Thursday, September 12, 2019

Retrospective #208: “Teach Doctors Nutrition”

Driving up the New Jersey Turnpike, 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 blonde driver 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, to a Florida doctor. He was mentoring a medical student, and except to ask if I needed any prescriptions filled, he had more to say to her than to me. I listened as he pointed out to her my high HDL (90mg/dl) cholesterol, saying that he was among who counted a “high” HDL as “good.”
The report actually cited my HDL as “H” and outside the Reference Range (40-60mg/dl for that lab). But the only things that matter to such doctors are Total Cholesterol and LDL. And that to lower the patient’s “high” LDL, the patient takes a statin. A statin will lower Total Cholesterol to less than 200mg/dL (which they define as “under control”) and by so doing it will lower LDL. My Total Cholesterol was 207mg/dl, and it was flagged as “high” (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 (49mg/dL average over 10 years), were due to eating 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, 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; he replied 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. 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. Too bad the only way they know how to get them is by prescribing drugs. Perhaps my tutoring of the medical student on the role of “good nutrition” in my own lipid panel will “stick.” The challenge now for her will be to see that she gets educated about what “good nutrition” is.
For those to whom this is still not clear, I refer you to two of my most popular columns, Retrospective #25, “Understanding Your Lipid Panel,” and Retrospective #27, “…the strongest predictor of a heart attack.” These are both “accessible” explanations of an alternative view of the lipid (cholesterol) panel and other health markers. Another very good column is Retrospective #187, “Chronic Systemic Inflammation and hsCRP.”
Finally, the extremely troubling view of the modern medical profession as practiced as a business today, described in Retrospective #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 and confirming that I was taking my medicines. The first one he asked me if I was taking was a drug I had never heard of. Turns out, it was a statin. I stated my full name and DOB, and he replied “yes.” How could that be, I wondered?  How could he have in my medical records that I was taking a statin that he had prescribed for me?
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,” her boss 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 non-compliant.”

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