Marks Daily Apple
Serving up health and fitness insights (daily, of course) with a side of irreverence.
11 Jul

An Open Letter to Doctors

thumbnailI realized recently I’ve never written this kind of open letter. I figure if kids and Taco Bell got the benefit, maybe primary care physicians could as well. Kidding aside, there’s a genuine mismatch these days between standard medical advice and effective lifestyle practices. I think we can all do better. I’m not letting patients off the hook here either. (Maybe that’s fodder for another letter.) However, we naturally look to our physicians as our healers, as the experts, as our guides. Unfortunately, we’re not always well served by that kind of faith. I’m of course not talking about any one doctor or set of doctors. I happen to know a great many primary care doctors and other medical practitioners who are incredibly forward and critical thinking professionals. They balance their perspectives with the likes of medical logic, broad based study of existing research and close attention to real life results. While I think I’m not the only one who would have much to say to many specialists out there as well, let me specifically address primary care physicians here. They’re on the front lines – for all the good and ugly that goes with it. More than any specialist, they have the whole picture of our health (and a fair amount of our life stories to boot). It’s more their job (and billing categorization) to provide general health and lifestyle counseling to their patients. It’s with great respect that I offer these thoughts. As my readers can guess, this could easily be a tale of ninety-nine theses, but let me focus on a few central points.

The State of Weight Counseling

Can we talk about this for just a moment? Statistics vary, but generous numbers suggest two-thirds of physicians don’t counsel their patients about their weight – this at a time when approximately two-thirds (yup) of the adult population in our country is overweight or obese. I’m not pointing fingers at any specific people here, but this is disconcerting. It seems to be a downward aiming trend to boot. One study of primary care appointments, for instance, found doctors offer weight related counseling less often than they did twelve years ago. In fact, of the appointments researchers analyzed, doctors only discussed weight in a mere 6.2% of visits! In the year these statistics were gathered, 63.3% of adults were overweight or obese. Does this even make any sense? But there’s more. The same research found those with high blood pressure and/or diabetes were also less likely to receive weight counseling than they were twelve years ago – 46% and 59% less likely respectively. Any jaws dropping yet? Pardon me, but does this jive with some version of the Hippocratic Oath I don’t know about?

This utterly confounds me. Sure, I get it on an emotional level. It’s awkward. You don’t want to make anyone feel bad. But it’s your job to tell the truth – whether it’s convenient or not. It’s your job to steer folks in the right direction health-wise, to educate them in making better choices for their health. No one’s suggesting you call them at home to wake them up in the morning to encourage them to go workout. No one thinks it’s your job to write a personalized menu plan.

Nor is anyone saying you have to be a jerk about it. (Please don’t.) You really can have a conversation with a patient about his/her weight without shaming or blaming. The thing is, I’ll bet the person already knows he or she is overweight (just a wild guess). Mentioning it won’t dismantle any delusions of god-like svelteness or superhero health. I’d even venture to say they’re waiting for you to talk about it – as in, their weight and assorted related concerns/questions are already on their minds. Just be honest – and professional – and compassionate (without patronizing). Be down to earth about the real risks they face and the concrete strategies they can use. Bond as you would with any other patient. I say this because – guess what – research also shows physicians tend to bond less with overweight patients than they do with normal weight folks. As the researchers note, less engagement likely means less adherence to whatever good advice you do offer, and you might be wholly missing the patients who need you (and the care you provide) the most.

The Questioning of Conventional Wisdom and the Myth of the Magic Pill

With all of the above in mind, can we talk about the information itself? This is kind of big. In fact, it could be a book in and of itself. (I do have a few recommendations on that front….) I realize I’m not the first one to observe we’re living in a health care system that favors intense intervention and fails too often at basic prevention.

One of the things that troubles me most is the all-too-frequent, razor-focused commitment to conventional medical wisdom. I’m talking particularly about the red herrings and ridiculous claims like saturated fat is the bane of human existence, that dietary cholesterol is the culprit behind unhealthy lipid profiles, that 350-450 grams of carbohydrates are reasonable if not desirable each day, that whole grains (including GMO corn and gluten giant – wheat) are an essential part of a healthy diet. The research doesn’t line up – and never really did line up – behind these assumptions. The more our population follows these recommendations – eschewing whole foods like eggs, pastured butter, coconut oil and organic meats for the likes of whole wheat snack products and carb heavy dishes at every meal, the more unhealthy we get. Diabetes isn’t an organism that mutated. We’ve just never worked so miserably against our own physiology before in human history/pre-history.

The fact is, even studies published in some of the bigger name journals are beginning to demonstrate these truths and dismantle decades of erroneous conventional assumptions. To an extent, it’s a matter of reviewing the research, keeping up on what’s being said and shown. I know, I know. It’s difficult to impossible to stay abreast of the latest research – especially when you expand the scope beyond the most conventional sources. It’s tough for physicians to stay current on ALL the new research. It’s often fuzzy or contradictory, and much of it is still poorly conducted or biased in its funding, so even reading research can be a frustrating time expenditure. Even physicians agree that physicians regularly fall behind for various reasons. Some among them suggest more than anything “Continuing Medical Education” at the point of patient care – reports and summaries at hand of the latest thinking and evidence based findings. That sounds great. I have a more modest proposal, however.

Outside of accidents and serious genetic defects, 80-90% of conditions doctors treat are either prevented and/or cured…or at least mitigated…by lifestyle adjustments. And much of that is diet (although exercisesleep, sun, stress control all play an added role). How about just investing in some nuts and bolts education on lifestyle interventions. Ideally, a physician would get 2-3 months of focused diet/exercise/lifestyle training in med school aimed at fixing various common health issues, rather than just relieving the symptoms.

Medicine in our country (as a culture), however, focuses on the symptoms more than the source. A stent, for example, offers relief of a symptom but doesn’t address the larger health issue or seek to remedy it. Gastric bypass isn’t a fix but a procedure that circumvents the bigger source of the problem. In some extreme cases, it might be an advisable course of action in the context of a bigger plan. Most of the time, however, psychological and lifestyle means are much safer and much more effective in the long run because they can address the root causes.

When it comes to the top selling pills, the same principle holds. Statins address the manufactured symptom of high cholesterol. When we put our faith in them, we lose sight of the real processes going on in the body – the processes we need to be addressing. The same goes for PPIs and SSRIs. Respectively speaking, heartburn is generally associated with too little acid rather than too much. Taking them might alleviate some short-term discomfort, but they’re contributing to long-term digestive issues and nutritional deficiencies. Likewise, SSRIs and other mental health meds often cover up underlying therapeutic needs for stress reduction and sleep improvement as well as physical conditions like dietary allergies/sensitivities, nutritional deficits, and drug interactions. Can we all back up for a minute and reconsider the conventional teachings and protocols?

Sure, you can’t redo your med school experience. Likewise, it’s probably not in the cards to take a leisurely sabbatical during which you get to delve into the sea of research that’s been published in the last year let alone decade. Still, you can forge your own commitment to the process of learning about lifestyle interventions, about recent findings and reviews. You can open your own mind to the less popularly cited studies, to the less front and center journal selections. Find a few that suit you, that you can believe in. Dabble for a while in the outer reaches of lifestyle research. Choose some publications that interest you. Commit to following them. Likewise, choose some less formal reading to fill in the gaps. Look for some books and blogs (I know of one.) you can feel comfortable with but that nonetheless challenge your way of thinking. Good Calories, Bad Calories or Why We Get Sick, for example, would be good places to start. They’re relatively easy and decent ways to digest a lot of info at once.

And while we’re on the subject of good resources, how about giving out the names of books and articles in lieu of many of these prescriptions? The fact is, we lean heavily on the latest pharmaceuticals rather than lifestyle measures. How often do we really exhaust the lifestyle intervention possibilities before handing out the magic pills? Can we give patients more credit? Can we challenge them more effectively to change their diets and daily regimens before getting out the prescription pad? Is it asking too much to go out on a limb and ask patients to educate themselves? Suggest accessible, engaging material on the blogs and books you see fit. Can I suggest The Primal Blueprint as one possibility? Many doctors already recommend it to their patients and – no surprise – their patients have seen the same kind of incredible results that we see here on Mark’s Daily Apple every week. If you’re an interested physician, contact me here and let’s see what we can do together.

