The mind boggles…

Hello, my name is Anastasia. It’s been 32 days since my last nutrition rant. I thought I had everything under control. I was calmly writing a huge post on polyunsaturated fatty acids. It came out of the blue. I walked into a scheduled lecture on major clinical concepts surrounding diabetes naively believing I had the willpower. Those of you watching me implode on Twitter know just how wrong I was.

The endocrinologist who was standing in front of us is probably a fantastic doctor. He was just asked to help some medical students revise the clinical approach to Type I and Type II diabetes. I cannot judge his level of knowledge or his expertise based on a few slides. But maybe you can.

After briefly recapping the definitions of Type 1, Type 2 and LADA (late onset autoimmune), he got my attention by declaring that Type 2 Diabetes was a genetic condition. I was a bit flummoxed. Sure, I know of the studies isolating the genes involved. I also know of the popular quoted statistic that the identical twin of a diabetic patient has 90% chances of getting the disease. Still I think of Marfan’s or hemophilia as a typical genetic condition: a known mutation of a certain gene causing a problem.

The next important fact to be addressed was the increase in the prevalence of diabetes. I thought you had to have spent some serious time under a rock not to have noticed that but nevertheless I observed many students scribbling furiously.

At this point I was getting a little confused: why would a genetic condition increase in prevalence in such a short period of time? The answer was on the next slide.

Causes of increasing prevalence of T2D:
– increasing gene pool
– obesity
– high fat and high GI diets
– less physical activity

“Increasing gene pool” had me slide down my chair in a fit of silent giggles as I was mentally fighting off in a image of all those sex-crazed diabetics hellbent on spreading their defective genes.

And you all know how the obesity story goes: being a glutton and a sloth makes you fat. Being fat makes you a diabetic. Hang on, wasn’t it genetic? I’m lost.

This disease is so horrible that if you are thin then it’s your genes, and if you are fat then it’s your fault!

So is there any hope???

Here is a long awaited lifestyle slide:

1. Refer to a dietician for diet advice.
Good to know that we as doctors are prepared to admit that we are totally inept in giving diet advice.
2. Lose weight.
If only somebody ever told a fat diabetic that all they have to do is to lose weight! They wouldn’t have had years of silent small vessel damage destroying their retina, eyes and kidneys.
3. Maintain physical fitness, eg walking 30 minutes a day 5 times a week.
My sarcasm has actually failed me at this point. I honestly have nothing.

The discussion on the lifestyle changes for diabetes was pessimistically concluded with: it’s too hard to convince patients to change their diet and increase their physical activity. The lecturer sounded genuinely upset about this fact, lamenting that most lifestyle changes tend to fail, at which point all diabetics inevitably progress to medication.

Ah, yes, the medication. Quick rundown on the drugs: from metformin (“a fantastic drug which assists with weight loss and improves the liver insulin sensitivity”) to sulphonylureas (“fantastic drugs with a proven safety record which increase the insulin output from the pancreas”) to glitazones (“recent drugs exciting some cautious optimism, still associated with some unfortunate side effects, like HEART FAILURE”) and so on. Until, finally, insulin. All roads lead to Rome, all drains lead to the ocean. All diabetics end up with insulin.

Apparently, the trick with insulin is not to forget to increase the dose when you know that you are about to shock your system with a gargantuan serving of pasta with a low fat sauce. Silly me, I would have thought it sensible to reduce your requirements for insulin in the first place.

And of course as any medical student knows, a discussion on diabetes has to be wrapped up with some happy snaps of gangrenous toes. That will drive the message home!

I know that many of you are reading this with a mixture of exasperation and amusement. And a shadow of superiority. Surely any intelligent person would critically appraise the information given, research the best sources, analyse primary studies, draw their own conclusions and use their own brain???

What if you are a medical student? You have 5 months till people call you “Doctor”.  You need to be able to deal with trauma, haemorrhage, heart attack, delirium, burns, sepsis, anaphylaxis, organ failure, psychotic episode, dislocated shoulder, meningitis, testicular torsion and a spider bite.

Senior doctors inspire our admiration with their wealth of knowledge, confidence in dealing with the unexpected, their people skills (not always) and the sheer fact that they have been through what we are going through and survived! Even if you were crazy enough to start a nutrition blog in your last year of med school, do own research on the train to the hospital and write angry posts instead of studying for exams… would you question an esteemed professor during his lecture?

Everything we know is just what we have been told. Based on that, the future of medicine has me worried.

I am eagerly awaiting your comments.


