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. Happy Birthday Mark. I just changed doctors because every time I went to the old one he would do a quick check up and tell me he would refer me to a specialist. The only thing he did was give me some blood pressure medicine. I took it for a week and stopped. I started doing primal 2 1/2 months ago and have lost 30 pounds. We found a new doctor and blood pressure was good. I still have to go get blood work done. Told her we are doing primal/paleo and she said she had been thinking of trying it herself. I think I found a good doctor. .

    Dennis wrote on July 11th, 2013
  2. Amen Mark. Happy early birthday. You are the man. All other claims to being the man are erroneous.

    BW wrote on July 11th, 2013
  3. I’m always amazed when people get drugs and surgery and then, after the surgery fails, they get sent to me (rehabilitative movement teacher) to see if exercise can help.

    Every now and then they get sent to people like me first and we help them prevent or delay…

    I have long thought we need like a coffee clatch (klatch?) with say a neurologist, a sports med doctor, a Pilates teacher, an Alexander teacher, a nurse, a family care doc, osteopath, acupuncturist, Physio etc and just get us sharing what we know.. :)

    Angela Barsotti wrote on July 11th, 2013
  4. Happy birthday Mark? Can’t find the words to thank you for all you’ve done. You are my hero!

    Now, on to the doctors. If you ask me, Good calories, bad calories should be mandatory reading in medical school (and also for nutritionists). This book and The Primal Blueprint were true eyeopeners and have done more for my health than anything else.
    With the help of the Primal community, I cured my body (gluten intorlerance and several nutritional deficits: B12, Magnesium, Vit D etc). My doctors? They tried twice to prescribe me antidepressants after I explained my symptoms, even when I told them that I am SURE my health problems have nothing to do with my mental health! All I needed was REAL FOOD.

    brighteye wrote on July 12th, 2013
    • But I don’t blame the doctors exclusively. It’s the “system”, Big pharma pushing pills, a consultation that takes 10 min maximum, and I guess a fair number of patients that don’t want anything else than some pills from the doctor.

      brighteye wrote on July 12th, 2013
      • To be fair, they get paid and, as importantly, get respect and a hell of a lot of status on the basis they’re the people who defend our lives against life’s depredations, so it actually is their job to stay informed – and especially to not peddle the whole-wehat/low fat car-crash that almost every doctor I’ve ever seen is fond of promoting.

        If punters like us bother to see through the labels in the stores and CW advice that’s everywhere, the ones responsible for our actual lives have a duty to do the same with pharmaceutical marketing.

        Patrick wrote on July 13th, 2013
  5. Dr.’s like to keep ‘em sick and comin’ back for more. I sell motor spares and dread the day they make cars that don’t crash or break down. I suspect the doctors feel the same about the obesity pandemic. It’s a gold mine!

    Spinsei wrote on July 12th, 2013
  6. I am a physician and thankfully also had the pleasure of meeting Mark several years ago. He not only has changed my life, but as a result has changed the life of countless patients that I see and educate.
    I am an ob/gyn. Although I attended one of the top medical schools in the country, UCSF, I truthfully cannot recall more than 1-2 lectures total in our 4 years on nutrition. Holistic and alternative medicine wasn’t even mentioned.
    It makes me sad that so many patients are disenchanted by their physicians. From the physicians perspective, I actually have found that spending time with patients talking about a LIFESTYLE CHANGE, the importance of exercise, the value of alternative therapy and incorporating acupuncture and natural remedies is an essential part of my practice. Insurance companies don’t reimburse any doctors for “nutrition counseling”, yet doctors do a disservice to patients by NOT addressing these in detail.
    However, to be fair, I think patients must take accountability for being their own advocate. There are lots of fabulous physicians who do realize that the mind, body and spirit are all interconnected. Furthermore, many of my patients come in and want a quick fix. A pill to help lose the perimenopausal weight, a prescription for hcg or human growth hormone, for phentermine, for a diuretic… you name it. I am asked for this on a regular basis. For every patient I educate on diet, exercise, the Paleo diet, probably 1 of 30 actually implement this. Most are off juicing and cleansing away, working out every day before dining out, heading off for a nonfat skinny vanilla latte with a think thin bar, and spewing out the importance of a vegan diet and how meat is poison etc…
    I have had patients leave me for another doctor when I discuss weight, especially during pregnancy. I tell them 25 #- 30# is all you need for weight gain and I review their snack options. But the moment I tell them, “Let’s talk about the last month and this 12 pound weight gain…” forget it! I am labelled the horrible bitter doctor who is mean and wants to insult women in front of their husbands. In this town, the egos preclude anyone from wanting to be told:

