Saturday, May 10, 2014

The Nutrition Debate #208: “Teach Doctors Nutrition”

Driving up the New Jersey Turnpike on our return from Florida, I saw a bumper sticker that lifted my heart in joy: “TEACH DOCTORS NUTRITION.” At 75 miles per hour, I raised both hands from the steering wheel and shouted in exultation, “Hallelujah!” I don’t think the attractive middle aged blonde noticed, but my wife did. She grinned and told me to pay attention to the road.

I did, but I was reminded of my last visit, in both senses of that word, with my latest Florida doctor (see #207). During the “consultation” he was mentoring a medical student. Except to ask if I needed any prescriptions filled, I reckon he had more to say to her than to me. I listened as he pointed out my most recent HDL cholesterol, saying that he was among those clinicians who counted a high HDL to be a “good” thing.

Apparently, there are some practitioners who are skeptical of the value of a high HDL. The lab report actually cited my HDL as (H), meaning outside the Reference Range, which was “40-60” (no units!). All that matters to such doctors, with respect to the lipid panel, is that the patient take statin(s) sufficient to get the patient’s “high cholesterol” (>200mg/dL) under “control.” Statins do that, if nothing else, by lowering LDL cholesterol. My total cholesterol of 207 was flagged (H).

I jumped into the conversation he was having with his medical student to crow about my low triglycerides (34mg/dL on the last test), and to beam that that low count (and all the other lows I have had for over 10 years: 49mg/dL average; see # 68 here) were due to Very Low Carb. The student looked at me blankly for a few seconds, and then said, “Nutrition.” I said, “Yes, I did it by eating a Very Low Carb Ketogenic Diet and 2 grams of fish oil a day and a can of sardines for lunch.”

The doctor grabbed her attention back by pointing out my very good total cholesterol to HDL ratio, which at 2.3 was less than his 3.5 benchmark. I commented that I thought the benchmark was 5.0, and he replied to the effect that, being less than 3.5 meant plaque formation was in regression; a ratio of >5.0 would indicate that plaque was in formation. I hadn’t heard that before, and I admit I was pleased. He turned back to the student and said, “a ratio of 2.3 is really remarkable.”

When I tried to suggest that the explanation for these “remarkable” lab scores was nutrition, asking my doctor if he had looked at my website on nutrition (“The Nutrition Debate”), he replied dismissively “no” and went back to tutoring his student on my lab results. I felt like a cadaver in an anatomy class, except that cadavers don’t have feelings, do they?

Anyway, I applaud that doctors are interested in results (if you consider a low LDL and low total cholesterol a good result); too bad the only way they know how to get them is through pharmacotherapy. Perhaps the medical student’s grasp of the role of “good” nutrition in my own lipid panel will register. The challenge now for her will be to see that she gets educated in what “good” nutrition is. I hope that I planted a grain of doubt in her mind that the way to get “good” results in a lipid panel is not by pharmacotherapy, but by “Healthy Eating.” See column #200 for a discussion of that controversial subject.

For those to whom this is still not clear, I refer you to one of my most popular columns, #25, “Understanding Your Lipid Panel,” from August 2011. Column #27, “...the strongest predictor of a heart attack” is another online favorite. These are both “accessible” explanations of an alternative view of the lipid panel and various other health markers. Another good column, which addresses chronic systemic inflammation (possibly the only benefit of taking a statin) is discussed in column #187, “Chronic Systemic Inflammation and hsCRP.”

Finally, the extremely troubling view of the modern medical profession as practiced as a business today, described in column #206 by Dr. Cate Shanahan in the Epilogue of her very good book, Deep Nutrition (reviewed in #205), came into vivid clarity at the beginning of this consult. My doctor was viewing my medical records on his computer screen and confirming that I was taking my medicines. The first one he asked me about was a drug I had never even heard of. It was a statin. I asked, “Daniel F. Brown, 5/10/41?” and he said “yes.” How could it be, I wondered, that he had me taking a statin?
The answer I suspect, and as Dr. Shanahan relates, is that in large medical practices/businesses today they have “quality improvement programs that track physician prescribing patterns.” “We call it ‘quality,’ but it’s really about money,” an MD told Dr. Shanahan. “The doctors who prescribe the most get big bonuses. Those who prescribe the least get fired.” I suspect my doctor entered in my chart after my previous office visit that he had prescribed a statin for my “high” cholesterol (207mg/dL). With the medical student looking over his shoulder, he “corrected” my medical record to reflect that I was not taking a statin. He probably entered in his doctor’s notes,” “Patient is non-compliant.”

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