89 thoughts on “The mind boggles…

  1. To be honest your post pretty much reconfirms my views of the majority of GPs. I was diagnosed with PCOS not long ago and when the doctor advised me she told me I had one option – metformin. This was even before doing the proper blood test that tests my insulin reaction or whatever. It’s so hard to trust the people that we are told are supposed to be experts and it’s not as though doctors are something you can easily “shop around” for.
    By the way – I found your blog through IWCF and love it. Disappointed I missed your talk a few weeks ago though!

    • Emily, PCOS should definitely be addressed throughout diet/exercise. You might find metformin useful but aim to restore your metabolism via lifestyle changes as well. Metformin improves the insulin sensitivity in PCOS patients. So does exercise, so does the diet low in fructose/sugar, grains and other carbs, industrial vegetable oils and processed anything. Crossfit will help. Did you do the Paleo challenge? To repair metabolism in PCOS might take a long time, so be patient and stick to it.

      • Thanks for your reply! I didn’t do the Paleo Challenge as I wasn’t comfortable with sticking to a diet that I knew little about without having the time to do further research – I am definitely trying to push my diet in that way though and am enjoying reading the science side of eating on your blog. I think I eat ok now, I don’t use industrial vegetable oils and steer clear of processed things… I could do with cutting down on sugar and grains though. Is PCOS definitely a symptom of metabolism issues? I guess I had never considered I had a problem with my metabolism as I am not overweight at all – am I wrong in thinking that metabolism issues manifest in weight gain? So much to learn!! Thank you for educating people like me who like/need to understand the science behind things we are expected to accept.

    • I would suggest get enough sunlight (Or supplement with vitamin D3) and drink good amount of milk or eat cheese from grass fed cows. PCOS is pretty much related to calcium deficiency in most cases.

      • Be careful with dairy and PCOS, it contains IGF-1 which can in fact make PCOS symptoms worse. I have PCOS and any dairy stops my weight loss and guarantees an outbreak of acne that otherwise is pretty well controlled.

        • Dairy also seems to provoke insulin response greater than its carbohydrate content. This makes it less advisable for those after weight loss and with insulin resistance, diabetes, PCOS, etc. I might eventually do a post on it, Jehane.

  2. Hang in there, Anastasia. Speaking as a type II diabetic who had to learn on her own how to ‘manage’ her diabetes, we need you out there in the medical profession, not in prison for semi-hysterically clubbing some idiot who can’t even logic-proof his own slides, much less keep up with actual research.

  3. When you are practicing, let us know and I will send my type 2 husband to be your patient. It is amazing the mindset that all people are too stupid to actually research treatments on their own, and too lazy to give up junk food and prepare healthy food. My husband has stayed off all medications with his low carb diet. Though they say no one could stick to it. He is doing fine since 2008.

    The medical community, we have found is actually antagonistic toward carb reduction for diabetics. My son made a business plan in college aimed at creating an internet based support system for diabetics, and their ideas of carb reduction were considered out of the mainstream and therefore unqualified as an option for the business. Doctors make assumptions and arrange treatment for the lowest common denominator among patient responsibility. Those of us who think, who really care, are left on our own.

    • Low carb is definitely viewed as suspicious. To medical profession in general it has a whiff of danger about it: cutting out “a whole food group”, not getting enough fibre and don’t get me started on all that saturated fat. And you can never stick to it, therefore it must be a fad. They should mention it to Dr Bernstein who has been managing his Type 1 Diabetes for decades with a low carb diet. Happy to see your husband, Lisa, as long as we are in the same hemisphere 😉

  4. It could be worse. You could be an economics Post-Grad being lectured by his university professors on the glories of Keynesianism as the entire industrial world is on the verge of economic collapse…

    • And you just lost me, Jack ;). I assume it’s like a final year medical student being taught the gross anatomy of the heart.

      • It’s more like having to sit through lectures on leeches while everyone around you is bleeding to death and talking about the four bodily humors.

    • Even worse than that, you could be a Keynesian being lectured on the glories of Milton Friedman’s free markets and deregulation after shelling out trillions to bail out bloated financial institutions. Welcome Age Of Austerity!

      Anastasia, I agree with all you say, but I’m curious about your opinion on this. I had dinner with a good friend who is a cardiologist this weekend, and his main complaint is patient compliance. It doesn’t matter what advice about diet or exercise he gives them, they continue to do what they want. Must be very frustrating…

      • I think it’s a bit of both, Melissa. Some patients will never follow our advice. It’s frustrating but it is their decision. However, if we are giving the wrong advice (low fat diet plus walk 30mim daily) and they do not see any results, is there any wonder that they give up on us?

