Thursday, May 30, 2019

Retrospective #104: It’s Not Feckless to Be Fickle

I have mused a few times about how most doctors and dietitians, especially established practitioners, are in a bind. 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 in 1961,, and made the cover of Time Magazine, the “die was cast.” Everybody read Time in those days. Now, it’s just a pamphlet! But the medium spread the message. To this day, the health establishment trumpets it.
2) The specialties in medicine are governed by medical associations that set “Standards of Practice” that are in turn adopted by Medicare and then by private insurance companies. In some ways it makes medical care simpler, quicker and certainly less risky. The older clinician gives you and the standard exam, the standard reimbursable tests using the standard medical codes, for which he gets paid, and the standard treatment: a script for pill(s) and advice to lose weight (“eat a balanced diet”) and “move more” (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? Admit that what he has been prescribing for many years, doesn’t work that well? That what he has been telling you all these years is wrong? That it is exactly backwards? That the diet-heart hypothesis was not evidence-based, just bad 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? How can I still be confident? Is he a quack?
Many doctors and nutrition scientists are saying this now, but to be fair, not for the same indications. My doctor, who was a board-certified internist and cardiologist, suggested that I try Atkins Induction – off label, as it were – to lose weight. He had just read Gary Taubes’s July 2002 New York Times Sunday Magazine cover story, “What If It’s All Been a Big Fat Lie.” He had tried it himself, had lost 17 pounds in a little over a month (with no ill effects on his cholesterol panel), and suggested I try it. Ever cautious, though, he did monitor me monthly for a year.
Anyway, most doctors would have a hard time doing what my doctor did, even if they believed in it. But you, their patient, are not in the bind that 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. You, the patient, can change what you eat.
Okay, you don’t have to do “the full Monty” to start with, or ever, for that matter. 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. Or, you could work your way down to 20% carbs (100 grams of carbs/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 even be hungry). Or, you could do Bernstein (6-12-12 = 30/day), or Atkins Induction (20g/day) or my current Way of Eating. I do 15g of carbs/day. I now eat 5 grams of carbs at breakfast, zero at lunch, and 10 at supper, unless I have a glass or two of wine, which I often do now. That bumps me up to between 25 and 30 grams of carbohydrate a day. And I’m still ketogenic.
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 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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