    IT IS NOT YOUR HORMONES. IT IS NOT YOUR THYROID. IT IS NOT YOUR FETUS THAT IS CAUSING THE WEIGHT GAIN.

    They want something to blame and something to fix the cause and fast. If they don’t leave with a prescription of sorts many feel my appointment time was wasted. So it requires an even greater effort on my part to explain my philosophy of prevention over treatment, of alternative options other than pharmacological or surgical.

    Mark changed my life and health, and also that of 8 year old son. I have a strong history of diabetes in my family. My son and I share food and he never even considers options from the kids menu. He devours salads, fish, veggies, only drinks water or almond milk, no juice or soda ever, and can self regulate the desserts at birthday parties. We exercise together all the time – whether it is tennis, learning to surf, biking, running. He loved biking alongside me while I trained for my first marathon. I would never have implemented these changes in my life had it not been for Mark, who inspired me and educated me more than my 4 years in medical school. So even if only 1 of my 30 patients per day will also have their life and health changed by Mark, I am happy with the 1, and will consider it a successful day as a doctor.

    Shamsah Amersi wrote on July 12th, 2013
    • You’re awesome and I wish you every success in your practice! Made my day! :)

      Patrick wrote on July 13th, 2013
  7. When I was in college in the early 90s, I was gaining weight with all the junk food and beer. I went to the university medical service for something else, and while I was there I asked the doctor about what foods I should or shouldn’t eat to lose weight. He said that it didn’t matter what I ate. He said I could eat cake and pie exclusively every day and lose weight as long as I ate fewer calories than I burned. Even as a 20 year old with no nutrition or even biology background, I knew better than that. Ever since then, I’ve completely ignored doctor’s nutritional advice. They have very little training in nutrition, and what they do have is at best standard CW.

    Maybe Mark should start a foundation that provides free training on proper nutrition to doctors.

    en2ec wrote on July 12th, 2013
  8. Working in a doctors office, I am wedged in between a physician who has never let an animal cross his lips, and another who goes strictly by CW. When I have to counsel folks over the phone about diet after talking to them about blood test results, I’m really stuck! Fearing for my job, I usually give them the CW talk, but have started adding, “if you’ve already tried this and it didn’t work for you, there are other ways to lose weight. I would urge you to research on your own about alternative methods such as PALEO, and others.” I have to be so careful how I say it though!!! :( If they ask what I do, I tell them.

    Lucy wrote on July 12th, 2013
    • Yes be careful you don’t cure to many people :)

      Mitch wrote on July 12th, 2013
  9. ER Doc here, I am still trying to convince my patients to stop smoking. Or to stop shooting up heroin. Or that feeding your 8 month old child chicken mcnuggets (whilst in the ER!) is not a good idea.

    Please bear in mind that the audience of MDA is not representative of most doctor’s general patient population (certainly not mine). Also, the population mostly affected by obesity and diabetes does not consist of people who follow the conventional advice of low fat “healthy whole grains”, fruit and vegetables and too much chronic cardio. It’s a sedentary, poorly educated, lower socio-economic population who eat processed food and expect their doctor to give them a pill to make them healthy. Sad, but it is my everyday reality. And I am sure I’m not the only physician with this experience.