Finally, can I just say a word about the later decades of life? You see, I have some expertise here. I’m turning sixty this week – yup, 6-0. The thing is, I don’t really fit the common image of a sixty-year-old that we’re given in our culture. Call me an outlier if you will, but the fact is I direct my lifestyle to live and feel the way I do. I don’t work as hard at it as you might imagine. I don’t train for hours a day. I eat amazing food. I play hard and sleep well. I live exactly the way I outline above. Nothing particularly special. Nonetheless, I think I demonstrate (along with some friends) that with a little effort and forethought, a modest portion of commitment and unconventionality, sixty doesn’t have to mean a life of aches, pains, prescriptions, and increasing impairment. Feel free to check out some photos of me to see what I mean.

Thank you, by the way, for reading. I appreciate your taking the time and thought to consider one humble guy’s opinion. If you’re ever up for some conversation, I’d love that. That’s where good things start. In fact, let’s make it lunch – Primal style of course.

Have a good end to the week, everybody, and share your “open letter” thoughts!

You want comments? We got comments:

Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. Ugh, I don’t know where to start. In recent years, I have found doctors to take a bullying/hectoring stance when I’ve refused their medication. I’m sure there will be plenty of patients willing to do as they are told but a genuinely open, respectful doctor is worth their weight in gold, IMO.

    Alison Golden wrote on July 11th, 2013
    • So true. I once had a doctor come unglued when I told him I also see a homeopath on occasion. I guess he thought he had a right to yell at me. I told him he didn’t, and I fired him on the spot. If more people would refuse to put up with bullying doctors, we would see far fewer of them.

      Shary wrote on July 11th, 2013
      • There’s a vast chasm of difference between the science-backed lifestyle and diet that Mark espouses, and the pseudoscience (read: utter lack of evidence despite a large number of clinical trials) in homeopathy.

        In this case, your doctor was right to yell.

        The whole point of this article is that doctor’s should follow the science rather than fairy tales. Homeopathy replaces one set of fairly tales for another.

        michael wrote on July 11th, 2013
        • BS, Michael. A doctor never has a right to yell at a patient, regardless of the reason. The doctor works FOR the patient and is employed BY the patient–not the other way around. I’ve had other, more enlightened doctors merely ask me what homeopathic remedy and strength I was using, without batting an eyelash.

          Regarding homeopathy, you are parroting what you’ve read and obviously have never tried it. Therefore, you don’t know what you’re talking about. I see you also have a problem thinking outside the box. Didn’t anyone ever tell you that today’s scientific “evidence” is often tomorrow’s debunked theory?

          I’ve found that classical homeopathy (using a trained, experienced homeopath–NOT quasi-homeopathic OTC drugstore preparations–works very well for many things, including vastly superior pain relief. It has NO side effects, in glaring contrast to the drugs prescribed by the allopathic profession you seem so ready to defend. If it didn’t work, millions of people wouldn’t use it.

          Shary wrote on July 11th, 2013
        • Can’t really agree with you there when it’s SCIENCE that says that one of the most effective treatments for most maladies today is……wait for it…..a PLACEBO pill. That’s right. It outperforms drugs.

          So, that’s a fairy tale. And it’s a working fairy tale.

          The doctor shouldn’t yell at a patient just because they have a different belief system. That very belief system, no matter how different from the doctor’s, may be the VERY thing that saves them. And there is science to back that up.

          Suzanne wrote on July 11th, 2013
        • That’s not actually true. Most studies show placebos have little to no impact on objective measures. They have variable impact on subjective measures, such as pain, but this is often temporary amelioration lasting up to 30 minutes or so.

          Besides, I’m pretty sure dugar pills aren’t Primal. ;)

          em wrote on July 11th, 2013
        • If homeopathy is placebo, then how come it worked on my cat?

          Kate wrote on July 11th, 2013
        • Disclaimer to all fans of homeopathy who get defensive when it is attacked by science: You may not want to read this comment. I am overall opposed to the practice, although I concede that there are some good elements to the traditional homeopathic treatment that would improve medical treatment.

          About homeopathy working on animals:
          It has been shown that there are placebo effects in non-human animals, e.g. http://www.ncbi.nlm.nih.gov/pubmed/22871471

          In animal homeopathy, similar factors may play a role as in human homeopathy: the personal care received, the fact that it is more “warm and caring” as opposed to the “cold and sterile” of regular medicine. (These are the mentioned good elements.)

          In addition, there are a number of observational biases, i.e. if the owner/person administering the treatment believes it works, he/she may interpret animal behaviour in a way that matches expectations. This works especially well with animals since they can not express their symptoms or lack thereof verbally.

          I live in Germany, where homeopathy originated and is at least partially covered by universal health insurance, much more widespread and even taught at universities to med students. So here it is pretty much part of conventional wisdom, to the point that I have argued with several doctors who where firm believers – just as I may argue about cholesterol and saturated fat.

          I often see an almost knee-jerk reaction against any CW on these comment boards, which is no doubt often healthy and justified. Here, such a reaction might actually go against homeopathy.

          I am no fan of homeopathy for the same reason that I am a big fan and follower of Marks writing – it is the most rational and scientifically sound position I could find in my years of searching.

          Chris wrote on July 12th, 2013
        • Cats respond to special treatment and extra attention just like humans.

          Cats are able to get over illness just like humans.

          Science requires double blind tests with controls – statistically homeopathy perform equally to placebos.

          Placebos and special attention reduces stress ( lower stress helps healing) and comforts the patient.

          Mitch wrote on July 12th, 2013
        • I find discussing whether homeopathic medicines “work” or not is like talking about whether astrological predictions/statements are “true” or not.

          It smacks of pure superstition. What gave someone the idea that sugar, after coming in contact with some substance or other in the very bizarre fashion prescribed, somehow obtains some medicinal properties? There is no changed property or added substance that anyone knows how to measure on that sugar. It’s just sugar as far as we can tell. Did an alien tell the original practitioner this magic secret? It could not have been determined scientifically, as there is no known scientific way to even know or detect exactly what, if anything, happened to that sugar to make it “medicine”.

          From what I’ve read, no homeopathic “cure” has EVER passed a bona fide double-blind clinical trial. Ever. That says it all as far as I’m concerned. Now, if YOU can dissolve some sugar which has been magically touched by some herb or other substance under your tongue and cure your ills, don’t let anyone tell you otherwise and go for it!

          But, until it can pass a real clinical trial, that could be just about anything under your tongue, as long as you believe in it! IMO, that doesn’t give anyone the right to claim (in public) that it “works”.

          Salim Morgan wrote on July 12th, 2013
        • I am a 4th year Naturopathic Medical Student. I have seen homeopathy work wonders. I have gotten 2 patients of their psych meds through homeopathy. I’ve seen someone who had hiccups for years and seen many types of specialists for it be cured seconds after he took a dose, There are many, many stories like this. There are many pharmeceuticals out there where the mechinism of action is not known. Most pharmeceuticals have very bad side effects. And many of the chemicals come orriginally from plants, about 80%. A natural molecule is extracted from the plant and the chemical structure is slightly changed so it can be patented. These laboratory changes in the chemical make it more harmful than good.
          By the way there is a lot of scientific evidence for homeopathy. There are many scientific journals for homeopathy. I would advise you and others to keep an open mind. Homeopathy has never killed anyone. The establishment admits to about 200,000 deaths per year due to pharmeceuticals. And I was almost on that list several times. What are they not telling us?
          As a Naturopathic physician, I will usually prescribe homeopathy or a natural remedy before I prescribe a pharmeceutical.

          Jeff wrote on July 17th, 2013
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        WilliamJori44 wrote on July 12th, 2013
        • spam here. this article sure is generating some heat.

          Louise wrote on July 13th, 2013
        • Dudes, even if ALL homeopathy has done is turn the ability to invoke the placebo response into a fine art, then it has real merit, because triggering the immune system and body to mend itself is the ultimate goal of all medicine.

