Saturday, June 8, 2013

The Nutrition Debate #115: “My Doctor Never Told Me…”

Sound familiar? In a recent class conducted by a Certified Diabetes Educator, I heard the phrase “My doctor never told me…” a few times from newly diagnosed type 2 diabetics. It’s been years since I was diagnosed, but I sensed palpable anger among some of my classmates. They are still in shock and looking for help. They are trying to cope with how to live with this disease for the rest of their lives. And as I see it they are in denial about the how they came to be in this place, and they are trying to transfer responsibility of how it came about to others. But it’s not as simple as laying it off on your doctor.

I know this from my personal experience. I was diagnosed a type 2 at age 44 in 1986 by an observant physician who looked at some clinical signs (my weight, my fasting blood glucose, and my blood pressure), and decided to treat me for type 2 diabetes and hypertension. I don’t have the lab report from that doctor’s visit, or even remember his name, but this guy was ahead of the curve, and I am grateful for his treatment. He started me on oral medications for my incipient diabetes and frank hypertension. I was lucky. My doctor acted, proactively, on the clinical signs; he did not wait for my fasting blood sugar to be 140, the threshold for a type 2 diagnosis then (vs. 126 today). Neither do I recall what, if anything, he told me at the time about my weight, or my high blood pressure and elevated blood sugar. Whatever it was, I chose to ignore it. I just filled the prescriptions and took the pills as directed. A little later I had a physical at a local hospital wellness center and my weight was 300 pounds, my fasting blood sugar (with meds) was 108, and my blood pressure was still 174/124 (with meds).

Five years later I was living in a different city and had a different doctor. At my first visit to him (on my 50th birthday), I weighed 310 pounds (not much gain in 5 years), my BP was 130/112 (improved but still much too high), and my fasting blood sugar was 135 (out of control). He upped my diabetes meds, added a blood pressure med, and made an appointment for me to see his Registered Dietitian. For the next 11 years his treatments for blood pressure and blood sugar had some salutary effects. In 2002, my blood pressure was 140/90 and my fasting blood sugar was 81, but my weight had ballooned to 375 pounds. All his efforts over the years to get me to lose weight were fruitless. His dietitian, of course, had advocated eating a restricted calorie “balanced diet,” with regular exercise. What would you expect?! And that’s still the drill today.

Anyway, I can’t berate either of the doctors. They treated my hypertension and my type 2 diabetes. Both of them acted proactively and aggressively. What I’m saying is they did what they could. The fact that they did not know how to treat me for my obesity is not their fault. Besides, losing weight was not something they could do for me. That was my responsibility. I had to do it. But they, or at least the one I had been seeing from 1991 until 2012 (when he died), had been telling me to lose weight from the get-go, and he had done all he knew how to do and in his power, to get me to do it. He did tell me.

So, this is not a case of “My doctor never told me…” This is a case of my doctor didn’t know what to tell me. He didn’t know how, or he’d forgotten how, my physiology worked when my glucose metabolism was broken by insulin resistance. He didn’t understand that I am carbohydrate intolerant. He didn’t even know, but suspected and actually remarked that, if I lost weight by eating Very Low Carb (on the Atkins Induction diet that he suggested), that “it might even help your diabetes.” He just wanted me to try Atkins to lose weight. He never gave up on me. He had my diabetes “under control” (he thought, with progressively increasing amounts of oral antidiabetic medications), and he just wanted me to lose weight.

Well, little did he know (literally) how right he was. Of course, eating Very Low Carb did make it easy to lose weight, and it dramatically reduced, instantaneously, the need for oral antidiabetic medications. And, as I adapted to this Way of Eating, my HDL doubled, my triglycerides dropped by two-thirds, and after I Iost a lot of weight, my blood pressure dropped from 140/90 to at one point 110/70 and is now stable at 120/80 on the same meds. How did all this happen? Answer: I took responsibility for my own weight loss. My doctor suggested the diet, even if for the “wrong” reason, but after I started it, he just sat back and watched…and smiled every time he saw me. He never had to cajole or badger me again to lose weight.

Occasionally he would ask me, “How do you do it?” And I would just smile and answer, “It’s easy, doc! You just stop eating carbs. After a few days, you never feel hungry again.” And that’s the truth. You switch from being a “sugar burner,” with constant cravings for sweets and snacks, to being a “fat burner,” who lives off the fat you eat and the fat you’ve stored. Your body is “happy.” If you are not eating carbs, you need to eat some protein and fat at every meal. Allowing at least 14 hours between supper and breakfast will make for some serious fat burning in a “fasting state.” Your body will naturally switch to fat burning when the evening meal is fully digested and while you sleep. More details on how I eat here: #59:
Your doctor is not likely to tell you this (or approve, if you tell him). He isn’t trained in nutrition, and his advice would likely be wrong anyway. But the bottom line for both you and your doctor is results. If you adopt a Very Low Carb WOE, your results will tell that you’re doing it right. He may ask you how you did it, but he is more likely to say to you, “just keep on doing what you’re doing.” As mine did. “Just keep on doing what you’re doing,” he said. We both couldn’t be happier.

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