Let’s say you have finally turned your back on the “calories in = calories out” drivel, donated the hearthealthywholegrains to the neighbourhood birds where they rightly belong and swapped your industrial seed oils, masquerading as vegetable derivatives, for good old-fashioned butter. You feel great, you are losing extra weight, you have reduced your medications and enjoying a healthy relationship with food for the first time in your life. Proud, you announce to your family doctor that you now eat like a caveman and in return you get a blank look with a hint of concern for your mental and physical wellbeing.
What do you do?
Disclaimer: I’m not a general practitioner, PCP or a specialist (yet!). I’ve spoken to many and been taught by a few. As a pre-intern and before, a medical student, I have been a part of the treating team in general practice, outpatients clinics and in the hospital setting. On that basis, I will take the liberty to draw some tentative observations and give some generic advice on this subject. Health professionals reading this, please feel free to chime in.
If you just want to rub it in to your doctor’s face because you have had a tough relationship with the medical profession in general, I get it. You can stop reading now ….
However, if you are intending to maintain a mutually respectful and useful relationship with your GP and even educate them about a couple of things, you might need a few hints.
1. Don’t make assumptions
This might sound obvious but you shouldn’t assume that all docs are stuck in the dark ages and will be naturally resistant to anything out of mainstream. If you are working yourself up for a confrontation you are going to get it. If you expect an open mind from your doc, you need to approach that conversation with an open mind yourself.
2. Don’t accuse the doctor of ignorance or incompetence
It mightn’t be a good idea to start the talk with: “You know nothing about nutrition, I read this blog from a medical student that says so”. May I also refer you to my other post where I point out how many years medical training actually takes. It’s deplorable that nutrition is not part of the curriculum but it is hardly the fault of a person in front of you, who has studied 12+ years and might have x years of experience. Tread with caution.
3. Be careful with conspiracy theories
We all know about pharmaceutical, agricultural and political interests involved in the business of food supply. But as a conversation opener it really sucks.
“Doctor, I have stopped eating wheat because Monsanto’s unethical practices compromise the health of the planet”
“Riiiight… Erm, have you been under a lot of stress recently?”
4. Bring science to the table
Whether you are a science guru or a curious web wanderer you can use Evidence-Based Medicine to your advantage. If you have access to studies and a deep desire to educate your doctor in the error of his/her ways there are a couple of things you can do.
~ pick your battles: choose one area at a time, eg. Saturated fat is a necessary part of human diet, not a killer substance designed to punish us for our gluttony
~ find the evidence: doctors prefer randomised controlled trials and meta-analyses, like this one:
~ bring a hard copy to the consultation. Emails are less likely to be read as most GPs are very busy. Even better, highlight the abstract of the article and leave the paper for your doc to read. They might or they might not. A simple overview will go a long way to spike their interest:
“Hi, doc, I’ve come across a recent study you might be interested in. Looks like they analysed 21 prospective cohort studies with a total of almost 350 thousand people with a follow up between 5 and 23 years. They found that there was no link between saturated fat intake and risk of coronary heart disease, stroke and cardiovascular disease in general. Seems to be one of several studies in the last 10 years that exonerates saturated fat. Me, I’ve never liked that low fat yoghurt, they just replace fat with sugar. Here is copy if you want to check it out”
~It’s ok if you are not well-versed in the intricacies of Evidence-Based Medicine. Many bloggers out there pull out the latest studies and break them down for those less time/inclination/patience (PubMed…yawn) making a job easier for you.
5. N=1 is a great start
Your results are the best proof that your Paleo/primal/traditional/low carb lifestyle works. You will see the new respect in your doctor’s eyes when they see a drop in your blood sugar numbers if you are a diabetic. They will join you in rejoicing when your long-standing eczema, for which they have written countless steroid cream prescriptions, goes away. “MY irritable bowel syndrome is better now that I don’t eat bread or pasta” might even get your doc interested enough to read that study on gluten that you have printed out for them. Don’t underestimate the deep (sometimes very deep) desire of most doctors to help people and see them get better. They might even suggest a similar strategy to another patient of theirs with the same problem.
6. Admit it: you are a freak
If you think that it is normal to read 5 blog posts a day on nutrition, follow 200 health professionals on Twitter or know the difference between fructose and sucrose, I hate to break it to you. It isn’t. You are officially a part of 0.01% *of the population who a) care about their health b) seek out information c) use their brain d) dare to question the conventional advice. You are a rare breed.
*no actual statistics was used to determine this number. Please do not send emails requesting scientific references
The majority of patients are not like you. They want an instant result with little effort on their part. I do not blame them: they have been conditioned to believe that everything can be solved with a pill, a surgical procedure, a new face cream and an AbCirclePro.
Do you know what most doctors think about lifestyle change recommendations? It’s not that they don’t work. It’s that people don’t follow them. The frustration leads to indifference. Like many patients, I have issues with the advice to “just eat less and move more”. But sometimes doctors have to deal with people unwilling to stop injecting IV drugs, smoking cigarettes, drinking a bottle of scotch before lunchtime and feeding KFC to their one-year olds. You might just rekindle a jaded doc’s belief in the power of good.
7. Go for the young’uns
Medical students and junior doctors get picked on. A lot. If you survived medical school with your ego intact, congratulations, you must have started at a higher baseline than me. Maybe this is why, in my experience, young doctors are much more likely to admit that they know nothing about nutrition. And why they tend to defer to government guidelines, dietitians and nutritionists. Another reason why the young docs are “an easy target” is because they are still relatively uninfluenced by the pharmaceutical propaganda. They are still naively excited by free Viagra pens. So don’t be afraid to share your experiences and ideas with medical students and hospital residents. Sure, you might get a funny look and a sneaky PRN order for haloperidol (sorry!). But one comment may be all it takes to plant a seed in someone who can look at the system with fresh eyes.
Doctor-bashing is practically a national sport nowadays. You can always count on an after-dinner horror story about corrupt GPs handing out antibiotics like candy, inept hospital interns missing blood vessels and arrogant surgeons leaving objects in body cavities. If you have decided to turn your back on the Western medicine you might have a good reason for doing so. But if it’s just a knee-jerk reaction born out of frustration with the system and a couple of bad apples, I might be able to convince you to reconsider. And at the end of the day, even if you cannot find the doctor who is willing to let go of the fat phobia or recommend kimchi for healthy gut, the next best thing is a doctor who treats you with respect, empathy and is prepared to listen.