The problem with the concept of "self-directed health" is how ignorant most people are about health in the general population. The online community is self-selected and we are extremely well read and aware.

But I have friends and even family who have medical conditions but know nothing about physiology and  have no interest in learning about it.

My belief is that most people don't develop an interest in self-directed medicine until, like myself, they or a family member have been seriously hurt by a doctor they trusted. Until that happens most people will trust their doctors.  Sadly, for many of them the "seriously hurt" translates into "Unnecessary first and fatal heart attack."

I would love to utilize the "a la carte" menu of healthcare model... in fact in many ways I already do.

Hopefully the next thing to go will be the horrified looks... as if I am endangering my health by directing my care, for asking for tests or services when they are needed, for refusing to be a drug company research subject or pawn, and for being as informed about my body and about medicine as I can be.

Yes, it is definitely time... but this model only works for those who are informed, aware and proactive.  Those who are too timid, or intellectually challenged, or lazy to direct their own care, will prefer the status quo.

madcook

I agree with your assessment. Unfortunately, there are many who believe that a national health care bureaucracy is the "answer." If this comes to pass, we will all be paying twice for our care: once for the bloated and ineffective system (just look at our public schools) and once for our self-directed care.

Thanks for spreading the news.

Speaking as someone in the "Investment Adviser" business, I can say with great certainty that Ameritrade and Charles Schwab can give people the ability to make stock trades cheaply, but they cannot help them (much) make trades wisely.  Main Street Joe has gained incredible ability, but expertise lags considerably.

Most importantly, expertise will ALWAYS be lacking because (if Joe is doing his job) he spends most of his learning time on his real job, whether that's carpentry, plumbing, doctoring, or whatever. The guy who looks at stocks professionally will always have a better feel for the market and what makes a good stock.

The solution isn't to fire the investment adviser (aka, the expert), but to change the incentives. Get rid of the commission. Fee-based advisers (who take a fee determined by the total assets under management) have the same incentive as the investor - to grow the value of the portfolio.


----

We can make an analogy to Doctors. If the General Practitioner acted more like a Health Adviser who got paid only when you get healthy (rather than get paid when they sell you a medication or procedure) I bet we'd see radical improvement in care. There would probably also have to be payments in the event that the patient refuses to comply with taking his vitamins or stop eating bad things.

I'd love for this to hurry up and be the case. My current GP always seems "concerned" if I try to take a detailed interest in my own health, as if I am a hypochondriac. I'm quite good at reading body language and am not a paranoia-prone person, so I don't think I'm misreading the situation. She got upset when I brought in some information relevant to my case because it had come from the internet. It wasn't even anonymous, dubious information, it was a guideline authored by two eminent professors in the subject which was widely linked to by medical professionals. But because it came from the internet it was somehow invalid.

There will be some doctors that will fight tooth and nail before they give up their paternalistic doctor-is-god ways.

Good thoughts, all.

The fact that we are even having this conversation online is testimony to the fact that self-directed health is ALREADY happening. It is not some sci-fi figment of imagination. It is happening, it will happen, it will grow.

Granted, "only" 5-10% of the population (15-30 million) will, in the next 30 years, participate. That should not stop one of the most exciting, revolutionary steps in healthcare to develop.

Fully agreed! Yes there are a lot of cranks on the internet but equally there are a lot of people pointing and yelling "Crank!"

This does NOT happen with your GP who might actually know very little about your specific condition, and that knowledge may be 50 years out of date. Sadly this is likely to be the case if he (or you) inform yourself from some of the woefully inadequate "professional" sites.

Many doctors are first class, as are many other sources of health information. Increasingly we are seeing first class patients also! Teamwork is the best plan, my GP has pointed me to information I didn't otherwise know, and I've returned the compliment.

it reminds me of speed limits on our Highways. where many people can safely drive at 100 miles an hour but not every one is capable of doing it. Therefore speed limits needed where majority is expected to drive safely. The concept of "self directed health" runs in to the same danger. even though i my self, treated my misery by self educating after years of appointments with doctors and not only suffering physically but also paying big price socially and economically. It is  important to change the selection process of these so called doctors before an individual is allowed in to a medical school. the selection should be based on not only academic achievements but a real personality for community service without ego should be a major criteria. A doctor's inability to treat patient accurately effects our social life and community at large. i still believe that more doctors are sick themselves and therefore are blinded by the false ego. Most don't have the stomach to Liston to their patients. general public shouldn't have to waist their time learning "self directed health treatments". we have a system in place and there are people being trained to take care of the society. it is the selection and training of these individuals which needs an over haul which will require some major alligators/licensing authorities  in the medical system to be shaken.
However, since internet is a useful tool for learning and millions are already using it for self diagnoses, The medical language (studies and trials findings)posted on the internet should be in plain English so that misunderstanding can be reduced for general public.

