove of you, check yourself and see if the criticism is valid. Going by what you've said, you'll probably have to choose between professional camaraderie and the best interests of your patients.

    A couple of books that are good tools for thinking for yourself: The Consolations of Philosophy by Alain de Botton and Mistakes were Made (but not by me).

  • kellgy

    10/30/2010 1:35:05 AM |

    I know exactly how Theresa feels. After losing 95 pounds, reversing hypertension, and arrhythmias, I have returned to school for an advanced degree as a FNP. My hope is also to provide an approach of health and wellness through nutrition, education, and exercise.
    I have the feeling that there are going to be more of us than the pharmaceutical companies know what to do with. Maybe I am a hopeful optimist, but the influence of a sustainable evidenced based approach as propagated here is already having it's effects.

  • Valerie LeComte

    10/30/2010 1:43:47 AM |

    I agree with Sassy, I would love to see your answers.  I am a second year medical student and am struggling with similar issues.  
    You aren't the only one Theresa! Good luck!

  • Anonymous

    10/30/2010 1:59:07 AM |

    Theresa,

    The practice model you are seeking already exists.  Check out the Institute for Functional Medicine at www.functionalmedicine.org .  After reading your letter to Dr. Davis, I think you'll find IFM exciting.  Good Luck.

  • Anonymous

    10/30/2010 2:40:22 AM |

    Medicine isn't the only field like that. Clinical & school psychology is just as rigid with its hierarchy of gurus and 'prescriptions for care' that are questionable. I was in the field for 30 yrs. before retiring and I can tell you that if you deviate from the path you'll be drummed unceremoniously. Those smiling faces have knives behind their backs. Where do you turn for straight answers? As always, you have to find them yourself. (My identity is anonymous because my username/password is being rejected. Wonder if 'they' have gotten to blogger dotcom too. JK.)

  • Anonymous

    10/30/2010 3:07:00 AM |

    A typo in my last post; should have read:

    I was in the field for 30 yrs. before retiring and I can tell you that if you deviate from the path you'll be drummed out unceremoniously.

  • Kim

    10/30/2010 4:41:05 AM |

    Theresa, please tell me you will practice in Arizona. I need a doctor just like you. Im sick of being offered bandaids to cover up symptoms instead of figuring out a cause for the symptoms. I wish you the best and hope there are more out there like you and Dr. Davis.

  • moblogs

    10/30/2010 9:09:25 AM |

    Just hearing one account of a student upset with the status quo definitely makes me more hopeful for the future. Eventually these voices accumulate and change happens.

  • Buy Flonase Online

    10/30/2010 11:16:57 AM |

    I was in the field for 10 yrs,Medicine isn't the only field like that, before retiring and I can tell you that if you deviate from the path you'll be drummed out unceremoniously.

  • Anonymous

    10/30/2010 11:25:22 AM |

    I was at the grocery store Meijers yesterday morning.  And when there early, I typically am left having to use the self check out lanes.  I dislike using these machines.  They all to often break while using them, causing a delay as I wait for someone to come fix the problem.  Meijers employees early in the morning are often not motivated to fix much of anything I've come to find in the past.  

    So as is all to often the norm, my self check out machine gave an error.  The machine reported something was on the conveyer belt - while in reality nothing was.  No more items allowed to be checked until the error was fixed though.     I pressed the help button and with little surprise no one came to fix my problem.  So I packed up and was ready to visit another checkout machine.  This simple act apparently is the motivation Meijers employees need!  She came stomping over, full of attitude.  She really let me have it for wanting to leave the machine.  it was kind of funny.  I just smiled as she lit into me, and was working the check out computer to clear the error.  Once done and walking away, I joked, "let me guess you once were a doctor?"  She didn't like that either.  I'll be shopping at Wal-Mart across the street in the future, even though the same setup and type of employees work there.