    Claire wrote on July 12th, 2013
    • Who sets up the expectation of a magic pill? Your patients probably know everything you’re trying to tell them, but have chosen to ignore it. I haven’t met a smoker in the US that doesn’t know the risks. One of the worst habits MDs get into is assuming that once people know something, they’ll act on it in the same way they would. Handing back true responsibility back to the patient or parent for their health, regardless of income or education level, might free up the system to be much more effective.

      Amy wrote on July 12th, 2013
    • Amen! Totally agree. Very skewed population here in the best possible way!

      Jo wrote on July 12th, 2013
    • Wasn’t there an experiment during the 2nd Bush years at some hospitals where they assigned a nurse to call patients on a regular basis to see that they were adhering to the advice the doctors had set up for them to improve their health? As I recall, the patients health improved with this attention and health care costs went down. I do not know if this practice has continued at these hospitals.

      Maybe some variation of this would work for the typical patient you see. It must be very frustrating and discouraging as a doctor to encounter patients with no regard for their health. It would be easy to become cynical and uncaring.

      Sharon wrote on July 12th, 2013
      • That strategy may be effective, but where is the line between the patient’s responsibility and the doctor’s responsibility?

        Given the litigious society we live and work in, this is not just a hypothetical or philosophical question. I see my patients as independent competent adults who have a right not to follow my advice, and I don’t believe it is my medico-legal obligation to ensure that they follow it.

        Claire wrote on July 13th, 2013
        • My depression was alleviated by cutting out gluten, so I wonder how many patients battling an addiction are being set back on their heels because when they do make an effort to get healthy, they’re hitting the gluten-heavy low fat CW diet that seems in my experience and from some studies to be the least supportive of good mental health and mood?

          There’s research to show that some people with Northern European and Celtic ancestry have a special need for Omega 3 that, when not met, almost inevitably births addiction in the desperate search of something to relieve despair, hence why the Irish for example have a global reputation for alcohol abuse.

          I see diet as a vital part of staying mentally healthy, which then facilitates quitting addictions instead of making it even harder, and as a former drink-addicted guy, if I started eating the breakfast my doc favours (whole wheat cereal and egg white omelet) the urge to booze it up to get some relief from the pain of hunger and bad brain chemistry would be WAYYYY much harder to fight day to day.

          Patrick wrote on July 13th, 2013
  10. Thanks for writing this article. I will be starting at a medical school in the United States in three weeks. I subscribe to the ideas articulated so well on this site, and I think that prevention is an invaluable part of good healthcare. I’m very excited to challenge Conventional Wisdom while keeping an open mind so I can best help my future patients. Also, I’m glad to say that, of the few classmates whom I’ve already met, several of them are Primal/Paleo.

    Jacob wrote on July 12th, 2013
    • Heartening news! :)

      I think when the revolution in thinking on this happens, it will be like the fall of the Berlin Wall – sudden, dramatic, and absolutely no going back.

      And I think it WILL happen, because the internet has made even the daftest of patients start to think they can research, and have an opinion on, their own healthcare and diet.

      I praise anyone who’s pioneering this change, after the tens of millions crippled and killed by poor health and obesity that stems directly from incorrect dietary advice (and the knock-on effects that’s had with food manufacturers, who then promoted high-carb & veg fats) in the past four decades.

      Patrick wrote on July 13th, 2013
  11. I just had a friend go to the doctor for high blood pressure who ASKED for advice on how to change her lifestyle to improve the situation.

    The doctor shrugged his shoulders and told her she may just be a “2-3 pill type person” in order to be “normal”.

    Needless to say she’s doing a Whole30 now to purge out the bad stuff and cravings and plans on keeping the Paleo lifestyle in order to try to get off the meds.

    ElcyIL wrote on July 12th, 2013
    • That’s the mindset that says ALL illness is caused by a deficiency of pharmaceutical compounds, it would be laughable if the human cost in misery and death weren’t so high…

      Patrick wrote on July 13th, 2013
  12. Actually many of the patients would be startled to find out they are overweight and argue back. My dad, who is having open heart surgery very soon, acted incredulous that he could be diagnosed as overweight/obese at 270 lbs.