          Just because there may not be a measurable chemical pathway doesn’t take away from that, and to yell at someone who’s getting pain relief that WORKS – for them, but works nonetheless – is imbecilic scientISM (that which masquerades as science, but clings to dogma, rather than measurable cause and effect).

          The hate spawned by scientism against anything that doesn’t fit within its narrow remit is scary and shows we’re not so far from the dark ages as we thought.

          Patrick wrote on July 13th, 2013
      • Actually, the doc should have fired you. Without anger or yelling, but just a simple goodbye, have a nice day, would be enough.

        DavidO wrote on July 18th, 2013
    • I recently changed doctors because my former one was hectoring me to take the convention wisdom meds like statins, and because she yelled at me for taking supplements like fish oil. I am thankful to have found Kathleen King, D.O. in Sacramento, CA. She still has to mention meds like statins because the insurance company is going to ask why I am not taking them. But she has a very Primal-friendly orientation, e.g. testing my D level and wanting me to bring it up.

      Happy birthday Mark!

      Harry Mossman wrote on July 11th, 2013
      • “She still has to mention meds like statins because the insurance company is going to ask why I am not taking them”.

        And there yo have it. CW is where the money is.

        The system itself will never change. There’s way too much money in “managing” chronically ill people. You’ll have to just buck the system and do it yourself. What really hacks me off is that now in the US I will be forced to pay into a sick, dysfunctional “healthcare” system.

        Dave, RN wrote on July 11th, 2013
        • It’s only going to get worse under Obamacare and “outcome-based payments” to doctors–if we’re not meeting our FDA-stated goals for health parameters, we won’t get coverage…or in other words, it’s always been, and always will be DOCTORING BY THE NUMBERS. You don’t take their pills, and don’t meet their numbered goals, then the insurance company can refuse to cover you.

          Wenchypoo wrote on July 11th, 2013
        • +1

          HopelessDreamer wrote on July 11th, 2013
        • ” You don’t take their pills, and don’t meet their numbered goals, then the insurance company can refuse to cover you.”

          I’m not sure about any of the Obama care stuff. I can say though, that it’s difficult to force people to take medication against their will. They can be bought and then thrown away. Kids under direction supervision have been know to palm them. One of the biggest complaints I’ve read from primary care physicians about patients is lack of compliance with drug regimens. Truthfully, I’m not sure that’s a bad thing except in a few specific circumstances.

          Amy wrote on July 11th, 2013
        • “I can say though, that it’s difficult to force people to take medication against their will”.

          Yeah, and that’s why now we have drugs with microchips that spy on you, already approved and ready for the market: http://io9.com/5930822/meet-the-future-of-medicine-an-ingestible-microchip-that-monitors-your-medications

          klipka wrote on July 20th, 2013
      • Great find Harry. Finding someone around here is like trying to find a needle in the haystack!

        Nocona wrote on July 11th, 2013
    • Happy Birthday, Mark! My husband will be sixty later this year and I’ve told him he’s in good company. You are a great role model and huge inspiration!

      Alison Golden wrote on July 11th, 2013
    • Insurance companies also engage in such tactics. My previous doctor wrote “RMA” on my chart when I refused to take cholesterol medication she wanted to prescribe as a result of an annual physical. It was only 210 and I wanted to try getting it under control through diet changes. She insisted the pills were easier and I would be more likely to stick with it.

      Annual wellness physicals are 100% covered by my health plan but because I “Refused Medical Advice”, the insurance company refused to pay for the physical.

      Bruce A. wrote on July 11th, 2013
      • Lol, the last doctor I saw walked out of the exam room while I was still talking to him. I guess he didn’t really care about my opinion. Then his nurse assistant came back with a prescription. My entire appt took 4 minutes. Quality medical care, folks!

        Bev wrote on July 11th, 2013
      • So take the pills and toss ‘em (responsibly). The $20 copay is less than being billed for an entire physical.

        That’s really unbelieveable, but sadly not unexpected. The shape of things to come.

        GroketteinND wrote on July 11th, 2013
        • What’s cheaper is to refuse to pay the bill entirely, although it’s more stressful.

          Amy wrote on July 11th, 2013
        • Also, you’d only really need to take the prescription and skip buying the meds. The insurance companies and MDs are surprising blithe in assuming everyone’s following what’s written down.

          Amy wrote on July 11th, 2013
        • At the time, I felt I was partnering with my doctor in my health care the way it’s supposed to be. I was under the impression that doctor and patient work together to find the best course of treatment. I wasn’t refusing medical advice, just that particular option. Had my cholesterol been significantly high, I would have considered it a more acute situation and would have opted for meds to gain control, then work on a more long term solution that didn’t require them. 210 is not acute as far as cholesterol is concerned.

          Rather than work with me to find a solution, she made an arbitrary call without my involvement. Had I known what the outcome would be, I would have just taken the script and been done with it.

          As for paying the bill, I decided to get some legal advice. My attorney was able to negotiate a significantly lower bill for the physical. I haven’t been back to that doctor since.

          Bruce A. wrote on July 12th, 2013
        • Sadly, insurance companies must think they’re saving money by doing this. No insurance company would willingly incentivise people to get sicker; they’re the only group of people that would stand to profit directly from prevention-based, evolution-based medicine.
          We should start a campaign to send ever health insurance exec. copies of Gary Taubes’ GCBC & The Primal Blueprint… & perhaps Fat Head for those who can’t read them big fancy words Taubes wrote.

          mm wrote on July 18th, 2013
      • “Annual wellness physicals are 100% covered by my health plan but because I “Refused Medical Advice”, the insurance company refused to pay for the physical.”

        I hope that was the last visit to said Doc’s office? (Although there isn’t always a choice.) I’d lag on paying the bill and/or be a pain in the rear with payments (like $10 a month)

        Some Docs are will absolutely shot themselves in the foot professionally/economically to maintain the illusion of control.

        Amy wrote on July 11th, 2013
        • Yes, I “fired” her as my primary care right after that.

          Bruce A. wrote on July 12th, 2013
  2. Happy Birthday!
    You have brought many good things to my life and I am deeply grateful to you

    DP wrote on July 11th, 2013
  3. Leading by example. Well done, Mark. And Happy Birthday!

    bryan wrote on July 11th, 2013
  4. Excellent article. It’s incredible that you’re turning 60 and look like that

    Callum wrote on July 11th, 2013
    • And you can look at the new issue of ESPN the magazine and see a 77 year old famous golfer, Gary Player, that looks incredible too! With all this great info. on MDA, there is hardly a limit to what kind of health we can accomplish.

      Nocona wrote on July 11th, 2013
  5. Mark, at least for me, you have the uncanny ability to hit on topics that are timely. Having this discussion with a friend just yesterday…..

    I’ve resigned to the fact that modern medicine for some has become nothing more than writing a prescription for a daily dose of something to mask the symptoms. I know that’s not a ‘blanket’ statement, there are reasonable, needed drugs for some things. But, MDA is, and many other websites are full of stories of disappearing symptoms that many doctors would have written a prescription for, unnecessarily.

    I always try to give kudos to those in the medical profession that encourage people to look at their diet for some symptom relief, it works a lot of the time. If you’re one of those, good on you.

    Bryan wrote on July 11th, 2013
    • Almost forgot…

      Happy 60th Mark! I know you’ve heard it a million times, but it’s true….. Your work and words are inspiring!

      Bryan wrote on July 11th, 2013
  6. Perhaps doctors don’t do weight counseling because they see that “eat less, exercise more” does not work well and they don’t know what to do. I used to eat “healthy whole grains”, low fat, etc. but really could never maintain a weight below 165 (5’7″ female) so overweight but better than where I was at one point. I never even thought about getting below that weight until I stumbled upon low carb then paleo/primal. When I cut out grains I lost weight without trying, now at 145 and still expect to lose more eventually. So, the initial problem I see with your open letter is that most docs don’t have the right initial tool to give a patient. Without that, weight counseling will not achieve its goal in the long run and could do more harm than good with standard advice (low fat, calorie restriction).

    Colleen wrote on July 11th, 2013
    • Exactly! The one doctor that did tell my non-primal husband to lose weight said that he needed to eat less and exercise more. That was the sum total of his advice.

      b2curious wrote on July 11th, 2013
      • I got my blood work done because my insurance was going to up if I didn’t. (Really!)