    Hope you keep up the work doctor Davis!  I've learned a great deal from your sight, as I'm sure many others have too.  I tell everyone about this place.  Having had a life long chronic illness and seen more doctors than i wish, what disappoints me equally about the lack of care in modern medicine, is the belief by most in society that hospitals have all the answers - that taking responsibility for your own health is unreasonable and even dangerous.  I figured out quickly in my quest for an answer to my chronic health problems that I was not going to be cured in a hospital.  All to often rude, even angry doctors would let me know in one way or another all they dealt with is pharmaceuticals or procedures, items that did not work in my case.  Going outside of that was unwelcome territory.  I kept going to see doctors though.  It wasn't for me that I went.  I did it because family and friends believe in modern medical myths.  I even got to the point where I would take  family members to my meetings with physicians so they could hear what was said for themselves.  That seemed to make doctors nervous.  If I brought someone with me, they would bring a colleague with them!  I actually found these "group health gatherings" to be good, not only to further inform disappointed family members, but also for what ever reason I didn't receive the level of lip from doctors.  

    Anyway, not to bash on doctors and hospitals, just my hope is that someday a majority of people come to realize it is alright to take health care into your own hands.  Hospitals don't have all the answers, and all to often the answers that they do provide are inferior to a good proven diet and a few supplements.  I guess there will always be a place for expensive drugs and procedures, they just shouldn't be the first option, when there are other healthier and cheaper possibilities, in my opinion.

  • Anonymous

    10/30/2010 11:26:53 AM |

    I was at the grocery store Meijers yesterday morning.  And when there early, I typically am left having to use the self check out lanes.  I dislike using these machines.  They all to often break while using them, causing a delay as I wait for someone to come fix the problem.  Meijers employees early in the morning are often not motivated to fix much of anything I've come to find in the past.  
      So as is all to often the norm, my self check out machine gave an error.  The machine reported something was on the conveyer belt - while in reality nothing was.  No more items allowed to be checked until the error was fixed though.     I pressed the help button and with little surprise no one came to fix my problem.  So I packed up and was ready to visit another checkout machine.  This simple act apparently is the motivation Meijers employees need!  She came stomping over, full of attitude.  She really let me have it for wanting to leave the machine.  it was kind of funny.  I just smiled as she lit into me, and was working the check out computer to clear the error.  Once done and walking away, I joked, "let me guess you once were a doctor?"  She didn't like that either.  I'll be shopping at Wal-Mart across the street in the future, even though the same setup and type of employees work there.
      Hope you keep up the work doctor Davis!  I've learned a great deal from your sight, as I'm sure many others have too.  I tell everyone about this place.  Having had a life long chronic illness and seen more doctors than i wish, what disappoints me equally about the lack of care in modern medicine, is the belief by most in society that hospitals have all the answers - that taking responsibility for your own health is unreasonable and even dangerous.  I figured out quickly in my quest for an answer to my chronic health problems that I was not going to be cured in a hospital.  All to often rude, even angry doctors would let me know in one way or another all they dealt with is pharmaceuticals or procedures, items that did not work in my case.  Going outside of that was unwelcome territory.  I kept going to see doctors though.  It wasn't for me that I went.  I did it because family and friends believe in modern medical myths.  I even got to the point where I would take  family members to my meetings with physicians so they could hear what was said for themselves.  That seemed to make doctors nervous.  If I brought someone with me, they would bring a colleague with them!  I actually found these "group health gatherings" to be good, not only to further inform disappointed family members, but also for what ever reason I didn't receive the level of lip from doctors.  
      Anyway, not to bash on doctors and hospitals, just my hope is that someday a majority of people come to realize it is alright to take health care into your own hands.  Hospitals don't have all the answers, and all to often the answers that they do provide are inferior to a good proven diet and a few supplements.  I guess there will always be a place for expensive drugs and procedures, they just shouldn't be the first option, when there are other healthier and cheaper possibilities, in my opinion.