  5. I hope you can open some eyes in this regard to some of your fellow students/teachers…otherwise, there are some fantastic naturopathic medical schools in the U.S. Maybe a transfer is in order? You may be learning all the wrong things at this school 🙂

  6. I happen to know just how little doctors know about lots of things, not just nutrition, diabetes, etc. I have EPP (erythropoietic protoporphyria), and must doctors have no idea what that is. I usually have to bring in all my information if I’m going to a new doctor.
    Keep up the good work trying to bring the truth about nutrition to all those who think they know best – I love reading your blog!

    • *looking up EPP right now* 😉 We need patients who are educated enough about their own condition to help us help them. Thank you for your support, Chris.

  7. There needs to be a serious paradigm shift in respect to diabetic treatment and diabetic “care”. I was formerly a thin, fit person BEFORE children. I thought I could avoid diabetes by being healthy and fit because of what I was taught. Big mistake. Once I had my first child, I kept the baby weight (even though I was vigorously exercising and dieting). If only I had known that becoming insulin resistant during pregnancy was not my fault nor was the extra weight gain with each child. Many years later, I lost over 100 lbs yet I still developed diabetes. Eventually, I became an insulin dependent diabetic because I was LADA instead of a Type 2 diabetic. I had been low carbing for years, exercising an hour per day, and taking Metformin when I progressed to insulin dependency. Obviously NOT my fault, but the doc in the hospital thought I was a non-compliant diabetic even though I was not even overweight. <<>> The only way my blood sugar came down to normal levels was with insulin, yet this doc refused to discharge me from the hospital with insulin. He gave me oral meds instead. I had to go to another doctor and endure my blood glucose elevating to dangerous levels until this other doc could see me. He prescribed insulin and immediately administered some in his office. Thank goodness for caring, knowledgeable doctors.

    All of the insulin resistance during pregnancy and the unexplained weight gain while exercising were all signs that were missed by many doctors. I kept being told to take my meds and exercise more. If more doctors would take the time to research the disease instead of blaming the victim, us diabetics would receive much better treatment. If weight loss and diet made diabetes go away, my diabetes would be nonexistent.

    • Insulin saved many many lives since it was discovered. I rate it together with penicillin as one of the miracle drugs of the 20th century. Most LADA patients end up requiring insulin much sooner than T2D. But I am sure you dont use sky-high doses of NovoRapid to cover for a massive pizza you are about to eat. Doctors need to give people the tools to control their condition and one of them is definitely the lifestyle change.

      • I agree, Anastasia. I would be dead without my insulin and I am happy I live during a time when insulin is easily obtained. Due to a low carb lifestyle and exercise, I typically only require 5 units of insulin in the morning and 5 units at bedtime. Lifestyle changes (low carb living and exercise) definitely need to be done in order to deal with diabetes. However, doctors need to stop blaming diabetics if their mode of treatment does not work. They need to search for answers to the WHY a treatment plan is not working instead of constantly playing the blame game. Yes, SOME diabetics are non-compliant, but all of us should not have to pay for those misconceptions about ALL diabetics.

  8. I was diagnosed with Metabolic Syndrome in the 90s, when it was still called Syndrome X (which sounded way cooler). My sugars got up to 123 at its worse. I refused meds (fear of side effects) and begain my journey to figure out how the hell to lose weight and learn to like exercise. It’s been a long hard 7 years of figuring that out. But as of June this year, my doc took me off the last miniscule bit of blood pressure meds and announced, “Your prediabetes is now resolved.”

    What I do in the last year that made a big change? I started addressing carbs. I started eating in a way to decrease insulin production. I started doing walking, consistently, along with the consistent Pilates I’d done for 3 years prior. I focused on fresh, real food in modest portions.

    It was incredibly hard to get a handle on my binge issues. It was incredibly hard to MOVE when I was 300 pounds and down to 186 now and still wanting to lose. Every pound was a fight, as with insulin resistance, losing weight was tough and my appetite was that of four burly men.

    But dang, doctors have to give patients hope it CAN be done. All meds have side effects. Some really bad ones. I was afraid enough of the Actos they originally wanted to put me on (and glad I turned it down) that it set me on a journey of learning and trying stuff and working on issues.