    And my friend, who weighs in at 330 lbs, said he is not obese. Argued with me on what obese means, and he concluded he is only a little overweight. Apparently “obese” means “immobility level of fatness” to him. So I showed him the BMI method of determining obesity since we were having trouble with definition. Which at 5’11”, he would have to go down to 215 to merely be considered “overweight.” Then he stated if he weighed 215 he would be “emaciated.” He then got several other friends to agree that anything under 220 for a man is “emaciated.” He thinks 100% that he is within healthy weight range and only a little overweight. — NOTE: He is NOT muscular. Very Peter Griffin type build. I do agree that if someone is very muscular the BMI chart may not work for them.

    I find that women tend to think they are overweight whether they are or not and men can go up to 300 lbs and more without even admitting to themselves they are overweight.

    This might be part of the reason doctors never bring up weight. They don’t want to argue about it. My weight has fluctuated greatly over the years. I notice if I go in and I’ve lost a lot of weight the doctor will comment on it, but if I’ve gained a lot, they stay silent. The only doctor that ever told me I need to lose weight when I was at a heavy weight was a dermatologist who diagnosed me with acanthosis nigricans. And that was only because I kept asking what’s causing it and how to get rid of it.

    KC wrote on July 12th, 2013
  13. As a critical care (ER and Flight RN), patient education regarding diet and lifestyle choices are a priority. The majority of patients don’t understand how their body works which leads to a unrecognizable disembodiment between their actions and their body’s response.

    My goal as a nurse is to teach my patients about their body, to understand how their body responds to the environment (diet, lifestyle, stress, etc.) and to offer them resources and healthy alternatives so they can live a more healthy life.

    Patient Education wrote on July 12th, 2013
  14. As a UK GP with nearly 30 years experience (happy birthday Mark!) I can only agree with the other docs who have posted. Maybe 1% of our patients have the motivation to make primal/paleo changes to their lifestyle. Maybe another 5-10% do the CW chronic cardio stuff. The rest remain staunchly sedentary and overweight. For the ones who can’t or won’t change, and I offer nearly everyone 3 -6 months of lifestyle changes first, medication is the best I can offer to reduce their chances of strokes and heart attacks.

    Of course I can advise people that they are overweight, but most of them are well aware of it already, and as I don’t have an effective treatment to offer them, they just get annoyed if I keep nagging.

    We aren’t just up against big pharma, it is the entire food industry from subsidy-dependent big agriculture through to the supermarket giants. If you aren’t convinced, look up the British Nutrition Foundation’s very authoritative looking website, then look at their list of sponsors.

    gnarlybuttons wrote on July 12th, 2013
  15. Went to the Dr. to get my blood work done. My LDL was high so Dr. put me on low dose Crestor. Didn’t take long before the side effects started and called and said I wouldn’t take that any longer. Gave me an Rx for another statin. Never filled it. Started taking Red Yeast Rice (a natural statin w/o the side effects of prescrip statins). Also started taking CoQ10, which the Drs do not tell you that Statins pull CoQ10 out of your system so you hurt so bad you can’t or don’t feel like exercising. Had more blood work done after 3 months and everything looked very good (my LDL came way down). He said to keep up what I was doing and I smiled and ok.

    Drs. are so in cahoots with the drug companies, they don’t want you to figure things out for yourself and come up with solutions on your own because they loose their perks from the drug co. I get that Drs are human and make mistakes, but they can look at different things out there and do some research on their own as to what does and doesn’t work.

    I’m also tired of TV people, for example Dr. Oz and Rachel Ray, telling everyone on their shows that we all need to eat whole wheat X number of times a day and use Canola or vegetable oil to cook in. REALLY???? Have they even checked into that garbage? NO! and yet people hang on every word they say, religiously.

    We just have to try and help people one person at a time and hope they listen to what really works and let them know that “healthy” fats are not a bad thing but bread and sugar are.

    Debbie wrote on July 12th, 2013
  16. My own docs aren’t as likely to mention weight these days. But when they do, they recommend a diet based on “healthy whole grains and fruit.” I’m diabetic, by the way. No way can I keep complications at bay, let alone prevent obesity (I could lose weight, but am no longer obese), on such a diet!

