Saturday, March 30, 2013

The Nutrition Debate #95: My Doctor Died Last Week – An Appreciation

My doctor died last week. The cause, unfortunately, was bad medical advice. An internist and cardiologist educated and trained in the traditional school of medicine; he was taught how to treat symptoms: Write a script. High cholesterol? Prescribe a statin. It will lower LDL cholesterol and get the Total Cholesterol within the guidelines of the standard of practice. Unfortunately, it did not lower his risk for all cause mortality. My doctor died of…intransigence.

I remember my doctor as someone who cared about me. When I first came to see him in 1991 (on my 50th birthday!), I was morbidly obese and I had already been a Type 2 diabetic for five years.. My doctor first focused on improving my blood sugar control. He prescribed higher doses of the sulphonylurea (Micronase) I was on and then, when it became available in the U.S., added Metformin. When I was “maxed out” on both of those, he started me on Avandia. None of these drugs seemed to work  well though, or at least not well enough. My diabetes got progressively worse, but then it was supposed to, according t protocol. The medical establishment describes Type 2 diabetes as a “progressive disease.”

Of course, my doctor also really wanted me to lose weight. I remember when the Registered Dietician he had on staff counseled me to eat “a balanced diet,” cut down on calories, and exercise for half an hour at least three times a week. She even gave me suggested meal plans and ideas for snacks when I couldn’t get to the next meal without a little “energy boost.” None of this worked for me either. He tried, though, to get me to lose weight. I was just unable to do it, or lose it and keep it off. He probably wrote in my chart that I was “non-compliant.”

Then, luckily one day in August 2002, when I walked into his office, he was standing at the nurses’ station. When he saw me he said, “Have I got a diet for you!” Turns out the month before he had read the Gary Taubes’ cover story, “What If It’s All Been a Big Fat Lie,” in the New York Times Sunday Magazine and had tried the recommended diet himself. He lost 17 pounds! So, I tried it. It was Atkins Induction in which you eat less than 20 grams of carbohydrate a day to lose weight. I did it for nine months and lost 60 pounds. During this time my doctor saw me monthly to monitor my health.

The first thing that happened, though, was that I started getting “hypos,” or hypoglycemia, a low blood sugar condition. I called my doctor and he progressively took me off all the medications I was taking until I was just on a minimum dose of Micronase and Metformin. A few years later, when I switched to the Bernstein Diet (designed for diabetics), I lost another 110 pounds and titrated off the Micronase completely. I still take 500mg of Metformin with my evening meal.

My doctor saved my life, but couldn’t do it for himself. He reverted to a “balanced diet” and regained the weight he had lost and then some. When I continued to see him three times a year for many more years, and regained some weight and then lost more, he would always ask me, “How’d you do it?” I would answer, “I stopped eating carbs!” He would look at me and smile wryly, perhaps wistfully. I wondered if he was thinking, “How does he do it? I wanted to tell him, “It’s easy, doc, once you get keto-adapted.” But, I know he couldn’t do that. It would just go against the grain for a traditionally schooled cardiologist to eat a diet that is 70% fat, 25% protein and just 5% carbohydrate. It would be anathema to him to add salt to his food, and to eat all the saturated fat and cholesterol that his heart (literally) desired.

Of course, he ordered a lipid panel for me each time I saw him (and an EKG, which was always “normal”), and echo cardiograms and carotid tests once a year. He saw that on my Very Low Carb diet my HDL doubled and my triglycerides dropped by two-thirds. He saw that my A1cs and my C-Reactive Protein (hs-CRP) tests were stellar. But, despite the evidence of my good health – my greatly improved health on the diet he recommended to me more than 10 years before – he was unable to bring himself to try it again. What more evidence did he need? Maybe it was something else. Maybe he just couldn’t accept that his entire life in medical practice had been “a big fat lie.” I mean, how do you do that?
Virtually the entire Western world is now vested in the “lipid hypothesis.” For more than fifty years, starting with Ancel Keys (who made the cover of Time magazine in 1961), and then the American Heart Association, and the American Diabetes Association, and the list goes on, everyone has been piling on to a then unproven hypothesis which is now a disproven theory. George McGovern got the government involved in 1977, and from 1980 onwards we have been getting the “Dietary Guidelines for Americans.” The current version equates saturated fat with trans fats! And recommends steep reductions in sodium and cholesterol for all Americans. The science doesn’t support these nutrition goals. But the USDA and Big Agribusiness and Big Pharma are all, metaphorically speaking, “in bed with each other” along with the big manufacturers of processed foods. Can this ever be turned around? Will it ever be? It is so frustrating. Anyway, I am grateful to my doctor for saving my life, even if he couldn’t save his own.

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