  • Anonymous

    10/30/2010 11:32:15 AM |

    Hope you keep up the work doctor Davis!  I've learned a great deal from your sight, as I'm sure many others have too.  I tell everyone about your writings.  Having had a life long chronic illness and seen more doctors than i wish, what disappoints me equally about the lack of care in modern medicine, is the belief by most in society that hospitals have all the answers - that taking responsibility for your own health is unreasonable and even dangerous.  I figured out quickly in my quest for an answer to my chronic health problems that I was not going to be cured in a hospital.  All to often rude, even angry doctors would let me know in one way or another all they dealt with is pharmaceuticals or procedures, items that did not work in my case.  Going outside of that was unwelcome territory.  I kept going to see doctors though.  It wasn't for me that I went.  I did it because family and friends believe in modern medical myths.  I even got to the point where I would take  family members to my meetings with physicians so they could hear what was said for themselves.  That seemed to make doctors nervous.  If I brought someone with me, they would bring a colleague with them!  I actually found these "group health gatherings" to be good, not only to further inform disappointed family members, but also for what ever reason I didn't receive the level of lip from doctors.  
      Anyway, not to bash on doctors and hospitals, just my hope is that someday a majority of people come to realize it is alright to take health care into your own hands.  Hospitals don't have all the answers, and all to often the answers that they do provide are inferior to a good proven diet and a few supplements.  I guess there will always be a place for expensive drugs and procedures - as if I have a choice in the matter - they just shouldn't be the first option, when there are other healthier and cheaper possibilities, in my opinion.

  • Dr. William Davis

    10/30/2010 12:32:36 PM |

    Hi, Sassy--

    This was my simple response. I operate in the real world, too, and do not have perfect solutions. I also invited her to my office to see what it is I do and how I do it.


    Sadly, your criticisms and concerns are right on the money.

    The problem: It will take 30 years and legions of our colleagues before there is a "sea change" of practice patterns and what we do becomes the norm. In the meantime, you have a satisfying and honest career to carve out.

    Training will try to push your round shape into a square hole, forcing you to mimic the thinking of conventional medicine. It may be a compromise you have to draw. I know of few good opportunities to break out of this mold. I believe that University of Arizona offers some sort of holistic medicine training. More of these programs are popping up. While they may not be precisely what you are looking for, perhaps they offer more leeway and less dogmatic training.

    I do sense that more and more of the primary care community are slowly rejecting conventional approaches, but I estimate it's less than 5%. But it used to be practically nobody. So it's a start.

    One good thing to know: I do what I do with little friction from colleagues. Most have no idea what it is you're talking about, but most stop arguing when they see what you can accomplish. Then they kind of turn a blind eye to how you did it, rarely asking why you did worked and their approach didn't.

  • Dr. William Davis

    10/30/2010 12:39:14 PM |

    Anonymous from Meijers--

    I hear you. I agree wholeheartedly that there is a huge and growing role for self-empowerment in health. It certainly will not come from conventional health channels, but from unconventional sources, such as online health information, direct-to-consumer testing, and other growing services.

  • Dr. William Davis

    10/30/2010 12:40:52 PM |

    Hi, Tara--

    I empathize.

    I know several very excellent dietitians, all of whom are affiliated with hospital systems (the only ones who hire), who are deeply frustrated as you are.

    I can only hope that we achieve a "critical mass" sometime soon, numbers of dissenters sufficient to be heard and not shunned, criticized, or fired.

  • Anonymous

    10/30/2010 12:47:31 PM |

    My dad is a family physician (MD) for 30+ years and over the past few years has been implementing many more natural approaches to preventing illness. It is a DIFFICULT path to take and one that is fought every day in the exam rooms with the patients and in the hallways with other doctors.

    What amazes me is other doctors willingness to RX medications that JUST CAME OUT ON THE MARKET without having done their due research, yet they very quickly judge and frown upon my dad's approach to medicine which he arrived at after many, many months of reading and researching these alternative therapies.

    While they claim to not doubt his intentions, its clear they disapprove of his methods, even in the face of proven results (less flu, fewer office visits for his patients, improved lab results).

    The reality is, he studies more in one evening (after seeing patients all day) than others study in a year. When he employs a therapy, its because he's researched the hell out of it and he's convinced it's the right approach to take. He understands the science behind HOW it works.

    Taking a preventative approach is difficult enough, but enduring the constant judgment from others who practice big-pharma medicine is what makes my dad the top-notch physician that he is. He doesn't back down from a good opportunity to educate both patients and other physicians alike about why he's decided to prevent disease instead of simply treating it.

    How refreshing to see others (especially younger physicians) who are also enduring this difficult path. It is the right thing to do.