    But I still hear of docs who basically refuse to discuss or treat almost any ailment “until you lose that weight!” Never mind that losing said weight may be impossible unless other health concerns are treated.

    Docs do need to address these issues, but not while gazing down at a book of bad science written by Big Insurance, Big Ag, Big Pharma and Big Junk Food. Listening with respect and compassion is a great prescription.

    Marian wrote on July 12th, 2013
  17. This is true, but you are forgetting some things here. I’m the daughter of a GP, my mom. She’s wonderful and wants the best for her patients. She studied hard te become a GP and the knowledge she learned back then is buried deeply inside her. I try to make her think and rethink about what she learned back then, but this is really hard while she is constantly busy with other things and had to work with other doctors who also operate with CW. Also, while we live in Holland and medical care is watched over carefully by the government, she can’t just neglect the rules of how to operate and go her own way. If something would go wrong, someone getting a heart attack after not having got his statins, she would be sued and/or arrested for not having operated correctly. So there isn’t a lot to do. My generation, therefore, has to set a new standard. That’s my goal!

    Tosca wrote on July 12th, 2013
  18. Ok now, I have a friend whose sister recently found out she has very high cholesterol. She was against taking the medication and ask the doctor if she could improve her eating and see if her cholesterol lower. Her Doctor, said, “sure you can do that but it won’t work. You will be back here in 6 months and need the medication.” And she did go back in 6 months and nothing had changed and was put on Statins. I was outraged when my friend told me this! I couldn’t believe the Doctor actually said this to her. And what about the dangers of taking Statins that he has now just jeopardized her health with. It really doesn’t surprise me though. Not sure how her eating was improved. With no proper guidance, she probably reduced her animal and fat consumption and ate veggies but also ate loads of grains (lots of gluten!). So of course she may didn’t succeed. I informed my friend that this was not true (in my reality) and through a primal or paleo diet/lifestyle she should be able to lower her cholesterol and pointed him to your site.

    Allie wrote on July 12th, 2013
  19. Happy Birthday Mark, and many more, having a “red” will toast your 60th here in Perth, Western Australia. PS Thanks for this site, has been a great inspiration to me and my family. JoyK

    Joy wrote on July 13th, 2013
  20. At the risk of sounding incendiary: to all readers who are unhappy with the advice or treatment their doctor provided, I would encourage you to write letters of complaint and/or sue your health care provider.

    Yes, we are influenced by imperfect CW and Big Pharma and insurance dramas and food industry etc etc., but we hate complaints and lawsuits more than anything, which is also one of the causes of our habit of overprescribing.

    Take your doctor to court for prescribing statins or antihypertensives instead of talking about the Paleo lifestyle, get Mark to testify for you, and invite CNN, Dr. Oz, the New York Times etc. If you want to change doctor’s behaviour, this would be one way of accomplishing that. Just make sure you bring a good lawyer.

    Claire wrote on July 13th, 2013
    • But with respect, how many of us, especially if we have a major health problem, have the time, money and energy to become single-issue campaigners taking on our healthcare providers, and even the govt., food-manufacturing and pharmaceutical companies who promote CW?

      Do you have any idea how campaigning like that just becomes your entire life? I was an activist of sorts in my 20’s for causes I cared about (some, I still do) and it can completely eat your life up – not to mention money, if you get involved legally with it all.

      I hope someone with the right mindset does this at some point, but meanwhile the tide is beginning to turn anyway, one person at a time, and I (possibly you as well?) are evidence of that because boy, did I believe some wrongo things about health & nutrition in my time!! ;)

      Patrick wrote on July 13th, 2013
      • I was being semi-flippant. About the legal stuff, I mean.

        How about a simple personal written note or email saying that you would appreciate more information on nutrition and prevention of disease, perhaps ask his or her opinion on the paleo/primal lifestyle?