        My total cholesterol was 199 and the sum of my Doc’s advise was “watch your diet”. Okay….

        Amy wrote on July 11th, 2013
    • My doctor and his entire staff are thrilled with my progress, and have all said they wish they could bottle what I do.

      Which… is a nice thought, but goes right back to the whole “take this and get well” scenario, when you think about it.

      At least they are supportive.

      GroketteinND wrote on July 11th, 2013
      • Sometimes it’s hard even to find supportive. The insecure Docs are quite a treat to deal with. :(

        Amy wrote on July 11th, 2013
    • Dr.’s receive training in chemistry, biochemistry, anatomy and physiology. Through out their college years they only receive a few weeks of training in nutrition. How can they give sound advice unless they receive more adequate training themselves. Also, the words “dietitian” and “nutritionist” are often used interchangeably, but they are not the same. A dietitian is a Registered Dietitian, which means the person has a degree — that’s what the initials R.D. mean after someone’s name. All dietitians are nutritionists, but not all nutritionists are dietitians. Only an R.D. has the training and the knowledge to give you expert personalized advice based on current nutrition science.

      Getting an RD title takes a lot of work. Registered Dietitians are food and nutrition experts who have to follow specific educational and professional requirements from an accredited program to attain their title, including a bachelor’s degree, completion of a Commission on Accreditation for Dietetics Education (CADE) program, which includes classes in biochemistry, anatomy, and physiology plus a dietetic internship for a minimum of 900 hours. Before becoming an RD, you also have to pass a standardized national exam and complete continuing education credits to maintain your title — meaning RDs have to stay abreast of current trends and issues.

      For the most part, nutritionist is not a licensed title. There is, however, something called a certified nutrition specialist, CNS, which is a licensed nutritionist. This title does not require intensive clinical hands-on training.

      Theresa wrote on July 15th, 2013
      • For all the training required to get the RD credential, as a retired and reformed RD I can guarantee that RDs don’t know the half of what they need to know to give advice on truly healthy eating. I’ve learned so much since I retired and escaped the blandishments of the food & drug industries, and also had to unlearn a lot. Now I’m 80, in excellent health, and take no drugs. Thank for this piece, Mark.

        Kris Johnson wrote on July 17th, 2013
      • Why would you want MDs to get more nutrition training? So they can be even more sure of themselves when they spout out their gov’t-approved food pyramid propaganda?

        mm wrote on July 18th, 2013
  7. Well said Mark, and happy birthday to you!! Talk about aging gracefully!! You look great and give us all something to work towards.

    shellyann wrote on July 11th, 2013
  8. The medical system is just like any retail organization. Invite them in, take them for a ride, cash them out (until they’re out of cash) and spit them back onto the street with a future appointment already booked (otherwise they’d never come back)

    Groktimus Primal wrote on July 11th, 2013
  9. Happy B’day, seeral years ago I had a bad ear infection. I went to the VA. emergency. The Doctor I saw prescribed Zithromax. I told her I had taken it before. That it did not work for me and was expensive. She informed me itwas the re.med and would not change it. I took it for the prescribed 5 days symptoms returned 6th day. She again gave me more. Worked about the same. I never received anything that worked well. Went to CR on vacation, called another MD for suggestions. You an buy most med in CR over the counter, Took a while, but recovered. Not typical of VA, usually they do very good, by me.

    Terry wrote on July 11th, 2013
  10. Happy birthday Mark!

    I worry about this, because the incentives are all wrong. There’s little money in prevention, and loads in ‘cure’ (especially for chronic conditions). I think what we have here is a massive ‘tragedy of the commons’, and it would require some top-down institution to solve. Or perhaps, if everyone just walked away, Big Pharma would have no customers… ?

    Scott UK wrote on July 11th, 2013
    • I don’t think you state that quite right. There loads of money in managing and relatively little in curing. Taking drugs and all the other stuff conventional medicine recommends is just managing the illness or diseases. Doctors rarely cure you of anything. For the vast majority of problems, lifestyle changes are the only true cure. To make money at that you have to get people to pay for your consulting only. Selling drugs is much easier to make money at.

      Steve wrote on July 11th, 2013
    • I am wondering about switching to the prize model rather than the patent.

      Latitude was a documentary about how to calculate latitude. Whoever solved the problem would get a purse, there were charlatans and tests.

      Having prize instead of patent would mean that studies on carrots or vitamin C or going “Forks over Knives” would be funded… rather than putting a pittance towards disputing those studies to protect a patentable medicine.

      I’m not sure how much it would affect actual medical practice, except to stop with the “drugs are the first answer” mentality.

      Kelekona wrote on July 11th, 2013
    • I think you’re dead on, though I would swap ‘cure’ for ‘management.’

      Regardless of who’s paying, the incentives are still bass-ackwards. The article below is written from the point of view of reducing cost, but it addresses the incentive issue and, can you believe it? actually suggests how to fix it. Really great article, but looooong.

      http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande

      Julie wrote on July 12th, 2013
    • The incentives are all right for insurance companies

      mm wrote on July 18th, 2013
  11. I wish my doctor would read this. At my last doctor’s visit, he insisted that I start taking a statin, because I have type 2 diabetes and “your cholesterol is a little higher than we’d like for it to be.” He also put me on an incretin medication because my blood sugar was very high. Being a non-confrontational person, I accepted the prescriptions, but didn’t fill the one for the statin. Since that time, I have been striving to eat clean, whole foods, and to eliminate grains completely. I’m also slowly trying to incorporate some very light exercise in to each day. I’m curious to see what my next set of labs will show. The scale is telling me I’m on the right track–12 pounds down (and a LOT more to go). I’m hoping to eliminate the incretin medication if the diet and exercise changes help me to get my blood sugars under better control. I so appreciate the information and support that this website offers.

    Janey wrote on July 11th, 2013
    • Janey, I’m positive you’re on the right track. Eliminating the sweets and grains should normalize blood sugar and very likely will eliminate the need for meds. The only “downside” to your approach, if you can call it that, will be needing to buy new clothes in a much smaller size. Best of luck to you!!

      Shary wrote on July 11th, 2013
    • I wish my *insurance* company would read this. They have a “lifestyle” website with a bunch of tutorials you can do in order to lower your insurance rate. One of the questions that comes up frequently is, “How often to you eat meals with a lot of saturated fats?” My answer, of course, is “ALL THE TIME.” As a result, I’m constantly being forced to sit through lectures on the food pyramid.

      At this point, I’m just going to start lying. “Saturated fat? Never touch the stuff!”

      michael wrote on July 11th, 2013
      • I got bad marks on my company’s health website for answering “0” to the servings of whole grains questions! Sites like these are well meaning, but perpetuate the nutritional myths and misinformation that put so many people in this country on the wrong path.

        David Pryor wrote on July 11th, 2013
      • sadly you are better off lying, until the “coventional wisdom” catches up. I am working on becoming a RD, ive learned to just nod and smile when my professers talk about how important whole grains are. Saturated fat is too yummy to give up haha :)

        alexa wrote on July 12th, 2013
        • Alexa,

          If you do not mind please send my a private e-mail and I’ll show you where you can go and improve on our desire to help people with healthy eating.

          Philomina wrote on July 17th, 2013
  12. “approximately two-thirds (yup) of the adult population in our country is overweight or obese.”

    I haven’t read the whole article yet, but I just wanted to point out–to be fair–they tend to base those statistics on BMI, and we all know how unreliable that is. Of course, maybe you’re getting that figure from somewhere more reliable, and it may well be true, but I just wanted to point that out if only to play devil’s advocate.

    Cyborcat wrote on July 11th, 2013
    • Ditto to this. There is absolutely a large percentage of the American populace that’s overweight and it’s causing them to head into very unhealthy territory, but most articles I see about this cite BMI or height-weight charts for those numbers. Neither are reliable.
      Based on my experience, when I was first pregnant with my son and before any glucose test was run, a Dr wanted me to “cut carbs” which was refreshing…until I realized that the number he suggested I try to hit would put me at double the amount that I was already eating. He never stopped to think that I might be already eating low carb (Primal for 3 years, thanks!) or ask me what my daily intake looked like, rather he just plowed ahead based on my BMI. Drs need to ask questions of their patients, or at the very least listen to what their patients tell them, when patients offer information.