    (P.S. Dr Davis- Vitamin D, Magnesium, Iodine, and now Lipoprotein A....you and my dad are following similar paths. I tried getting him to check lipoprotein As on his patients about a year ago (after studying them on your blog), but he was coming up to speed on Iodine at that time. Now he's embraced lipoprotein A and I know it's going to save lives. THANK YOU!)

  • Anonymous

    10/30/2010 1:30:38 PM |

    If a physician steps outside guideline-based medicine (statins for MI), he/she would open themselves up for the lawyers if the patient had an event.  

    The system is defective, but in some situations, the fear of getting sued is stronger than any influence from pharma.  

    Also, many training programs do not allow interaction with pharma reps at this time (from what I have heard).  This has been a new development in the last 1-2 years.

  • Carolyn Thomas

    10/30/2010 4:45:44 PM |

    Interesting comments from this med student.  Welcome to the wonderful world of marketing-based medicine!

    But we live in hope! Many medical schools are in fact taking action to address the pervasive influence of Big Pharma on medical education.

    For example, here in Canada pharmaceutical companies have long supplied free lunches – and even fridges to store them in – in the student lounges of all Canadian medical schools.

    But if the association that represents Canada’s medical schools has anything to say about it, there really will be no such thing as a free lunch anymore – at least for medical students.

    This also means no more talks given by physician experts paid by pharmaceutical companies. No more unsupervised meetings with drug reps.

    The Association of Faculties of Medicine of Canada say that their aim is to limit the influence that the pharmaceutical industry has on medical students and residents, as well as to address the public’s concerns about the perceived coziness between medical schools and Big Pharma.

    Dr. Irving Gold of the AFMC described the potential impact of drug company relationships on these students:

    “There’s no question that the environment within which you’re trained will have an impact on the way you perceive these issues. The public has to trust that the doctors they see do not have any debts to pay to individual pharmaceutical companies or to the sector as a whole.”

    More on this at "Pens, Pizza, Parties: How Big Pharma Freebies Impact Your Doctor" on THE ETHICAL NAG: MARKETING ETHICS FOR THE EASILY SWAYED - http://ethicalnag.org/2009/12/08/pens-pizza-parties/

  • Larry

    10/30/2010 7:33:19 PM |

    Hang in there Theresa M.
    You have to do what your heart tells you to.

    Anyway.... about Dieticians and Hospital food.
    Does the average dietician really, truly, believe that the food they serve is really nutrititional ?
    Does Monsanto dictate the cirriculum ?
    We've all seen Cancer patients being fed juice, milk, bread, cereal, canned (dead) food, potatoes, cookies, cold cuts, etc.
    How can a dietician with a conscience, be part of this ?
    Not trying to be offensive, I'm just asking, as they have to know the whole paradigm is wrong.

  • Gutted

    10/30/2010 9:32:22 PM |

    Thank you, Theresa, for speaking out! Hopefully, we'll see more and more medical students like you who really care about patients' health versus playing the Big Pharma, imaging and "slice 'em up"  marketing games. Unfortunately, with all the greed I see in this world, I don't have high hopes. But please don't let that stop you!

    It doesn't help that I was victimized by the medical profession in a big way. My ob/gyn of 20 years rushed me into surgery for possible ovarian cancer. Despite a benign frozen section, he proceeded to remove all my female organs. I suspect part of the reason was to train two gyn residents. This experience has shown me how corrupt the medical profession can be. Many things in the oncologist's records gave the appearance of collusion with my ob/gyn. I now realize that the oncologist was protecting his referral base to the permanent detriment of my health. A complaint to my state's medical board resulted in no disciplinary action. The outcome of a complaint I filed with my insurance company was confidential but the doctor is still in their network.  

    After many problems from the assault on my endocrine system amd anatomy (aging 15 years overnight along with profound depression and anxiety which I'd never experienced), I started frequenting hysterectomy forums. That's when I discovered that my story is quite common. If women were getting informed consent from their gynecologists, 1 in 3 women would not be hysterectomized by age 60 (1 in 2 by age 65). 73% of women are castrated at the time of hysterectomy. These women have a much greater risk of all-cause mortality. Yet, the carnage continues to the tune of a hysterectomy every minute in the U.S.  