        90% of the patients that I give patient education to are uninterested, defensive or at times even aggressive. This is not good for the doctor-patient relationship, and surprisingly does not motivate me to spend more time on it.

        Occasionally I see a patient who is interested and wants to know more. Very occasionally I have received a written thank you note for spending the time to talk about lifestyle rather than just handing out a prescription. I really need this kind of positive feedback in order to continue spending time on researching nutrition and talking to patients about lifestyle changes.

        The point is, communicate your thoughts on health and nutrition to your doctor. Do it in writing, and make it personal. Many doctors have less than 10 minutes per patient. If you put them on the spot, the response will be a reflex: eat less, exercise more. If they receive a note (maybe with references to certain websites), you allow them time to read and reflect and respond. If you think your doctor is an evil idiot, make it a complaint, then switch doctors. Otherwise, formulate it as a friendly neutral nudge, much like Marks writes his posts.

        Claire wrote on July 14th, 2013
  21. Mark, I am 59 and your example is inspiring. About 6 years ago I was diagnosed with T2 diabetes. It runs in the family.My doc was also obsessed with cholesterol saying that it is a particularly serious heart disease issue for diabetics. The first thing my doc wanted to do was drugs. He let me try to control it myself for a couple of months. My degree is in biology. I read a lot and came to the conclusion that carbs were a lot of the problem. I cut out sugar, bread and fat. I exercised like a madman. Blood sugar dropped like a rock. He was pleased, but still not into the range he wanted. I went on Metformin. He persisted that I take statins, which I finally did. Even so, nothing seemed to improve the numbers beyond my initial hacks. I started learning about and noticing the side-effects of statins. When he prescribed a “preventative” kidney protection drug, that was all I could take. I actually read the side effects and didn’t like the risks I would have to take. I have not been back to him since. In fact, because of the continuing economic environment and the cost of preexisting conditions, I have not had health insurance. Even though I paid cash towards the end, his testing lab was prohibitively expensive. The whole allopathic medical system is mindlessly screwed up..

    I went paleo/primal over a year ago. I took myself off statins. i never filled the kidney med. I finally ran out of the Metformin prescription (which is considered an actually useful drug) last week, and will see if I can live without it. I have not been back to that office in almost a year. I feel better than ever.Think clearer than ever. I got over my fear of saturated fats. I bought a mountain bike to go with other weight equipment.Business is bouncing back some, but I am still uninsured, but that may change as Obamacare intrudes on our lives. My next step is to find a paleo/primal/functional doc I can rely on, who will be more concerned with cure than maintenance and will be able to work within the idiotic federal/industry framework.

    Keith wrote on July 13th, 2013
  22. Mark, this honest to gods made me cry because so many people I know are being told by their doctors to eat their healthy whole grain, low fat diet, and take statins, and anti-depressants, and insulin shots, and whatever else they get peddled from the pharma representatives…some of them are only in their 20s! It’s terribly sad and it makes me cry.

    My Mother is only 6 years older than you and she’s obese and got cancer and kidney failure and myriad other things that could have been fixed years ago, if she hadn’t followed doctors’ advice to eat the standardised low fat high carb junk food diet. Still they tell her to eat lots of fluffy white bread, and cakes and cookies and manufactured foods and all kinds of junk are on the OK list, and it makes me angry and sad that despite everything she’s read, she still wants to follow their advice, because it’s just easier to take a pill. Too many people are too lazy to even try. They can just take a pill right?

    Not me. I’m too stubborn for that. Live long, drop dead. Thanks for everything you do Mark!

    Rebecca wrote on July 13th, 2013
  23. Awesome Mark, I was thinking of writing to ask you to compile something like this but had no idea how to word such a massive request, nor whether you’d have the time and energy… then I swing by today and VOILÀ!