Emancipated Patients and a New Kind of Doctor

http://www.metzelf.info/articles/emancipated.html

Our medical director (and Vitamin D proponent) calls this concept "Medical Self Reliance."

Sounds...empowering!

Whoa, that's a lot of photos of spoons, hah.

I definitely get a worse effect from eating bread (historically, I don't anymore) than I have from eating table sugar (say in coffee or sprinkled on strawberries, neither of which I do anymore, either).

And... is sugar bad?

I can think of tastier options for consuming that much sugar, but only on my cheat days! -Kristie

Wrong. Table sugar is 50% fructose. Does bread starch break down to 50% fructose? Fructose and glucose are metabolized quite differently. The former only in the liver if I understand correctly.

What about bread made from sprouted grains -- e.g., Ezekiel Bread?  I understand there's still gluten in it, but this particular bread actually has a short, easily understandable ingredient list -- seems far better than the highly processed "whole wheat" bread out there.  Any thoughts?

Bread does not equal sugar. This is a too simplistic Doc, and you know it.

Of course we all know that bread starch does indeed break down as glucose in the body, but there is so much more to bread than just that. Of all people, in the entire blogosphere, I would expect this post from you the least. You know ALL about wheat and bread. You post more on wheat than any other blogger. Yet you say bread equals sugar. I know what you mean, for sure. I get it, but I would like to suggest to you that sometimes people seriously take you word for word, especially when you have a large following of daily readers that know you're a Doctor and maybe don't understand the differences. Then they are gonna run out and tell their friends and family that eating bread is just like eating sugar.

As another commenter mentioned, sugar is half fructose, and although the fructose is mostly bound to the glucose, some of it still definitely goes into your liver. A huge sugar overload is going to have drastically different effects on metabolism as a huge bread overload. Neither are good for you in any way. The bread comes with all kinds of problems that the sugar doesn't have. I'm not sure which is worse, but they're not equal to each other.

I think I just spurted out a bunch of insulin looking at those pics. ; )

Wow, take a chill-pill folks.

It states in the very first sentence that he is speaking in terms of carbohydrate content.

I don't believe for a second that the good doc's readers only read the headline and then run off making nutritional recommendations to their friends and family.

Thanks for another great post.

Thanks, Cary.

It never ceases to amaze that talking about food is like insulting your mother: virtual fist fights inevitably break out.

I was lumping wheat bread and gluten-free bread together. That is indeed misleading, because wheat-containing bread is far WORSE than sugar. The point I was trying to make, perhaps awkwardly, was that both wheat bread and gluten-free bread are, in effect, large carbohydrate loads. And I didn't insult your mother.

Although 2 slices of bread are generally equivalent to 30 g carbohydrate (although some are less and some are more), they are not necessarily equal to 6 tsp of sugar/2 tbsp of sugar.  The carbohydrate in bread is not all sugar.  Bread, especially whole grain bread has fiber which is an indigestible carbohydrate.  2 slices of whole grain bread have 4g of fiber generally, which you will not find in table sugar.  Additionally, this fiber helps to slow down the absorption of the carbohydrate or sugar in the bread.  Therefore, plain table sugar (just glucose + fructose) is far more easily digested than 2 slices of whole grain bread.  Therefore, from the pov that whole grain bread is not 100% composed of sugar nor is it digested in the same manner as sugar (in terms of their glycemic index/how long it takes for the sugar to enter the bloodstream), it seems incorrect to say that 2 slices of whole grain bread= 6 tsp of sugar.  I understand the logic of your reasoning in the sense that all digestible carbohydrate eventually breaks down into glucose, however, fiber (found in whole grain bread) does not and therefore its erroneous to say that they are equivalent to each other and may be misleading to individuals reading this article.