    The book "The Treatment Trap" is a real eye-opener into the dark side of medicine. I highly recommend it.

    Here's an article - Lies, Damned Lies, and Medical Science - about the flaws of medical studies:

    http://www.theatlantic.com/magazine/archive/2010/11/lies-damned-lies-and-medical-science/8269

    Per the article, a leading expert in medical research credibility estimates that up to 90% of published medical information is flawed.

  • Tara

    10/30/2010 11:43:40 PM |

    @ Larry

    I work in outpatient, but I can go ahead and tell you that the inpatient dietitians don't actually "serve" the food, nor do the prepare it or even choose it.  The food service company (typically Aramark or Morrison) is responsible for the selection, preparation, and serving of food to patients.  An inpatient dietitian's job is to oversee patient care related to nutrition in various disease states, calculate needs, educate, and in some cases order/manage TPN or tube feedings.

    Many of us HATE the awful food that is served in hospitals, but we have no say in the matter.  Hospitals are run like businesses, so the quality of food is not as important as the cost.  When my dad had his bypass surgery, I cooked and brought him food from home.

  • Dr. William Davis

    10/31/2010 2:34:52 PM |

    Hi, Tara--

    You know, the plight of enlightened dietitians today reminds me of the way the German people must have felt when the National Socialism movement coerced them to follow their dictates on pain of imprisonment.

    The whisperings of neighbors was all it took to have the Gestapo knocking on your door at night.

    Your experience, by the way, would be a great conversation for this blog. Please tell us more.

  • blogblog

    11/1/2010 6:42:05 AM |

    I was friends with two Indonesian medical graduates. In Indonesia medicine is a six year undergraduate degree. Students spend the entire first year studying anatomy and physiology in considerable depth. They then spend the next five years working full-time in a hospital or small clinic. They begin to perform circumcisions after their first year of studies. Before graduation they must deliver a minimum of 100 babies!

  • blogblog

    11/1/2010 7:14:29 AM |

    Hi Tara,
    with respect being a dietitian or other health practitioner is simply not comparable with practising medicine. I should know because I studied exercise physiology as a postgraduate. My academic workload was probably less than 1/4 that of a medical student.

    The fact is that allied health degrees like nursing, dietitics and exercise physiology are actually quite easy.

    The amount of underlying theoretical knowledge, the workload and responsibility is vastly greater in medicine than in any other health related profession.

    The reality is you get 1/4 the pay of a doctor because your job is 1/4 as hard. You don't have to work nights, weekends and public holidays. You also don't have to be on call, work 36 hour shifts, make instantaneous life and death decisions or deal with grieving relatives like doctors do.

  • Anonymous

    11/2/2010 1:03:07 AM |

    "In Indonesia medicine is a six year undergraduate degree. Students spend the entire first year studying anatomy and physiology in considerable depth. They then spend the next five years working full-time in a hospital or small clinic. They begin to perform circumcisions after their first year of studies."

    But only on adults who ask to be circumcised, right?

    I certainly hope the mutilation of nonconsenting infants is not the standard of care in Indonesia.

  • blogblog

    11/2/2010 5:55:28 AM |

    Hi Anonymous. Indonesia is a Muslim, country so circumcision is routine for babies.

  • buy differrin online

    11/2/2010 3:52:18 PM |

    I was just arguing (discussing) with my cardiologist about coming off my statin (40 mg). I never had a cholesterol problem and still don't, even though I had an MI. I point to niacin and he points to Zocor. I tell him about studies and he claims I'm reading the wrong studies and that it is his job to know these things. He claims the zocor isn't for my cholesterol it is to control inflammation. I again point to studies that dispute statins ability to do that and again suggest niacin.

  • Tara

    11/3/2010 2:12:06 AM |

    @blogblog

    I think you missed my point... My post wasn't to complain about the difference in our salaries.  My point was that because we are in a lower position, we have an even tougher fight ahead.  It's hard to make a change when your grassroots efforts are poorly funded and your profession is not respected.

  • blogblog

    11/3/2010 7:28:16 AM |

    Tara,

    I'm sure that you are well intentioned and wish to help people but you aren't in a position to do that within the conventional dietetics framework.