      AustinGirl wrote on July 11th, 2013
      • Dr.’s DONT listen – I told mine I was cutting out gluten and he started sputtering about some WHOLE grains are good for you, like WHEAT and rice…HELLO! I had just said I was cutting gluten!
        Sigh…

        HopelessDreamer wrote on July 11th, 2013
        • I had almost exactly the same thing happen. My dr. wanted me to follow the ADA diet (I’m t2 diabetic) and I refused, stating that I don’t eat grains of any kind. He then went on and on about how there were some grains that would be ok for me, even if gluten was a problem. I politely maintained that I was fine with zero grains. He ended the conversation by demanding that I not eat “starches and sugar.” Really? WTH do you think makes up those grains you’re trying to get me to eat, doc? Last time I saw him…

          Elizabeth wrote on July 12th, 2013
    • What ever the real figure is, Mark’s number is being very generous if we accept that one can be “normal” weight and still carry an unhealthy amount of retained abdominal fat (primally speaking). Perhaps a better quote would be “Over 90% of the population (not just adults) carry an unhealthy and worsening level of retained fat, and eat a diet likely to make the problem worse.”

      Superchunk wrote on July 11th, 2013
    • As of yesterday, Mexico stole our crown as the #1 obesity-beset country in the world. So where’s THEIR doctor advice to lose weight and take those pills?

      Wenchypoo wrote on July 11th, 2013
      • we weren’t number one to begin with. there are several other countries in the world that are per capita heavier than the US is.

        Erin wrote on July 11th, 2013
  13. Happy Birthday Mark! You look amazing for 60 (actually, you look amazing for 50, 40, and 30)! :) I’m turning 60 in a few months, and thanks to your book and website, I think I’m healthier now than I’ve been in 50 years (primal has mostly cured the chronic migraines and hypoglycemia that have plagued me since I was a teen). Thanks for all you do and for providing so much good info online –all for free.
    Sandy

    Sandy wrote on July 11th, 2013
  14. MODERN MEDICINE SUCKS!

    Mark P wrote on July 11th, 2013
  15. I haven’t been to a doctor in almost two years because of the attitudes. I have hashimotos and have been on thyroid meds for 12 years. I had to fight just to get a diagnosis in the beginning. My doctor at the time lied to me (said I had mono when I didn’t just to get me to shut up about possibly being hypothyroid), wanted to prescribe anti-depressants among other drugs to deal with the hypothyroid symptoms. I did find an old, Russian doctor in NYC who did a physical and cognitive exam and diagnosed me as being hypothyroid. Since then, I’ve had very few times when I had a doctor who got it. I have had a doctor tell me he would no longer treat my thyroid because my TSH was low (free T3 and free T4 have always been in range). Another who just wanted to lower my meds because “the TSH is the gold standard in adjusting thyroid meds.” I went along with it for two months where I repeatedly got sick and felt terrible. This doctor never even asked how I was feeling with the lowered meds as if “I” didn’t matter as much as a lab value. Years ago another doctor lowered my meds and my thyroid swelled so much that I couldn’t swallow without pain (btw, the swelling has now gone down since eating primal – woohoo!). I am so tired of doctors not caring how I feel. I have developed “white coat syndrome” and just don’t want to go to the doctor.

    Willow wrote on July 11th, 2013
  16. BOTTOM LINE. If an individual possesses the will and priority to find the truth, they will find it because they are open to it. If you are inquisitive, thoughtful, and refuse to give up on finding “your truth” for living healthy, no one ever fails.

    Choice is a funny thing. Being passive about health and forming dependence on drugs and chemicals to hold back the breaking dam of metabolic breakdown, a person has made a choice to put their life in the hands of someone else, regardless of what path they are told to take.

    If each of us chooses to prioritize our health and never stop LEARNING for ourselves instead of assuming doctors know best, they will inevitably arrive at the primal blueprint or something close to it.

    Dr Jason Bussanich, DC wrote on July 11th, 2013
    • You’re right, patients do need to take more responsibility. However, don’t you also agree that sometimes you need to look them in the eye and be direct?

      “You are X pounds over a healthy weight. The risks to your health are _____ . Statistically, you are more likely suffer from a major health event or death as a direct result of being so much overweight. Every individual is different and there are no guarantees; however, there is substantial evidence that indicates you can benefit from achieving a healthy weight through proper exercise and nutrition.”

      Granted, it’s a bit blunt but is it any worse than your eye doctor advising that you need glasses?

      Bruce A. wrote on July 11th, 2013
      • I mostly agree with you except that I don’t think a doctor should say “You are X pounds over a healthy weight” because there’s really no standard weight a person “should” be for any given height. A person could be 15-20 lbs over the accepted weight but still be in excellent health, or could be at or below that number and still be in poor physical condition. What doctors should do is look at a specific set of clinical measures and let you know if they think those numbers are healthy or unhealthy, when combined with other lifestyle factors (diet, activity level, stress level, etc.). The difficult part is coming up with the right numbers. Cholesterol level is one that CW medicine seems overly fixated on these days.

        Mantonat wrote on July 11th, 2013
    • I totally agree…except…
      -there are times in people’s lives where they are very vulnerable. If you are struggling with a major health issue there is a lot of energy wrapped up in that. Maybe someone who is naturally inquisitive will want to be able to trust someone to help them with a health issue like weight.
      -throw in all the trash that popular culture has to say about nutrition and honestly…how many years of digging will the average person spend trying different diets before they finally Finally FINALLY find primal.
      -you are assuming that people are used to critical explorative thinking and will pursue a question to the end. I find that most people only ask “Why” once or twice before settling on the most common answer.

      So having a doctor with authoritative health advice is helpful if not necessary for a lot of people to help them make changes in their diet.

      Candice wrote on July 11th, 2013
      • I think we’re reaching the point where low-carb, paleo & primal are becoming mainstream enough that people looking for weight loss diets will find it

        mm wrote on July 18th, 2013
    • Yes – but many of us grew up TRUSTING our doctors. It’s a huge mental shift for us to realize the medical establishment does NOT have your best health in mind.

      That transition took me about 10 years, and yes, landed me here. Lots of reading – When Doctors Don’t Listen, Fire Your Doctor, Pain Free by Pete Egoscue highly recommended.

      I haven’t seen a doctor (except for eye exams) in four years. My insurance is a Medicare Savings Plan, which pays the patient about $3k at the beginning of the year, it goes into an account much like an FSA, and keeps accumulating.

      So now, I’m getting paid to keep myself healthy. Not a bad incentive.

      Mark, Happy Birthday, don’t forget to get your shingles shot.

      framistat wrote on July 12th, 2013
  17. I would rather take diet and lifestyle advice from Iggy Pop than from my doctor. Iggy is 66 and looks better than my doctor too.

    My doctor told me that not eating sugar was a fad idea that would have no effect on my health. I can’t wait to discuss my latest blood panel with him, the one where every measure improved from 20% to 50% after 7 months primal.

    Bayrider wrote on July 11th, 2013
    • (Laughing at your comment)… Doctors don’t know everything. In fact some of them don’t know much of anything, other than how to write prescriptions for toxic crap that any sane person wouldn’t take. Your doctor’s archaic and uninformed notions regarding sugar would be reason enough for me to dump him.

      Shary wrote on July 11th, 2013
      • I listen to my doctor because he has a medical degree and I do not and I respect his knowledge and years at university, which I don’t have. I listen to my podiatrist because she has a podiatry degree and I do not. I listen to climate scientists because they have climate science degrees and I do not. I let pilots fly the plane because they have a pilots license and I do not. My cousins’ clients listen to her because she has a law degree and they do not. My clients listen to me because I am a qualified scientist and they are not.