    Lifestyle change feels better than drugs. And people need to find out that eating Primal/Paleo/Primarian/New Evolution style, real food with real healthy fats, is amazingly flavorful and satisfying. I do divurge for some no-sugar added treats (lower carb) (I’m more Primarian than Primal, let’s say), but food can be delicious AND good for you. It’s not about cardboard rice cakes, fat free cheese, and gallons of oatmeal with bran like in my old dieting days. 😀

    • Your story is exactly why I want to do this. It’s absolutely inspirational to see somebody take charge of their own health and go beyond just taking a pill and hoping for the best. As doctors, we have to believe in our patients and support them in their lifestyle changes. Not dismiss it as something unsustainable or inferior to meds. Wow, what an achievement.

  9. I am stunned and impressed how much patience it must take to sit there and not speak up. I don’t have enough resolve to grin and bear it. How do you do it?

  10. Ditto on mountains response! The more scenario’s like these in which you have some professor/lecturer telling you everything you need to know, and of course we can trust him…, because he knows everything, right?
    I just find it so sad in my stream of nutrition students that probably most of them are getting sucked in to this nonsense, similar to your example, but no one seems to have that little bit of extra passion to actually question what they’re tutor is telling them. They just take home what they’re told and then practice it on hundreds of people once they’re graduated! Gets you fuming! If anythings going to get me, it wont be my high sat fat intake, but having to sit there in class, blood boiling, listening to utter crap, it’s actually stressful, and unless your tough enough to raise your hand in front of hundreds, then you just feel helpless. That’s my rant!

  11. I share your rant… it’s just a joke isn’t it? Even deferring to a dietician is utter crap. I have husband & wife clients, where the husband is manager of the dialysis unit currently overwhelmed with diabetics, and the wife is a nurse within the hospital diabetes centre. Both are paleo, and both are constantly frustrated with the advice given out by doctors and dieticians. But neither can fight the system. So we are left with ineffectual lifestyle advice, where everyone readily admits it doesn’t work – but doesn’t work because of the patients it is given to, not because it is the wrong advice (wind back the clock two years and I absolutely subscribed to that). That leaves us with diabetic drug therapy, which by comparison to say, chemotherapeutics, are relatively safe. And all we need to do is use increasing doses of these drugs to offset the foods that got them into this mess in the first place. Everyone wins… the food industry, the fitness industry, the drug industry, the doctors, the dieticians… everyone has an income and everyone is happy. Quite a good system, really, don’t you think?

    • Absolutely, Jamie, it’s much easier to blame the patient for not following your advice than to admit that the advice was crap to begin with. And it’s easier just to give them drugs to control their sugar, control their blood pressure, control their cholesterol. The numbers will look great. For a while. And then you increased the dose.

  12. Hello, there. Been a silent reader of your blog for some time now, but felt compelled to comment here!

    I’m a nurse in the US, currently studying to be a Nurse Practitioner. Our curriculum contains a nutrition course, which I decided to stop attending half-way through the semester. I read her book and took the exams, but after the heart disease lecture I could take no more. Something about telling a fifty-something, chronically inflamed, post-MI, pre-diabetes, HTN patient to increase her intake of whole grains to six servings a day just seemed wrong to me…

    Anyway, you’re not alone! And if I am any indication then maybe you’ll have some Primal mid-levels out in Australia to support you in the future!

    • Of course the nurses get the same info as the rest of the health professionals! Looking for a nurse for my future practice will be a challenge, I am sure. Let me know if you are planning on moving to Australia in the next 5 years 😉

  13. It is quite a sad state of affairs. A largely optional disease is consuming our healthcare system, and worse yet, our health.
    People want doctors to give them a pill (should be small, easy to swallow, small co-pay) rather than taking personal responsibility for their actions.

    • I think it’s a bit of both: the doctors and the patients. Some patients would be more empowered to change their lifestyle if their doctor actually told them that their diabetes is not just a genetic disease that they can’t do anything about. Very sad.

  14. Hi,

    I’ve often thought about getting some formal qualifications in nutrition etc, but I realised I’d probably fail because I wouldn’t be able to put up with garbage like that…

    Great to know that Australia will be getting a new Dr with a clue in the near future. Make sure you let us know where you end up practicing!


    • Thanks, Craig. The end is in sight for me. Don’t let the conventional wisdom stop you if you want to get into nutrition. Do the course if you want to, just have a really good sounding board at home.

  15. The best wisdom I learned in my life goes like this: when in doubt, it’s because of money.

    It looks like too simple reduction, but my experience so far is that when something unimaginable happens, it is most likely because of money. Our current medical system is no exception here. Think about who make money out of such treatments for T2D.


