Retrospective #95: My Doctor Died Last Week – An Appreciation

My doctor died last week. [This is a 2013 Retrospective.] The cause was bad medical advice. An internist and cardiologist educated and trained in the traditional ways of medicine, he was taught to treat symptoms: High cholesterol? Prescribe a statin. It will lower LDL cholesterol and get the Total Cholesterol within the ACC/AHA guidelines. Unfortunately, it did not lower his risk for all-cause mortality. My doctor died of…intransigence.

I remember my doctor as someone who cared about me. When I first came to see him in 1991 (on my 50^th birthday!), I was morbidly obese and I had already been a diagnosed Type 2 diabetic for five years. My doctor first focused on improving my blood sugar control. He prescribed higher doses of the sulphonylurea (Micronase) I was on and then, when it became available in the U.S., added Metformin. When I was “maxed out” on both of those, he started me on Avandia. None of these drugs seemed to work, though. My diabetes got progressively worse. But then, it was expected to. The medical establishment still describes Type 2 diabetes as a “progressive disease.”

My doctor also really wanted me to lose weight. I remember when his Registered Dietician counseled me to eat a “balanced” diet, cut down on calories, and exercise for half-an-hour at least three times a week. She even gave me suggested meal plans and ideas for snacks when I couldn’t get to the next meal without a little “energy boost.” None of this worked for me either. They tried, though. He probably wrote in my chart that I was “non-compliant.”

Then, luckily for me, one day in late August 2002, when I walked into his office, he saw me and said, “Have I got a diet for you!” Turns out in early July he had read Gary Taubes’ New York Times Sunday Magazine cover story, “What If It’s All Been a Big Fat Lie.” He tried the diet himself and lost 17 pounds! So, he suggested I try it too. It was a Very Low Carb program in which you eat just 20 grams of carbs a day. I did it for nine months and lost 60 pounds.

The very first day on this new diet, though, I got a “hypo,” a low blood sugar. I called the doctor and that week he progressively took me off all the medications I was on until I was just taking minimum doses of the SU (Micronase) and Metformin. A few years later, when I switched to the Bernstein Diet (designed for diabetics), I lost 110 pounds more and discontinued the Micronase (the SU). I still take the Metformin.

My doctor saved my life, but couldn’t do it for himself. After he showed me (and him) it could be done, he went back to a “balanced diet” and regained the weight he had lost and then some. When I continued to see him three times a year for many more years, he would always ask me, “How’d you do it?” I would answer, “I stopped eating carbs!” He would look at me and smile wryly, perhaps wistfully. I wondered if he was thinking, “How does he do it?

I wanted to say, “It’s easy, doc, once you get keto-adapted.” “You’re not hungry when you let your body feed on its own fat”. But he couldn’t do it. As a traditionally trained cardiologist, how could he eat a diet that is 75% fat, 20% protein and 5% carbs. He couldn’t eat all the saturated fat and cholesterol and add salt to his food too!

Of course, he ordered a lipid panel for me every time I saw him (and an EKG, which was always “normal”), and echo cardiograms and carotid tests once a year. He saw that on my Very Low Carb diet my HDL doubled and my triglycerides dropped by two-thirds. He saw that my A1cs and my C-Reactive Protein (inflammation) tests were stellar. But, despite the evidence of my much-improved health on the diet he recommended to me more than 10 years before, he was unable to bring himself to do it again. What more evidence did he need? Well, maybe he just couldn’t accept that his entire clinical practice had been “a big fat lie.” I mean, really, how could he do that?

Virtually the entire Western world is now vested in the “lipid hypothesis.” The USDA and HHS and Agribusiness and Big Pharma are all, metaphorically speaking, “in bed with each other” along with the big manufacturers of processed industrial foods. Can this ship ever be turned around? Will it ever be? It is so frustrating. Anyway, I am grateful to my doctor for saving my life, even if he couldn’t save his own.