Saturday, January 4, 2014

The Nutrition Debate #173: “Anyone can be a doctor…”

When I first read, “Anyone can be a doctor…,” my reaction was, this is over the top. It was just a comment, to be sure, on a controversial blog post at Kris Gunnars’ excellent Authority Nutrition website; but still, I thought it went too far. Then, as I read on, I came to see the point: “…so long as you stay away from drugs [pharmaceuticals] and supplements and stick to using food as your medicine.” The commenter, someone named “Wenchypoo,” had got my attention with her trenchant and pithy lede, and while I might take issue with her caveats, she made a very good point. After all, it was Hippocrates, the father of Western medicine, who said, “Let food be thy medicine and medicine be thy food.” So, Wenchypoo was just echoing Hippocrates, who also said, Primum non nocerum,” “First do no harm.”

Okay, I’ll admit that medicine has come a long way since 370 BC, but so has “food,” unfortunately in ways that are mostly detrimental to our health. The prescription to use food as our medicine was more prescient than most will acknowledge today. Yet many clinicians and health care providers, and bloggers like me, are absolutely convinced that the dietary advice our government has been giving us since the days of Ancel Keys’s 1953 “Six Country Analysis” and George McGovern’s 1977 “Dietary Goals for the United States.” is directly responsible for the increasingly ubiquitous modern malady known as Metabolic Syndrome which underlies all of the Diseases of Civilization. These dietary principles still reign today in the “Dietary Guidelines for the United States, 2010,” the most recent iteration of this horribly-gone-wrong intervention.

Crop production, food manufacturing and marketing have been driven by the prescription that our diet be composed of 60% carbohydrates, 30% fat, and only 10% protein. Do the math yourself on the Nutrition Facts panel to see how a 2,000 Calorie a day diet is composed. And read The Nutrition Debate #171, “Dietary Protein and Its Impact on Obesity,” for my most recent exposition on that subject. Further, the guidelines still ordain that animal products, which are higher in saturated fats and cholesterol, be reduced, and vegetable fats, such as corn oil, soybean oil, canola oil, sunflower oil, etc., be increased. These constructs are both totally wrong and, in and of themselves, the cause of our health and obesity mess.

The pharmaceutical industry and the government agencies and medical associations setting the standards of medical practice are still getting it wrong with the latest revised cholesterol recommendations. See The Nutrition Debate #180 and #181 next month for details and analysis from the medical community on these very problematic new AHA/ACC guidelines.

So, under these circumstances, what’s a person to do? The answer, of course, is to take charge of your own health…with respect to your “dietetic prescription.” I claim no omniscience in this field, by the way. I discovered – completely by accident – that changing what I ate “cured” my Metabolic Syndrome. My motivation was simply to lose weight, so when my doctor suggested I try Atkins Induction (a very low carb diet), I tried it. It changed everything. Thank goodness he had read Gary Taubes’s “What If It’s All Been a Good Fat Lie,” a New York Times Sunday Magazine cover story in July 2002.

I wasn’t hungry, my blood pressure dropped from 130/90 to 110/70 on the same meds, my HDL more than doubled, and my triglycerides went down by more than 2/3rds. My total cholesterol stayed about the same, as did my LDL, but my LDL particle size/pattern changed from “small-dense” to “large-buoyant,” meaning they were less likely to get stuck in ruts in my arteries caused by systemic inflammation. The high sensitivity C-reactive protein test (hs-CRP, a measure of inflammation) went from a high of 6.4 in early 2003 to a low of 0.1 in late 2012. Oh, and I lost 170 pounds along the way.

Many people today subscribe to a proverb associated with the prophet Luke, himself a physician: Cura te ipsum ("Take care of your own self!" or "Cure yourself, before dealing with patients.” My doctor, an internist/cardiologist, after reading Taubes, had tried Atkins Induction himself. So I had my doc to guide me. I trusted him implicitly to care for my condition (type 2 diabetes) in a medically responsible way. And I think he did, to the extent he knew how, by training and clinical practice experience, and by following the standards of practice guidelines laid down for him my his medical practice specialty and by the public health and research bodies of our government, such the National Institutes of Health, and the National Heart, Lung and Blood Institute, the National Cholesterol Education Program, etc., etc.

But my doctor at first had followed the 2nd version of the English translation of the Hippocratic Oath before he followed the 1st version: The operable provision of the 2nd version is: “I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.” The operable provision in the 1st version is: “I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.” (Emphasis mine in both quotes) My doctor had “prescribed regimens” before he “applied dietetic measures.”
So, my doctor, in his unending search for a way for me to lose a lot of weight and keep it off, suggested, after reading Taubes, that I apply dietetic measures against the medical establishment’s recommendations. He did it “for the good of his patient” and “according to (his) ability and judgment,” and he “kept me from harm.” He must have recognized a risk, but by monitoring my health closely, we learned that the clinical outcomes clearly justified the risk. Good on him!

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