  16. I’ve been thinking about a related question a lot lately: how do you change a culture?… particularly one that doesn’t recognise its own failings? It can be done. History shows that you can change the way the masses think in scarily effective ways. Think Nazi Germany for an extreme example of this. Anyway, this is what I think needs to happen for any new belief/culture/theory to become mainstream:

    1) Some super smart, observant, counter cultural people see the conventional approach for what it really is and with an open mind they start seeking a better alternative
    2) An alternative is found. It usually isn’t as simple as this. The new hypothesis is refined over many years and with the input of many people
    3) The new approach is tested and documented

    This is all well and good so far but if only a handful of people are on board at this stage then nothing much is going to happen, which leads us to…

    4) A new sub culture grows up around the new belief. In the beginning the only ones interested were people with major dedication to the science of health (and let’s face it, most people want to be healthy, but don’t devour scientific journals and come up with their own hypothesis on how the body works) but now the believers are starting to become more general. Usually small, counter cultural sub-cultures develop a passionate following. It takes passion to swim against the tide.
    5) People “of significance” (or maybe I should say with popular influence?) are incorporated into the new culture. The wider community starts to listen to these people.
    6) Public debate and exploration of the new culture (probably via the media). Some people aren’t going to know about changes in the world unless they are on Today Tonight or in Womans Weekly (very sad, but you know it’s true.
    7) Finally, acceptance by the scientific community, government, health agencies, etc. In other words, there starts to be some “official” recognition.
    8) The new idea becomes the accepted cultural norm.

    I think number 7 could happed a little earlier… The scientific community is likely to adopt a new approach much quicker than, say, the government.

    I think the Primal/Paleo community are at step 5 at the moment. There is a small, but significant and growing community out there. What it needs is people with influence to join up. In my mind these people would include medical experts, doctors, scientists/researchers who already get respect, media types/journos etc.

    Bring this back to your situation Anastasia (yes, I wasn’t just high jacking your comments without reason), your lecturer has a pretty significant influence over the minds and beliefs of the next generation of health professionals. Maybe you could organise to have coffee with this lecturer and have a healthy conversation about your new approach?

    Sorry for the long reply.

    • Interesting thoughts on influence, Brian. Both Paleo and low carb crowds started off as a fringe community. As it always happens on the fringe, it is the most radical and extremist views that get the most public exposure. That’s why low carb always gets lumped together with Dukan diets/high protein/sausage and bacon all day long etc. I admire your optimism but I hope rather than believe that Paleo is at step 5.
      One of the problems of this movement is that to a certain extent we only talk to one another, only read each other’s work and have pointless arguments whether potato is Paleo. I meet about 10-20 new people a day. I can count on one hand how many of them know anything about carbs/insulin/fat/wheat/vegetable oils.
      We do need more exposure. A celebrity of some sort would be nice 🙂 but I’m afraid the chick from Transformers (what’s her name again?) is not good enough.
      My influence among my peers is nil, zero, nada. Most students know that I’m a little bit of a food Nazi and some kind of “gluten intolerant”. I am more respected for my medical knowledge than my nutrition knowledge. Nobody cares that unlike others I can actually tell the difference between EPA and DHA. I have received more support and respect from the Paleo community than my medical “family”. So I don’t think that professor will even sit down for a chat with me. Sad but true.

  17. The world as we know it today should always be challanged, that’s how we make progress … whether it be medicine or building a bridge. Love your thought process !

  18. Anastasia

    While in med school, it is best to keep your eyes, ears and mind open, and your mouth shut, lest you get the wrath of an attending, which befell me many times.
    Keep up your good work on this blog, and your open mind on treatments.

    I am curious as to what you have learned on statins and bisphosphonates. Are you a true believer or a skeptic?

    • Sounds about right: keep my head down and mind open. Regarding bisphosphonates and statins: like most I used to accept them as a given. I am not an expert on either, however from my current level of knowledge they seem more like a patch rather than actual treatment. The risk:benefit ratio is definitely skewed to the wrong side. And then there is a question of mechanism. I had a vascular surgeon openly tell me recently that they all know that statins work regardless of cholesterol level. I guess I can’t say I will never prescribe them (considering that decision will not be mine, as a junior doctor to make). But I will strongly encourage my patients to explore every other option: bone health via nourishing diet, resistance exercise and sun exposure. I’m not sure hypercholesterolaemia is a disease per se, in spite of what I write in patients PMHx, unless we are talking about FH. Same advice will apply there.
      I personally find that the skeptical attitude to most topics is very helpful in getting the best information.
      Which side of the fence are you on, DoctorSH?