Was there no point to this post but to keep the blog going and selling stuff?  What is going on here?

What was that you said about my mother?

Did you look at a table of glycemic indexes? Most bread, including whole wheat bread, has approximately the same glycemic index as table sugar.

Reduced/absence of fructose makes the bread less toxic, but I'm guessing this post was written from the perspective of the resulting insulin response - in which case, referring to six teaspoons of sugar is accurate for comparison purposes.

I watched Nurse Jackie this week (or maybe last week?) and the head nurse was 'educating' overweight children.  She named a bunch of candy bars/candies and asked what they all had in common.  A child responded "Sugar?".  "Correct!" she replied.  She then told them that when she wants a snack, she eats "These" - then holds up a box of raisins.  Oh, and the children were all holding apples.

you've covered this general concept in many of your other posts about bread and/or wheat in general. everybody knows that bread is carb heavy. but a carb is a carb is a carb is simply not true. besides that, i think the nasty ingredients in most gluten free breads are far worse than the carbohydrate content of the starch.

We are just blind to many other foods when trying to avoid sugar to save us from diabetes.I think we must consult a specialist to formulate our diet which would be healthy and accurate.

If only it were true that "everyone" knows that bread is carb-heavy, or that starches convert to sugar, or even that fruits are carbs! I asked my brother to tell me what he eats in a typical day. "I don't eat a lot of carbs... For breakfast, two breakfast tacos on flour tortillas and a Sprite, for lunch I just eat an apple and another Sprite, and dinner is maybe chicken-fried [breaded] steak and some cornbread, or maybe mashed potatoes." I asked him if he thought soft drinks don't have carbs, and he said he thought clear sodas "don't count"--just colas have carbs. To say nothing of the flour, potatoes, corn, or fruit.

That's a more typical (mis)understanding of carbs than we want to think. And that's why I dont mind reading posts like this.

There are many ways to skin a cat, as the saying goes.  I, for one, appreciate Dr Davis attempts to get the message across by putting it out there in many different ways and using different analogies.  You never know which description will hit home with someone or at least make him stop and think.

Many times I've come across exactly what Annabel describes - so many people lack even a basic understanding of which foods are carbohydrate-rich.  I was astounded when my husband mentioned that he'd always thought fruits were not carbs (and he's a scientist!).   To him, carbs are starches, only - bread, pasta, maybe potatoes, etc...

I used to eat a lot of bread.  Now, none.  I don't have a problem passing up ordinary, store-bought, mass-produced loaves, but when I'm in a deli or restaurant with quality breads -- well, that's harder.  Still, I know I will get a lot hungrier a lot sooner if I eat the bread than if I don't, and so I don't.  It seems paradoxical that eating more food makes you hungrier sooner; knowing that is the key.

Doctor Davis:  It would be helpful to see a post of how you would construct a daily diet for heart health that minimizes the carbs.  There seems to be a full range of low carb alternatives ranging from Atkins like to Rosedale(high fat), etc.  Thanks,

When I first started following Dr. Davis and the TYP eating guidelines, I had a hard time giving up wheat - hell it's in everything!!!  Plus it's a hard addiction to break.  

Now that I'm wheat free thanks to Dr. Davis' recommendations you couldn't pay me any amount of money to go back.

The debate over glucose vs. fructose is interesting but the only thing that's really important is how I feel.

-s-

I used to be a wheat addict but no anymore.  I've had one wheat product in the last 6 months and since then have lost 30 pounds.  I've done nothing different in my diet or exercise program - just ditched the wheat.  The weight dropped off easily.  Dr. Davis rocks!!!

That is messed up
fresh apples are better for children.  All of us.  Everyone.

But, raisins are a better alternative to candy/packedged/processed food...even organic.  or hydroponic.  I say kids.  Eat the apple.

I stumbled across this blog quite a while ago and remain a casual reader of it.  What attracted my attention is how eliminating wheat was what I needed to do to get rid of my belly.  I have been sorely disappointed!  I am a 60 yo female, 5'7", weigh 132, small frame, have always been thin but started gaining weight around midsection in my 50s.  One year ago I gave up my daily glass of wine, and 8 months ago eliminated wheat from my diet.  That was hard!  I agree that I feel better and the hunger is not as intense, but I have long zero weight.  I walk briskly, as briskly as my bad knees allow (former jogger) every morning.  I eat fruit, yogurt and nuts for breakfast, a bowl of raw veggies for lunch (no dressing) and some protein and more veggies for dinner.  Will I ever lose this 5 to 7 pounds around my middle?  Thank you for letting me vent!

