My doctor stumbled upon Low Carb dieting on a Sunday morning in early July 2002. He opened The New York Times and saw on the cover of the Magazine a big juicy ribeye steak with a melting lump of butter on top. If his biochemistry is the same as the rest of the human race, his salivary glands began to secrete digestive juices and a signal went from his hypothalamus in the center of the brain to his pancreas to start secreting insulin. There was no olfactory stimulus. The visual image was enough to start this autonomic response. Even the idea of eating will do it. It tells us, “It’s time to eat!”
Of course, my doctor didn’t act on these impulses because another part of his brain told him 1) it’s just a picture and 2) it would be bad for his health to eat so much saturated fat and cholesterol. The rational mind overrode the autonomic. As an internist and cardiologist he had learned in medical school, and had had reinforced in continuing education throughout his professional life, that saturated fat and dietary cholesterol were verboten. They would clog his arteries. He had seen atherosclerotic patients every day in his practice. They were a constant reminder that eating saturated fats and cholesterol would be “the death” of him. We have that message drilled into us constantly as well. The DEATH of us.
But, that particular Sunday morning my doctor was relaxed at home and engaged in one of his favorite day-off indulgences – putting his feet up and reading his favorite newspaper. Besides, he was intrigued because the title of the cover story was, “What If It’s All Been a Big Fat Lie?” The author, Gary Taubes, is a highly regarded science writer who has won the National Science Writers “Science in Society” award 3 times (and 3 is the limit!) And the New York Times was at that time still “the old gray lady” of print journalism whose motto was “all the news that’s fit to print.” So… my doctor decided to read the story. It was a life-changing event (for me)!
Then, in the noble tradition of medical self-experimentation exemplified by Werner Forssmann, “inventor” of cardiac catheterization in the 1930s, my doctor decided to try the diet that Taubes outlined. And in about 6 weeks, he lost 17 pounds on Atkins Induction! I assume he tested his blood chemistry and lipid panel before and after, and his n=1 self-experiment proved to “do no harm” (and maybe even a little good?). So, soon afterwards, as luck would have it, as I walked into his office, my doctor saw me and said to me, “Have I got a diet for you!” I needed it too. I had just discovered (on a Fulton Fish Market scale) that I weighed 375 pounds!
So, where does Pauline Kael (correct spelling) come into this picture? According to Wikipedia, Pauline Kael was “a film critic who wrote for The New Yorker from 1968 to 1991. “She is often regarded at the most influential film critic of her day,” according to Harper’s, and she was known for her “witty, biting, highly opinionated and sharply focused” reviews. I read her every week, but I remember her best for a comment she reportedly made in a lecture to the Modern Language Association in December 1972. It was in the wake of Richard Nixon’s landslide victory in the 1972 presidential election:
“I live in a rather special world. I only know one person who voted for Nixon. Where they are I don’t know. They’re outside my ken. But sometimes when I’m in a theater I can feel them.”
I have to admit that that image is pretty funny, and certainly “witty, biting, highly opinionated and sharply focused,” but Wikipedia notes that Kael was widely criticized for this sentiment. It illustrated the isolation in which it is possible to live, if you are surrounded by like-minded people, especially if you think of yourself as being superior in education or intellect. In such cases it extends to beliefs as well. Such elitism is common among the intelligentsia. New York Post writer John Podhoretz once claimed that New Yorkers “can easily go through life never meeting anybody who has a thought different from their own.” Under such circumstances, wouldn’t any disparate thought be heresy?
The world of human nutrition today suffers from this same constrained view. “The Nutrition Debate” seeks, in a very modest way, to present another view and to encourage self experimentation. There’s lots of support for this alternative; it just doesn’t get much play in medicine or the media. Of course, there are other forces at work here (big agriculture and big food manufacturers, to name just two of the major stakeholders), but the medical and public health communities are where integrity and professionalism are supposed to mean something. That is where I think we can best make inroads and foment change.
So, when my doctor was willing to try something that goes against the teachings he had practiced (and lived) by – first on himself (like Forssmann, whose self experimentation led to the Nobel Prize), and then on his non-compliant, heavily medicated, morbidly obese Type 2 diabetic patient (me), I think there’s hope. And if others try it, and it works for them too, maybe it won’t be as creepy as it was for Pauline Kael in that dark theater in 1972. That’s my hope anyway, and why I keep writing this blog.