Wednesday, May 1, 2013

The Nutrition Debate #104: It’s Not Feckless to Be Fickle

I have mused a few times about how most doctors and dietitians are in a bind, especially the middle aged and older ones. The younger ones can still have an epiphany without ruining their practices. It must be a rude awakening when they do, but they can do it with integrity if they are truth seekers. The older ones, as I see it, have three problems:

1) The mantra when they were schooled in medicine (doctors) and nutrition (dietitians) – never to be cross-fertilized – was the coda of the day: the diet-heart hypothesis (the saturated fat/cholesterol/heart disease hypothesis) from the now widely discredited work of Ancel Keyes. When he joined the Board of the American Heart Association, and made the cover of Time Magazine in 1961, the “die was cast” from that day forward. Everybody read Time in those days. (Now, it’s just a pamphlet!) But the message spread, and the media and the health establishment to this day trumpet it.

2) The specialties in medicine are governed by medical associations that set “Standards of Practice” that are in turn adopted by Medicare and private medical and liability insurance companies that stipulate “accepted practice.” In some ways it makes medical care simpler, quicker and less risky. The older clinitian gives you the standard reimbursable tests, for which he gets paid using the standard medical codes, and the standard exam and the standard treatment: a script for pill(s) and advice to lose weight (eat a balanced diet) and exercise. Then you’re outta there. Next patient.

3) The problem is, how can a doctor deviate from this? Will he get paid for that non-standard test? How can a doctor change when he has an open mind and sees something that works after so many years of the exact opposite? That what he has been prescribing for many years, doesn’t work? Admit that what he has been telling you all these years is wrong? That it is exactly backwards? That the diet-heart hypothesis was just a bad “take,” not good science? Many doctors and scientists have said so, but what will the patient think if his doctor, his trusted personal health advisor, does a complete about face, a 180 degree turnaround? Is he a quack? Is this patent medicine? Has it all been a big fat lie? ;)

Many doctors and scientists are saying that now, but not to the same patients they have been treating for years with the bad medicine. And if they are, they are certainly not trumpeting it. Although to be fair, my doctor, who was a board certified internist and cardiologist, suggested that I try Atkins Induction. He had just read Gary Taubes’s New York Times Sunday Magazine cover story on July 6, 2002, “What If It’s All Been a Big Fat Lie.” He tried it himself, lost 17 pounds in a little over a month (with no ill effects), and suggested I try it. Ever cautious, he did monitor me monthly for a year, to be sure.

Anyway, most doctors would have a hard time doing what my doctor did, even if they believed in it. But you are not in the bind they are in. You can be “fickle without being feckless.” You’ve got nothing but your improved health at stake (LOL). Not that that’s inconsequential. Most everyone would say that is the most important thing of all in this life: good health. But you do not have your professional reputation at stake, your practice, the respect of your colleagues, your reimbursement percentages, and your liability insurance premiums, not to mention sanctions from professional organizations that license and certify you in your specialization. You, the patient, can be fickle. You can change.

Now, all you have to do is figure out: change in which way? Well, if the way you are eating is starting to make you “sick,” if you are overweight, hypertensive, prediabetic, have “high” cholesterol, you might consider eating in a different way. If low fat (which means very high carb and moderate protein), is making you sick or diabetes runs in your family, then one alternative is very low carb, moderate protein and very high fat.

Okay, you don’t have to do the full Monty to start with, or ever, for that matter, if you are not already too “sick” to eat a more moderate diet. You could start with just a low carb, moderate protein and high fat diet. That’s still a very big improvement over the way you are probably eating now. The Recommended Daily Allowance (RDA) of the Standard American Diet (SAD), the one on the Nutrition Fact Panel on packaged (boxed and bagged) foods is 60% carbohydrate, 10% protein and 30% fat. You could do 40% carb, 30% fat and 30% protein. That would be a reduction from 300 grams of carbs to 200. Better yet, work your way down to 20% carbs (100 grams/day on a 2,000kcal/day diet).

Then, after you adjust (and lose weight and lower your triglycerides and raise your HDL), you could try 20 grams per meal, with no snacks (you won’t have any cravings – in fact, you won’t be hungry). Or, you could do Bernstein (6-12-12 = 30/day), or Atkins Induction (20g/day), or me. I do 12-15g/day. I now eat 2-3 grams of carbs at breakfast, zero at lunch, and 10-12 at supper, unless I have a glass or two of wine, which I might do a couple of times a week, if I feel like it.
The point is: You are not constrained by your profession. You will not be feckless if you change the way you eat. You can be fickle. You can try eating lower carb, or low carb, or very low carb the way I do. It’s okay to be fickle. It’s okay to do what works for you. It’s your health. It’s your life. And now, it’s your time to decide.

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