Marianne, you're still running on carbs instead of dietary fat. Most fruit and yogurt and sugar bombs. And without dressing or other fat, you won't absorb the vitamins A, D, E or K in your vegetables. Eliminating wheat is great--and I admire your dedication--but I don't see much fat or protein in your diet. Try adding a boiled egg or two and some dressing to your salad for lunch, some fatty fish or other fatty meat and buttered veg for dinner, and leftovers for breakfast. Give it a two-week trial.

I agree with Lori...not enough fat and protein, too many carbs.

You might enjoy reading Dr.(s) Eades book, "The 6 Week Cure For The Middle Aged Middle."  You should be able to get rid of those 5-7 pounds in a couple of weeks.  At your age, it may be mostly visceral fat, not subcutaneous fat, and visceral fat is far more worrisome to your overall health because it's connected to inflammation.

Joe

Another thing: various studies and a lot of anecdotal evidence have shown that aerobic exercise is ineffective for losing weight. IME, it's just as overrated for weight loss as whole grains are for health. Weight training is better for improving your physique and possibly improving insulin resistance. The Eadeses also wrote a book, along with Fred Hahn, called Slow Burn; Dr. Davis has some posts on this.

That doesn't give us any information about metabolic effects of the food.

Don't eat fruit.  Use some caffeine creme.  Have a cheat day.
When things get confusing, you have to log everything - you will be surprised, thats for sure.

Yes, that seems to be truth. I would go for high intensity training as fast twitch muscles drain glucose much faster then slow twitch muscle, plus, its much more doable given the modern time constraints.

There is a problem tho  - high probability for injury, with any type of exercise. Injury equals to even more sedentary life then before exercise.

In Marrianes case, I guess, however, that lots of effort needs to be devoted to solving menopausal hormonal disturbances which promote weight gain. This is, to my knowledge done with concentrating to food quality rather then quantity.  Supplementation is essential.

Lori, I don't think even weight training will rid her of her "middle-aged middle." Only a proper diet can do that (and pretty quickly, too), especially if it's all visceral fat, as is likely.

Weight training will give her a stronger mid-section, of course, but it'll mostly remain hidden under the fat.

Joe

Agreed--weight training won't get rid of fat, but it'll make you generally firmer.

One thing I really like about Fred Hahn's weight training method is that it's easy on the joints. In the doorknob squats, for instance, your feet are a little in front of your knees and you hold a door knob for support, making for a challenging exercise that doesn't hurt your knees.

Still, I don't think she could do enough ab work to get rid of her "middle-aged middle," which she claims is her remaining objective.

That's going to require a special diet, like the one the Eades recommend, for example.

By the way, the best ab workout, in my opinion, is sprinting. Spend a little less time walking or jogging, and a little more time sprinting (provided you're already in relatively good shape). I'm about to enter my 8th decade, and I'm still sprinting.

Works for me.

Joe

I disagree that wheat is worse than sugar, generally.  

Sure it's worse for celiacs, and others with gluten intolerance.  And sure it will raise worse than the equal "net carbs" of sugar since starch is a glucose polymer.

But sugar is half fructose which is a LOT of fructose.  And fructose is very bad for fatty liver, for diabetes, for triglycerdies, for adiposity, for everything...

On the other hand, this is sort of like arguing whether arsenic or cyanide is worse... doesn't really matter.

Hi, Jpatti--

This is a confusing issue. It is the reason why I wrote Wheat Belly that will be hitting bookstore shelves in early September, 2011.

I believe that, once you hear the entire rationale, you will agree that, not only is wheat worse than sugar, it is the most incredibly bad thing ever created by modern genetics and agribusiness and is responsible for more disease and suffering than any war ever waged.

I'm looking forward to your book.  I had heavy whole wheat bread (plus butter and jam) for breakfast for years thinking I was being health conscious (mostly because it was fibrous enough that I didn't snack till lunch).   How wrong I was!  Now that I've gotten educated on the metabolism of carbohydrates plus the dangers in wheat, I realize how unhealthy that was.