  19. This is so what I have been saying for years, we put our trust too much in GP’s and forget all about our common sense and our own ability to work out what is best for us. T2D is a lifestyle disease, change your lifestyle and like magic the T2D goes away…. we are so quick to blame genetics (my mum was fat, so that is why I am fat)… it is more likely you are fat due to bad food choices and education growing up.
    I cannot wait until you become a GP, I will be sending everyone I know and love to you for proper, real advice, real information and compassion.

    • Unfortunately diabetes does its damage sometimes even years before the person is diagnosed. Much of this damage will be irreversible. Our goal is to educate people way before they get to this stage, hoping for prevention. Its never too late to change your lifestyle but you might still live with it for the rest of your life. And when I am a GP I expect to see yourself in my clinic also 😉

  20. Hey Anastasia
    Now! Listen luv..the old farts will accuse you of being a bit wet behind the ears!
    You need to be aware that GOOD HEALTH IS BAD FOR BUSINESS.
    The dietary advice from the Heart and Diabetic groups (and most GP’s) are responsible for more deaths than ‘Pol-Pot’.
    Things may improve when the ‘old brigade’ slowly die and fresh minds like yours enter the arena.
    In fairness to Gp’s..they have too many areas to cover to be effective with dietary advice and most feel they have studied enough and are too tired to explore up to date research which is moving fast.

    • Hahaha I feel properly ashamed of myself. Maybe I am blogging myself out of business. As to “fresh minds”: they were diligently copying down every word from that lecture. GPs are definitely overworked and most honestly admit that they are not experts on diet or exercise. Fingers crossed I won’t find myself in the same position.

  21. I just read your entire blog in one sitting. You are fabulous–informed, witty, current, clear, eloquent, passionate. Thank you very much–I’m a new fan.

  22. “they were diligently copying down every word from that lecture.”
    Yes! But did you get names?
    Like Stasi & KGB..I need to compile a ‘black list’ to protect the innocent and ignorant.

  23. Anastasia

    Research the nnt, number needed to treat for both the statins and bisphonates.
    Then kook at the absolute percentages of side effects for each.
    Also look at the mechanisms behind each. Are they fixing a metabolic problem or are they just masking it?
    Are you becoming a physician to make things appear good, or to truly help the body and the person heal?
    Sorry for typos, iPads are tough to use on blog comment sections.

    • I have some interesting data from the Australian prescriber on statins including NNT, summary of studies, side effects etc. Have to hunt around for bisphosphonates data but I’m sure it will be just as fascinating. Agree on all points.

  24. Here in the US there are not enough general practitioners and there are certainly not enough psychiatrists – I could literally see patients 24/7 and would still be getting more calls for referrals. I don’t worry about putting myself out of business by spreading an evolutionary health message. It would be nice to get a break.

    • I am sure patients are queuing up to your door, Emily.
      Ditto regarding psychiatrists in Oz. Australasian college of psychiatrists actually does active recruitment which is a nice change from specialities which try really hard to convince us NOT to join their ranks (“You were late for a 7am meeting. You’ll never be a surgeon” “Your tie clashes with your shirt therefore you have no appreciation of patterns. You will never make a dermatologist”). I kid you not.
      But there are loads of GPs. Probably because you can get qualified 4 years after graduation as opposed to 8. Still the most common complaint I hear is: it’s hard to find a good one.

  25. I finished medical school just a few short years ago and am now just learning about the “primal” way of eating. I am so mad that I didn’t challenge the things I was taught in med school, I just took it at face value… SO WRONG of me. The biochemistry behind eating this way makes sense, I wish I had asked more questions back then.. SO ASK AWAY, challenge those teachers/Docs… and it is such a shame we don’t learn this as physicians… and it is like hitting your head against a wall trying to teach this to patients as it is not in mainstream…. keep chugging along girl!

    • DocMama, at least you didn’t have to go through med school feeling the frustration daily. I almost envy my friends who exist in a state of blissful ignorance. Good luck with convincing patients!

  26. Anastasia

    In my practice I let people know I am a strong believer in low carb and paleo style nutrition for prevention and treatment of disease.

    I have gotten quite a few new patients who came to me precisely for my views.

    So stick with it.

    You will be sought after!!

  27. To Emily Deans

    I am in practice in NJ as a gp.
    My wife, while being a vegetarian who eats some eggs and fish, also believes in paleo, but she can’t stand the taste of meat.
    Did I say she is an adult, child and adolescent psychiatrist?