        If I hadn’t listened to my doctor this last week I would be in hospital probably never able to walk properly again. But instead it cost me two quick appointments, some free equipment and a short round of cheap prescription pills. And if I hadn’t listened to him the time before I would be in hospital needing blood transfusions by now.

        pumpkin wrote on July 15th, 2013
        • That’s good you listened to them. What the Dr told you probably sounded to you like the right thing to do for you. People here are talking about when the Dr’s advice flies in the face of what they know about their own bodies. Our bodies are significantly different from machines, the earth’s climate or the law. Homeopathics work for some, and don’t work for others. Eating chocolate may not affect some people, and can totally wig others out.

          I cannot tell you how many times I listened to the Dr through my life and received advice adverse to my body, mind and wallet. One Dr even had me on high blood pressure inducing meds to address female problems that only went away because of me going off his meds, taking things in my own hands and fixing myself. But guess what, I still have High BP. Always had low BP before those meds

          Doctors do not know everything. We are responsible for our own bodies, and it is to our benefit to pay attention to what we can do to improve our health. Also, isn’t it glorious that we do have Drs in case we can’t figure us out? I would be dead if I didn’t go to the Dr when I was young (funnily enough, the diet of the time, the societal embracing of cigarettes and house hold chemicals, and the psychologically-unfriendly home life probably caused my asthma in the first place.)

          Humans. Not perfect – degree or not.

          Caroline wrote on July 17th, 2013
    • I don’t understand why doctors say things like “eating sugar will have no affect on your health”. If what you eat doesn’t matter, then surely they should agree that NOT eating sugar will have no affect on your health as well? But when you hear a doctor speak, giving up sugar is like a personal affront to them.

      Sunny wrote on July 11th, 2013
    • I can remember when our eldest was 3 and having lots of physical issues. At an early visit, her pediatrician told me to close the office door, leaned forward and spoke in a low voice (evidently not wanting anyone else to hear) and said, “Don’t repeat this to anyone or I’ll be laughed out of this clinic.”

      She went on to advise that we take dd off all sugar, including fruit juice, as well as artificial colors, flavors, and preservatives.

      This was more than 20 years ago, but it doesn’t sound as if the medical establishment has changed all that much.

      (p.s. Happy Birthday, Mark! Many thanks for Primal Blueprint and this website. You can’t imagine — well, maybe you can, at that — what an incredible difference they’ve made in my quality of life.)

      Jean wrote on July 11th, 2013
  18. Timely post since I’m currently shopping for a new primary care doctor. The one I currently have balked when I told her I took extra Vitamin D and just recently insisted that I have a pre-op EKG before my upcoming clavicle surgery despite both the hospital and my orthopedist saying that it wasn’t necessary given my age, terrific BP and resting pulse. Thanks for wasting my money…and my insurance company’s.

    Kay wrote on July 11th, 2013
  19. Thank you for writing this, Mark. The majority of the Dr’s I work with need to read this. Unfortunately, in the acute care setting, weight loss and long term health is the last thing on everyone’s mind. There is extreme pressure from hospital administrators and the higher ups to get people in and out as soon as possible. Sad but true. We usually don’t have time to educate adequately. Acute care is what brings in all the money though. Physicians have a huge incentive to keep their patients sick, and quite possibly, there are some that take that route with job security in mind. Call it negligence. Although, I have been privileged to work with very good, well-intentioned doctors. They are just constantly bombarded with CW.
    There needs to be more of a focus on community health focused groups. Primary care physicians and CNP’s especially have the greatest influence as far as education goes. I would love the opportunity to work in that area and get out of acute care. There aren’t many opportunities though, and the pay is not nearly as good.

    Erin wrote on July 11th, 2013
  20. The paleo community seems to honor self-expirementation over theories. And since most doctors I know could also lose a few pounds, they should try some lifestyle changes themselves for a few months. Imagine if doctors around the country start experiencing dramatic health increases – – nothing would be better in getting the lifestyle message out to patients.

    KenCo wrote on July 11th, 2013
  21. I posted my first comment before I read everyone else’s comment, but why all the “doctor-bashing?” Let’s just accept that nobody is perfect. It is hard for someone to completely reject CW after they have it drilled into their head nearly every day. Most are just teaching what they themselves have been taught. If you do not take a liking to your PCP, then find a new one. No need to be rude. Maybe refer them to The Primal Blueprint before heading out the door? Seriously… mature, thought-provoking comments would be great!

    Erin wrote on July 11th, 2013
    • I for one have tried–even bought my doctor her own copy of The Paleo Diet, The Primal Blueprint, and Gary Taubes’s Why We Get Fat, but she didn’t even open them–she gave them to her college-age kids to read (and throw away). Now all the business she gets from me are the bare basics: annual physical, CBC, and urinalaysis twice yearly–just enough to show the insurance people that YES, I’M STILL ALIVE.

      Wenchypoo wrote on July 11th, 2013
      • Why does she get any business from you at all (assuming you have a choice)? An unwillingness to walk away on the part of patients is part of the reason why Docs get their ‘tude.

        Amy wrote on July 12th, 2013
    • Maybe because most doctors are rude, bullying, jerk-offs to their patients. People are fed-up with the entitlement that most doctors have and the constant misdiagnoses or no diagnosis at all. Not to mention, the corrupt ways of doctors and the medical system in general.

      I have no respect for most doctors and know first hand, that if I hadn’t taken my own health issues into my own hands instead of being doped up be these glorified drug lords, I’d be crippled and on disability.

      I have found most of these comments to be mature and thought-provoking and quite accurate.

      Lorraine wrote on July 11th, 2013
      • Erin, are you married to a doctor?

        Nocona wrote on July 11th, 2013
        • HA!! I would never marry a doctor. Quite the opposite. I find rocket scientists to be much more intelligent, not to mention WAY more attractive ;)

          Erin wrote on July 11th, 2013
      • well let’s hope and pray you never get admitted to a hospital then, whether through trauma or illness. If you refuse to give them even the time of day, then you are no better off. Maybe in your experience doctors are rude, bullying, jerk-offs, which really is unfortunate. Sure, I have definitely come across several physicians who are just complete jacka***s. I do not comment in their defense because obviously the last thing they should be doing is working with and helping people. But I would highly disagree that “most” are just plain terrible at their jobs and hate their patients. I have been privileged to work with some wonderful doctors who really take the time to listen to their patients and do their best to work towards a good outcome, even if it is through CW. It is truly unfortunate they are just misguided. Give them the benefit of the doubt before trashing their reputation, though. Google search them, too. healthgrades dot com is a great website to see if a physician is worth your time or not. if you defer yourself to a doctor who gives poor care and opinion, it is nothing but your own fault for not demanding someone better.

        Erin wrote on July 11th, 2013
        • Clearly the opinions of those on this thread in regards to doctors offends you so greatly. Most doctors are incompetent and that has been a growing trend for some time. Instead of treating each case individually, they lumo everyone together as a whole.

          It takes more than having a good bedside manner to be a good doctor it takes for-sight and logic. Not everything is by the book.

          Going on those sites is not a good indicator of receiving quality medical care, you clearly lack reasonable thought when providing your testimony of good medicine. You think just by going on sites that rate doctors that the system isn’t flawed?!

          before you jump down my gullet maybe yo should take some time to assess why so many people are disheartened with doctors and the medical system in general. Clearly you side with the politics of the medical industry and the stance of keeping people in a constant state of pill pushing coma.

          Many doctors need a wake-up call and the arrogance that sweeps their offices is blinding.

          FYI, I have been in a hospital on more than one occasion and ended up sicker there than outside of one. Hopefully you can wake-up from the ass kissing coma you’ve put yourself in to realize that western medicine needs a complete over-haul in it’s behavior.

          Lorraine wrote on July 11th, 2013
        • ok then Lorraine, enlighten us on your solution to the current sick care system. I would agree with you that it is flawed. I just don’t think there is a perfect solution. It doesn’t offend me that so many people hate their doctors. It just is a disappointment and completely unnecessary. If people dislike their PCP then by all means find a new one.
          I specifically listed one site, and it is the one I used to find my PCP. He has been wonderful. Quality medical care does have a subjective side.
          I don’t push pills. I am a nurse. I work to help people get better while they are sick. Why would I side with the medical industry? It is not my expertise. Your rude comments are completely unnecessary here.