    The only really influential and widely respected professionals in health care are senior medical specialists working in teaching hospitals. The opinions and knowledge of others is often deemed irrelevant.

    I am speaking from the Australian perspective so my comments may not be relevant to you.

    The dietetics profession has an extremely unethical relationship with the food processing industry. Many food manufacturers employ dietitians primarily as effective PR personnel to give their extremely unhealthy products some credibility.

    The Dietitians Association of Australia actively endorses the type of unhealthy products manufactured by their commercial partners. In the recent past the DAA has even actively promoted confectionery as part of a 'balanced' diet for children.

  • Rogue Dietitian

    11/6/2010 5:26:05 PM |

    @Tara -- you're not alone! I too am a "rogue" dietitian and am so frustrated with my colleagues. I am lucky in that I work at a naturopathic practice where my nutritional point of view is in sync with the doctors I work for. So, I am not expected or criticized for straying from the ADA/USDA grain-dairy model. I hear your frustrations with the field. Luckily, there is so much you can do with it though. I had to find my own way.

    During my internship, I had reservations about having to give diet advice I didn't believe to be prudent -- eat a low fat diet, drink lots of milk, etc. Instead, I changed the script and focused on other pieces of advice. For example, for heart patients I focused on getting them to eat more vegetables, and ditching the margarine, and "forgot" to mention the parts I don't agree with. Or for diabetics, eating fewer carbs and focusing on gluten-free sources like potatoes, brown rice, etc. My preceptors were thrilled I was getting people to eat more vegetables, and I didn't feel like I sold out. Good luck to you.

    Dr. Davis, I have only recently discovered your blog but am enjoying it. I have some non-traditional ideas on heart health I would love to dialog with you about sometime.

  • Dr. William Davis

    11/7/2010 3:59:52 PM |

    Hi, Rogue--

    That's great! A clever, "stealth," way to say what you believe.

    You are welcome to post recipes here or to go to www.trackyourplaque.com and use the "contact" link. I look forward to seeing what you've come up with.

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  • Anonymous

    11/13/2010 3:27:27 AM |

    I learned a long time ago that 99.9% of doctors are worse than useless. I don't plan to ever see a doctor again. Sadly, I'll soon be forced into the medical system, like most Americans.

  • 2medicure

    12/10/2010 4:57:30 AM |

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  • Dana Seilhan

    12/11/2010 9:35:44 AM |

    Anonymous, no one's being forced into the medical system. They're being made to pay for insurance.  No one says you have to go to the doctor.

    I was startled to learn there are actually sound economic reasons for making everyone buy into health insurance in a given country.  Too long to explain here but the book I learned this from, well predated the "health care reform" debate.  In a nutshell, if you didn't want to have to buy a health insurance plan, you should have supported the idea of single-payer coverage.  But you didn't want that, because it was "socialist," if you are like most Americans.  So this is the alternative everybody gets to live with, since they decided it was more important to have health insurance companies than to fund health care like we do police and fire departments.  Dem's de breaks.

  • dr cate

    9/19/2011 12:48:11 PM |

    HI Tara
    I work with a dietician who, like you, has a real passion for her job. She told me that she feels like she has participate in "tragedies unfolding every day" when the doctors send patients to her expecting the usual advice. She is fighting back, though. She has a health radio show you can listen to: http://www.wkxl1450.com/site/index.php?option=com_content&task=view&id=4182

    I encourage you to seek out doctors who think outside the box in your area. I have been so grateful to have Chris available for my patients, and I know other doctors would be grateful for someone like you, too!
    (PS I am relocating soon to Napa, CA, you don't happen to be there...?)

  • Barb

    10/5/2011 12:20:23 AM |

    Not meaning to be a s*&t disturber, but then why do an alarming number of doctors seem to only know 1/4 of what other allied health practitioners do?? Are they being taught too much 'feather' and not enough chicken??

  • jpatti

    5/31/2012 3:29:00 PM |

    I have a sister who doesn't understand much about biochemistry.  She asks me for advice all the time with various issues/problems.  Vast majority of my advice is dietary/supplements.  Sometimes, my advice is for prescription meds, which I can usually locate without a doctor (not talking narcotics or anything).