    The paleo, lowcarb movement is gaining momentum, and will be a force within five years for one simple reason.

    It works!!

    Btw, I have offered my wife diamonds, and shopping sprees if she would just eat one steak. She still refuses!

  28. There is no hindsight in this area.
    This is a cutting-edge on nutrition and the science,mechanism and strong hypothesis did not exist (lets say 5 yrs ago)..So Doc could you see something that wasn’t there?
    Thanks must go to researchers like Taubes for asking questions on macro-nutrients and their effects on disease.

    And Dr SH..bribery with your wife won’t work..perhaps slip her a copy of Denise Mingers book on vegetarianism, and like yourself may be convinced regarding harm/food.

    The majority of people/patients won’t ever be willing to learn or change their ways (frustrating) for Medico’s like Anastasia….nor will governments or the food industry.
    But there is a minority out there that will benefit and be grateful for this type of blog theme.



  29. Anastasia, do you try to talk to the professors or fellow students about changing the way they see things? Not saying you should necessarily, I’m just curious. I’ll be a medical student next year and I’m so excited for the challenge but also a little scared of being disillusioned by narrow-minded attitudes…

    • Mary, I’ve tried with a few friends but even they are skeptical. Ultimately everyone is just too busy and denial is much less energy-consuming than doubt or critique. Good luck with med school. I don’t advise arguing your point of view to lecturers or other students: pointless exercise.

  30. I so enjoy reading your blog! I hope that there are med students similar to yourself here in the US. I am hard pressed to find them in practice. I am a middle school science teacher, and I am just so thankful that nutrition is not part of my curriculum. I could not teach the current dogma with a straight face, and I fear trying to teach paleo would get me in deep doo-doo. Instead I get to teach reproduction to 14-year-olds! Good times!

    • Teaching reproduction to 14 year olds sounds way too much fun: an unbeatable combination of embarrassed giggles and mortification. Teachers at my daughters school do teach nutrition, she comes home and complains about it: “Mum, they don’t understand that all this healthy food is making them sick!”

    • Hi Jack, I had a quick look at that post and I agree with some points and disagree with others. I also far from agree with Dr Lustig on everything while I still have tremendous respect for his achievements.
      My view on fructose. I think we have enough evidence to show that large doses of fructose as seen in the Standard Western Diet are bad for the liver causing NAFLD which is likely the first link in the chain reaction leading to metabolic syndrome, diabetes and heart disease. Its effects are probably amplified by other components of the SWD: excess PUFA in industrial oils, lack of protective nutrients like choline and antioxidants and possibly chronic inflammation caused by overconsumption of grains. A healthy fit individual on a traditional diet would just metabolise fructose in one soda for energy and be done with it while somebody with deranged metabolism can’t afford that luxury.
      In this context promoting substantial reduction/elimination in sugar and soda consumption is in my opinion warranted.
      I am less convinced in excess fructose being the cause of obesity. I grew up in Russia where I haven’t even seen a soda can until the age of about 10. Fruit was a summer luxury. But a visit to a typical Russian village would show you many a full-bodied woman who would be considered overweight by Western standards. They didn’t get there by drinking Coke. Interestingly though, most overweight women in traditional societies have an hourglass figure, not the typical muffin top-skinny legs that you see in soda-guzzling western teenagers.
      So I stand by my opinion. Fructose is a dose-dependent toxin. Its modern delivery mode (liquid) has probably largely contributed to its effects.

  31. Haven’t read the article yet but have a few from you that I will definitely be reading. It’s wonderful to see a young person, coming out of medical school with this knowledge. I’m 40. It gives me hope. I’m still trying to talk to my older brother (he’s very hardheaded) about how he can reverse his diabetes. He just finished up college and what I get in response is “I’m a science major” (he’s becoming a teacher). I plan on sending him some links and yours will definitely be among them. Going Primal/Paleo a few months ago was the best thing I have to for my mind, body and health. Diabetes is killing my dad (he’s on dialysis and fading fast). I’m going to do everything in my power to make sure it doesn’t take my brother. I KNOW IT WON’T GET ME!!! Thank you

    • Thank you Heather. I think giving advice to our loved ones is sometimes the hardest. They are less likely to listen to a sister/daughter than a doctor, or even Dr Oz. Lots of luck. You have made the first step: looking after yourself. All you can do is help educate and lead by example. All the best.