          Erin wrote on July 11th, 2013
    • These people get paid large sums of money to dish out bad advice that will kill you faster. Many of them are too stupid to even understand this. That’s why.

      mm wrote on July 18th, 2013
  22. I think the letter to doctors is well and good, but ultimately, it is up to the patient to make his/her decision (once the patient is willing to take responsibility for his/her condition). The medical profession, while I do respect what they do, are in a difficult situation with bid pharmaceutical. It is a system that needs fixing. If patients decide they can prevent most illnesses/diseases by preventive measures, then there will be far less medical visits. That means less money for doctors and big pharma, which means, they will adjust to meet the needs of the many.

    James wrote on July 11th, 2013
    • I agree completely. My parents are in their 80s and their primary care doctor is a pill pusher. Fortunately, my dad is an avid walker but I can’t get mom to get off the couch and off the meds.

      Bruce A. wrote on July 11th, 2013
      • Don’t forget, folks like my 80 year old father WANTED a magic pill like many others do. He never wanted to do the work or change his lifestyle and sadly he died after 6 years of Parkinson’s.

        Nocona wrote on July 11th, 2013
        • One of the most serious problems in modern medicine is the crush of people who WANT magic pills. My Mother is there too, in Magic Medicine Land, and is now in assisted living. My Father retains enough of his common sense to not believe, but really would like to believe.

          The drug culture would disappear tomorrow if people really wanted to be well, rather than pop pills and think they’re getting something for nothing.

          Amy wrote on July 11th, 2013
      • My parents are in their 80’s as well. It is difficult to change their habits at that stage, makes me want to live next door and offer to cook all their meals (whilst I throw out all the grains, muwhahahahaha)
        My mother in law was hospitalized and put on hospice because the doctors had nothing left to help her. She thought fine, I am ready to go, so she went off all her meds. They just took her off hospice last month because she was doing so well that she was getting out of bed and even cooking some while sitting on her walker. Seems that the meds were preventing her from living. Sometimes less is more.

        2Rae wrote on July 11th, 2013
  23. Amen! I’m so lucky that I have found a primary care physician that advocates for lifestyle changes first before automatically reaching for her prescription pad. Even so, she was still a little wary of my going paleo, but has kept an eye on my bloodwork and found no cause for complaint. Just the fact that I was able to have an in-depth discussion about my diet with her makes her amazing in my eyes.

    Kate W. wrote on July 11th, 2013
  24. Happy Birthday, Mark! Yowzeh, I practically cut my eyeballs on your razor sharp six-pack!

    Siobhan wrote on July 11th, 2013
  25. I really liked the article, Mark. I let myself decline for a number of years. There were all kinds of justifications and rationalizations to make me feel good about getting worse. While my doctor would occasionally mention my weight “might be a bit on the high side”, there was never a look-you-in-the-eye-and-be-direct moment. My response was always a dismissive “yeah, I know I should do something.” In the meantime, my blood pressure and cholesterol continued their upward climb.

    At the peak, I was 6′ and weighed 238. Some folks would say that’s not really that bad. Unfortunately, I’m actually a pretty skinny guy so it all landed around my midsection. I was in the store shopping for bigger pants when the light came on and I decided to take some action.

    Yes, it was a miserable experience just to get started but I started. And, I followed all the wrong advice. I crash dieted and spent just about every waking moment on a treadmill (no weight training to preserve muscle was a HUGE mistake). But when I lost 35 pounds in 4 months, I thought I was golden.

    Unfortunately it wasn’t sustainable. I went on vacation, let myself get derailed and started to put weight back on. Then I had a major life event that resulted in a job change and got derailed even further.

    I realized that I needed to get smarter or I’d be pants shopping again. So I studied a broad range of sources, including what the military does for special ops, and things started falling into place. I avoided magazines like a plague. They were one of the main reasons I got in trouble the first time. No one can get washboard abs, squat 400 pounds or get 20-inch biceps in 4 weeks. I’ve been working hard for the last 3 years and am just now starting to see definition in the ab area. (My favorite was an article on how to “Add an inch to your biceps in one day!”. I keep that one as a reminder not to get suckered into being stupid again.)

    Basically, I accepted that it wasn’t going to happen overnight, so I went on a more sensible diet plan and engaged in a wider range of physical activities. And, lo and behold, my body adapted in a wonderfully positive way! I got leaner and kept the majority of the muscle I was building.

    Did I mention I started my trek when I was 52? I’m 55 now and have never been healthier, happier, or more fit. My numbers are excellent for a man of any age, much less in my age group. I workout at least 4 days a week but now it’s more like play. I actually gained an inch in height from my spine getting stronger and my weight is stable between 175 and 180, even if I stray while on vacation. Strength training has been a big part of my training for a long time but I’ve recently discovered the joys of indoor wall climbing and it has become addicting! I actually look forward to doing pullups and frenchies.

    I also compete in mud obstacle course runs and am taking on my first marathon later this year! I even did well enough in an unofficial SEAL PST that I could be considered for BUD/S. (Spending a week at a SEAL Fitness Camp is on my bucket list.)

    Anyway, to make a long story short, even if my doctor had been more direct those many years ago, it would have fallen on deaf ears. It takes huge personal drive to make major changes. I agree that we (society in general) shouldn’t be jerks about it but maybe we (again, in general) shouldn’t be so accepting of being people overweight and having a sedentary lifestyle when they have the power to change.

    Bruce A. wrote on July 11th, 2013
    • One thing I forgot to mention is that I’m going pants shopping again. My 34s are too loose. :-)

      Bruce A. wrote on July 11th, 2013
      • Nice work! And I agree – a doctor telling you you’re fat isn’t going to motivate you. I think the only real motivator is desire to change coupled with positive results. Most diets aren’t successful even if a person loses weight, because they don’t necessarily feel any better, have more energy, or see a long-term means of maintaining. Positive results means not only losing weight, but actually feeling great on a daily basis. Otherwise it’s easier for me to be fat and miserable than less fat and still miserable.

        Mantonat wrote on July 11th, 2013
      • Awesome work, Bruce!

        Leah wrote on July 11th, 2013
    • What do you mean you can’t add an inch to your biceps in one day? Just duct tape a steak to your arm. :)

      Joanne wrote on July 12th, 2013
  26. Correction: SSRI, Mark, not SRRI. CW physicians will take the easy way out, and will hone in on that to discredit your entire treatise.

    Nannsi wrote on July 11th, 2013
  27. a few points…
    1- You’re doctor is only ONE tool in the toolbox. Yes, i know we treat them as the be all end all, but they are just ONE person. A very educated person in medicine yes, but one with limitations including which school (progressive/integrated vs old school) they attended, how they approach their practice (with god complex or with an open mind) and how/if they ‘update themselves’. I am lucky that my GP is NOT a know-it-all and has been open to my various approaches to my ulcerative colitis. She wanted to know alternatives so she could suggest them to other patients. Not all the specialists had the same attitude. FOr example, when I was going through a period of depression, her sub basically told me that i should take anti-depressants (i had no past history of depression) instead of, oh, i don’t know, take some time off from work to re-set. I told her I thought i just needed time off. But i had to TELL HER. Which leads me to…

    2- It is hard to find good doctors but this is a ‘take control’ moment. If you’re doctor is not what you are looking for…keep looking. They are out there. But don’t just leave, tell your doctor WHY you are leaving. They might just get defensive, but if they hear it enough, it just might start sinking in. And if for whatever reasons you can’t get another doctor…do you’re own educated research. Make changes to your life. You don’t need a prescription or appointment for that.

    I think a problem we tend to have in society is that others should hold all the answers for us. Whether it’s your accountant, doctor or any other professional. Yes, they are versed in that area, but they don’t know everything. And they should all be open to your questions based on your own research and readings. As Mark mentions, most of them do not have the time to “keep up” with recent findings. That’s where we all have to step up.

    melissa wrote on July 11th, 2013
  28. Taco Bell is apparently now testing a high(er) protein menu.
    abcnews.go.com/Business/taco-bell-testing-power-protein-menu/story

    Ted wrote on July 11th, 2013
    • I bet they just add more soy and chihuahua meat to their existing menu!

      Wenchypoo wrote on July 11th, 2013
      • AHahahahaha. You made me spit on my laptop.