    But my advice to her in a ACUTE situation is... don't wait to ask me, do what the doctor says.  IMO, if you have a broken bone, or are actively having a heart attack, or have a big infected boil, mainstream medicine is OK, pretty much the best we've got.  

    When you have a CHRONIC disorder, or are trying to preempt having one, that is when taking your health into your own hands is good.  That is when you look up all the prescribing info for the drug they want to put you on before taking it.  That is when you become more of an expert on your disease than they are.  

    I had a CABG several years back, I've been a T2 diabetic for years, I had a bad rT3 problem, and adrenal insufficiency (reversed both the rT3 and adrenal issues and am weaned off meds), I have low sex hormones (E, P and T), I have systemic yeast.  I know more about my COMBINATION of diseases than any doctor cause I'm more INTERESTED and have GOBS of time to research each issue and the endocrinology (which includes nutrition. since cholesterol and vitamins A, D3 and K2 all profoundly effect hormones) and of how they all interact.  I can spend hours looking at a diagram of steroidogenesis and trying to figure out myself.

    So... if a doctor wants me to use more insulin for tighter control, I know I need more K-Dur to counteract the K loss from insulin else my BP will go skyhigh.  They don't.  They just see my BP go high and want to put me back on Lisinopril (which never lowered it, after 2 years of increasing doses).  I know niacin fixes my lipid panel better than statins - and that I can climb stairs on niacin.  I know that high omega 3 intake, and high vitamins A, D3 and K2, and lots of CoQ10 are absolutely required for my health.

    I DO know more than they do about my chronic stuff, and my sister's chronic stuff, and my daughter's and husband's issues.  If it's anything chronic, I WILL know more in a few weeks time than any doctor treating me.  Cause... no one can be an expert on EVERYTHING and I CARE more when it effects me or mine than they do.  I'm one of 30 patients they are seeing today; I'm the only me I've got.  I just flat out CARE more.

    But in an acute situation, I trust them.  My sister needs an MRI on her back, I agreed she needs it, and just said, "Do whatever they tell you if it's based on the MRI."  Cause... I can't become an expert in 10 minutes, and the acute stuff, they are mostly pretty good at.  Someone has to decide in those situations, and you don't have time to become an expert.

    There's other stuff mainstream medicine has gotten right.  Antibiotics as an example... though the overuse of them is what they got wrong.  Similarly, while I think we overdo vaccinations, the fact is that when polio came through a town and killed or crippled most of the children, that was some bad stuff.  Mainstream medicine gets some things right.

    The problem with medicine is that it is not evidence-based, though they say it is.  At BEST, it takes 10-15 years for good research info to change the practice of medicine.  At worst, if there is no profit motive, good research info may NEVER change the face of medicine.  

    IMO, with mainstream medicine, you take what is good and leave the rest.  But throwing out the baby with the bathwater makes no sense.  Doctors do have their uses.  No matter how we rant against their stupidity, there is some worthwhile stuff there.

    One of MY reasons for hanging out here is that Dr. Davis changes.  When I started hanging on this blog and his website and bought his first book, he wasn't discussing thyroid, or K2, and his dietary ideas were quite a bit different than today (though the anti-wheat stuff was there even then).  

    Not that I agree with him 100% about everything, but... he DOES change the way medicine does not; he actually DOES do evidence-based medicine, based on actual evidence, not just evidence provided by pharmaceutical studies.  And since evidence changes over time, and he keeps learning, his recommendations change.  That gives me confidence in his latest ideas, to go research them for myself.  

    And for those who can't really research for themselves, without a solid science background and an understanding of how to read studies, if they have cardio issues, I just tell them to go do what he says.  I've told people to read his books, sent them to the blog and website, I've even sent a few people to see him, cause they were local to him and able to get there.  Cause even if I don't agree 100% about everything, he's the only cardiologist I know who is actually reversing CHD.  

    Granted, Dr. D is a maverick and himself rants against mainstream medicine.  But... he rants agaisnt specific stupidity.  I'm sure if you were having an actual MI right now, he'd recommend a procedure to save you.  Just... he'd rather you not have the MI in the first place, which is why he rants.

    But... baby and bath water...

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