    • Hi Skybluemonkey, I agree the article is a bit convoluted. I got lost around palmitic acid in cell cultures (we don’t eat palmitic acid in isolation and we are not cell cultures). I’d like to see the full text if you can get it. My questions would be: what was the breakdown of the high fat diet fed to mice (corn/soybean oil are the favourites with researchers)? Also a simple but a real-life question: were the mice force-fed or fed ad libitum? Is the reduced expression of glucose transporters a physiological phenomenon reflecting lower blood glucose? If you can get your hands on the full text please send it over. I tend to feel skeptical of any research involving a macronutrient cocktail instead of food and drawing parallels between enzyme expression and obesity.

  32. I could say I agree with the one who said it is GENETIC! It is all through my family and everyone has it! Even my husband and the cat have it…oh wait, that might mean it is more conditional than genetic, now wouldn’t it.

    I do think there is a genetic factor, as type 1 is also all through my family and I lost my brother and my father to it. Also my Grandma (who was one of 13 children, and they all had type 1 and died younger than they should have) But I think type 2 DM is tied to modern diet and lifestyle more than genes. That doesn’t mean genes don’t enter into the picture.

    I do think there can be a genetic predisposition to it and one of the things that type 2s have to constantly fight is their doctor’s et. al. blaming them for their disease. (the “if you weren’t so fat and lazy” attitude is a constant battle, even when it is a silent look)

    Now this doesn’t sound very important, but it isn’t just a matter of someone getting feelings hurt. Sometimes treatment varies, in that the patient it might be treated with not as much diligence due to this type of “blame the patient” thinking!

    I hold that I didn’t get diabetes because I got fat, rather I think I got fat because I got metabolic syndrome to which I was genetically predisposed and that blossomed into diabetes.

    I grew up eating meat as the main course and fresh vegetables as the staple. My family knew that potatoes, rice and flour were not conducive to good health and it was very limited. That meat I spoke of was never battered and fried because flour was fattening. We had cake only if one of the family had a birthday, then it was limited to 1 slice. We had cookies and homemade fudge at Christmas (Daddy doled it out, no eat all you want stuff in our house). No sodas in our house, but we drank milk like water because it was considered healthy for growing children. I eat less than most people and always have. I started my first diet before I started school! So, yes, I think there is a genetic predisposition but it is not predetermined.

    I am not saying Modern Awful Diet wasn’t involved (MAD) but I don’t think it is the determining factor.

    • My gripe is more with the attitude of: “It is genetic, there is nothing you can do. Just take the pills and eat whatever you want”. Your situation definitely sounds unusual, looks like genetics definitely played its part and you got the raw end of the deal. But the good thing is that you don’t let it beat you down into submission. You continue to take care of yourself, minimise risk factors, look after your diet and lifestyle. Many people don’t even realise that they have the power to do that. Good on you, Mary.

  33. “Internet is a great force, Ruth. We’ll get them, one skinny soy chai latte drinker at a time.” I so hope so! But I’m more interested in getting the professors, like the one you had to listen to, who are teaching our future doctors and nutrition experts. However, I would advise waiting until after you have your degree in your hands before you go challenging their thinking! Then challenge away.
    Doctor SH, Wish I’d known about you when I lived in NJ. I still have friends who live in NJ and hope they have the privilege of being treated by you. All of my friends in NJ with CVD, metabolic syndrome, diabetes, etc. are treated by doctors who are still mired in the conventional wisdom of shoving pills, pills, and more pills–no mention of life style changes. One friend is a diabetic (T2) who has been told by his doc that as long as his meds keep his BG in control, he can eat whatever he likes, which is mostly white bread, sugar soda, and cookies! He also takes Lipitor, of course.
    My doctor (in NJ) wanted me to take Fosamax and later Boniva–just because I no longer have the bones of a thirty year old (I’m over 60)! I took the Fosamax for a year, then got wise, did some research and quit. When he suggested Boniva, I politely declined–and explained why. I just had a bit of a fall down an escalator a couple of weeks ago and landed on my butt. Bruised, but nothing broken. I think I made the right decision! I’m glad to see you at least raising questions about these–and Statins (which I wouldn’t take nor would I allow anyone in my family to take.) It gives me hope for the medical profession, as do you, Anastasia.

    • Thank you for your kind words, Peggy. And we need the support of people like you. We feel alone enough as it is. Nice to know that somebody is listening.

  34. Reminds me of my visit to Rheumatologist to discuss my reactive arthritis – when discussing nutritional approach – do whatever you want nutritionally but I will give you high doses of prednisolone and sulfasalazine and you may or may not get better – and then we wonder why we don’t trust the medical industry any more.

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