        Keith wrote on July 13th, 2013
  29. My doctor told me that if I didn’t get my total cholesterol number down, I’d have to take a statin — and that my HDL was **too high** and my tri was **too low.** When I requested a VAT test to see the LDL breakdown, my doc refused.

    So high-cholesterol me went elsewhere. I’m quite happy. (Typed while munching Whole30-approved bacon.)

    JackieKessler wrote on July 11th, 2013
  30. Nanssi. Was thinking same. (discredit for wrong acronym) Would be interested to see Mark’s comments on the fish oil supplement study released today. I just started omega 3 supplementation at the start of the year. I have never believed in supplementation prior to following Primal lifestyle. Now I am wondering. Study seems flawed…but maybe that is because I have invested in a year’s worth of fish oil already 😛

    Kelly McCulloch wrote on July 11th, 2013
  31. Here’s to a Happy Birthday!

    Congrats, and looking great!

    Kerstin wrote on July 11th, 2013
  32. Very well and tactfully written Mark. I had actually gotten on antidepressants last fall after years of struggling with depression and anxiety that started almost immediately after being discharged from the army and moving back to the states from Germany. My husband tried to convince me I had PTSD but I knew it had to be something else. I started eating paleo April 1st and dropped 25 lbs and I can’t remember the last time I was this happy and energetic. I started eating paleo to lose weight but it really has changed every aspect of my life. A big thanks to all you bloggers for all the wonderful, life altering information.

    Jen wrote on July 11th, 2013
  33. Happy Birthday Mark! Thanks so much for all your hard work and for helping to improve so many lives.

    Bev wrote on July 11th, 2013
  34. Well, I think doctors know well that prevention is everything…but usually patients come with pre-existing conditions that already require medical intervention. In my country doctors simply don’t have time for patients, sometimes they accept 70 patients daily. That’s like 7 minutes on one patient. The discussion is severely limited and although the treatment is excellent, patients feel they deserve more discussion and attention.
    Also, many of the patients aren’t interested in change at all. They just want the pill, to play the hockey game even if they are sick, and come with decisions based on blogs, refusing reasonable vaccination for their kids based on popular scandalous article.

    Also, in medicine, if something is recommended it really needs to be evidence-based and safe. That’s why sprinting or lifting heavy things is usually not recommended. You’d need to pay the trainer for the patient to ensure safety.

    Ondrej wrote on July 11th, 2013
  35. Mark,
    Happy Birthday, and a big thank you for this post, this site, and everything you’ve done for our community.

    This post is right on target. I was pre-med in college in the 90’s and decided not to apply to medical school because of the very issues and problems with the system that you describe above. I didn’t want to be a part of it, thus found myself in industry instead. As luck would have it, I relocated to the west coast and discovered Naturopathic Medicine. As a result, I’ve obtained permanent remission of my Crohn’s Disease without any pharmaceuticals. I was so moved and so helped by the counsel of Naturopathic Doctors that I enrolled in and graduated from the National College of Natural Medicine with my Doctorate in Naturopathic Medicine.

    Many people don’t know that in 17 states and most Canadian provinces, ND’s are considered Primary Care physicians. We are a very different experience than the usual MD or DO, though I acknowledge that there are many excellent MD’s and DO’s out there. People in Washington, Oregon, and perhaps some other states are fortunate enough to have ND’s at their disposal that can bill health insurance and prescribe any medication should it actually be necessary, but the focus of any good ND treatment plan will be the stuff of this website. I frequently refer my patients to Mark’s Daily Apple.

    There are also websites like http://primaldocs.com/ that list Paleo/Primal minded MD’s, DO’s, DC’s, and ND’s that are located throughout the US.

    While the mainstream medical community is greatly flawed, especially in the primary care segment, there are excellent options out there if people know where to look. Unfortunately the problem stems to our culture as a whole, as any reader of this post already knows. TV and advertising are, in my opinion, driving most of it. The best favor we can give any friend is to steer them away from taking the mainstream media as gospel, to open their minds to alternatives, and to take everything they read or see on TV with a grain of salt. People like MDA readers know this. We got here by doing our own research, and this is the best advice we can give our friends and family.

    Joshua Moninger, ND wrote on July 11th, 2013
    • Joshua – I live in WA and just started seeing a naturopath in the past few months. You are correct – they focus completely on “functional medicine”, addressing my concerns with dietary and supplemental interventions. Never once was I asked to take any “big Pharma” drugs – the only thing she prescribed was some bio-identical hormone replacement – progesterone only – as I am 46 and in peri-menopause. I spent the past year in a fiery hell of anxiety and panic attacks that no antidepressant could touch. Gee, no one thought to test my hormones until I saw the ND – duh! One month on the progesterone and I was able to get off antidepressants all together.

      An ND will look deeper, ask more questions, order appropriate tests, and NOT follow the party line when it comes to diagnosis.

      I once heard someone say that an MD goes to medical school because he wants to be a *Doctor*, while a naturopath goes to naturopathic school because they want to cure patients illnesses and help folks live a healthier life. I believe this to be true.

      Ann wrote on July 11th, 2013
  36. Well this is RELLT interesting on (TWO) fronts ..
    1. I just had my cholesterol check couple of hours ago. Its the lowest since high school. When doc asked how I did it I said, “Bacon” (had stop takeN statins)
    2. I”m turning 60 the week after. I will be celebrating on top of Mt Baker ! (or I should say thats the plan) Happy Birthday Mark.

    james t

    James T wrote on July 11th, 2013
  37. Happy Birthday Mark!! It’s wonderful to be 60 – got there last year.

    Susan wrote on July 11th, 2013
  38. The 80% related to lifestyle contains within it the hidden dirty secret of America’s class divide: about 50% of lifespan is associated to economic status. The entire remaining 50% is divided between access to healthcare, genetics, independent lifestyle variable, and independent environmental exposure variables.

    You can’t give health education to an underclass that didn’t get a basic education. Once you understand that economic status is the biggest variable in healthcare, primary education becomes a health care issue, job training becomes a health care issue. These are far bigger issues, frankly, than whether your doctor brings up your weight, a conversation which has zero impact on lifespan. (Yes, zero. There is no arguing this point: weight loss in mature adults has zero impact on lifespan. Well adult visits have zero impact on lifespan. Zero + zero = zero )

    But by all means, lets keep the conversation on the least effective interventions.

    Mary wrote on July 11th, 2013
    • “You can’t give health education to an underclass that didn’t get a basic education.”

      Actually, you can if you’re will to step out of the Latin based vocabulary. People who didn’t finish high school aren’t stupid — they just didn’t finish high school.

      “, job training becomes a health care issue.”

      This turns this into a political discussion, but may I suggest that some people maybe low income because they blow opportunities given to them? Some MDs will refuse Medicaid patients, not because of pay, but because they will absolutely not listen to any advise and won’t take drugs regularly, etc. Positive life skills cannot always be taught.

      “There is no arguing this point: weight loss in mature adults has zero impact on lifespan.”

      Of course you can argue this point. And it’s silly to cling to it. Someone who is 100 pounds overweight *may* live as long as someone at a normal weight. However, I’m willing to almost guarantee that the last decade for the overweight feels much worst, all things being otherwise equal, then the one at a normal weight. Number of years in a life is not the only consideration.

      Amy wrote on July 11th, 2013
      • Why is this obsession with lifespan?
        Runaway inflation, exponentially balooning deficit/debt means you are better off bolting before you go too long into retirement!

        BT wrote on July 12th, 2013
        • I agree. I prefer to quality of life over quantity, but she seems to see it differently. :)

          Amy wrote on July 12th, 2013
  39. I want to see what Mark looks like signing up for Social Security! :)

    Wenchypoo wrote on July 11th, 2013
  40. Mark, this is the first time I have checked out your blog and I love it! The information you provide is great and I cannot wait to share it with others. I totally agree with you about medicine nowadays not focusing on the source. Everyone just goes for the medication without digging deep to find out the real source of the problem. And of courses, the medicine just covers up the issue and never fixes it. Everyone wants that magic pill! Thanks again for this blog!

    Christine wrote on July 11th, 2013

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