    Any evidence primal makes you psychic? :)

    Patrick wrote on July 13th, 2013
  24. Hi guys, just thought I’d reply to some of the medic hating going on. I work in the national health service in the UK. I love my job. At the moment I’m in training as an emergency department doctor. We see very similar health issues to those in the USA; obesity, high blood pressure, diabetes… the list goes on and on, doesn’t it? Now, asking around my emergency department, none of my colleagues said that they became doctors because they want to treat their patients badly. Not one of them said that they’re in it only for the cash; in the NHS that isn’t really an option-lol, and if you only cared about money you’d have gone into finance or something where you actually MAKE MONEY. Admittedly, this is the UK, not America. Perhaps because your system is private it’s more open to people who are only financially motivated? But, I care about my patients. I make the effort to give them life-style advice and so do most of my colleagues. But at some point these things are down to personal responsibility as well. You KNOW that you should stop smoking, you KNOW that you shouldn’t take heroin, you KNOW that you shouldn’t drink so much and you also KNOW that a big mac a day will not keep the doctor away. In that situation, I can give as much advice to the patient as I like; if their mind is closed to it…if they don’t want to listen…all I can do is be there when they do listen. And in the meantime treat their heart attack. I recognise that it’s frustrating to have a doctor that doesn’t seem to understand, but just remember that they’re trying to do their best for you. They also have patients who come in and tell them about the benefits of juicing regimes; it can be difficult to separate the wheat from the chaff. They’re following the accepted research to try and give you the best outcome. But attitudes are shifting and you can be a part of that. So rather than bitching about how your doctor only cares about the insurance fees, maybe recommend that they read Mark’s book? Just say that you’ve done some alternative reading and you’d be interested in their opinion too? Because I’ll be honest, posts like this really put my back up. They will not help medicine to change, because you’re forcing people to become entrenched and defensive of their views. They’re NOT committing malpractice; they are simply subscribing to a different (and well accepted and supported) world view to you.

    Helen wrote on July 14th, 2013
    • I think things are different in Britain for sure (thank gawd! ;) ) but to very respectfully play devil’s advocate (as a fellow Brit & massive supporter of the NHS), people who have been told to eat high-fibre, whole-wheat and low fat, and are getting sicker and sicker as a result of this, have every right to be upset they’re being told the wrong thing.

      That diet, in both my personal experience and according to an increasing body of research, can provoke insatiable hunger even when there’s an excess of calories taken in daily, mess with brain and body chemistry, and even contributes to diabetes and heart disease via inflammatory and insulin-related pathways.

      It’s not a “world view” – that could be belief in an afterlife, or the desirability of equal rights for a minority group – it’s being told to do things that are increasingly being seen to work against health, and not for it.

      Remember how long germ-theory was shunned when it was first proposed, and many doctors refused to disinfect their hands on the basis “a gentlemen’s hands are always clean”? ;) That same defensiveness is as much a problem with some medics as the greed for cash or any other driver.

      Doctors becoming defensive or, as I have experienced, trying to shut down dialogue with a patient on the basis “a little knowledge is a dangerous thing” is every bit as damaging to both parties as a simple eye for the fast buck.

      Heaven knows I’d feel the same as you if I felt that my lifetime dedication to helping people was being scorned, but people are suffering and dying because they’re being told to eat the wrong things, and a little professional ego-bruising can’t compare with the slide into misery, obesity, continence and mobility problems that beset so many more people every passing year, much of which is caused by adherence to flawed models of nutrition.

      And which of us hasn’t looked back on what passed for medicine in the distant past, the live mice and the radium ciggies, and been saddened or amused by the blind adherance to what must obviously have been totally ineffective methods? It’s just the same emotion being expressed here by many commenters. ;)

      I have every confidence that things will change, and seeing the number of doctors who’ve posted on here has really made my week – bless you all! :)

      Patrick wrote on July 15th, 2013
      • +1

        Elizabeth wrote on July 15th, 2013
  25. Americans actually *do* need to be told they are fat.

    As amazing as it sounds, they do not know it. Unlike in Asia, nobody ever tells Americans to their face. Most Americans can not tell you their body fat percentage; they have no idea. It might be 19% or it might be 29%, they don’t know. The doctor does not measure it and tell them. Everyone in NE Asia knows their exact body fat percentage and everyone is told when they start getting fat, to their face, by loved ones, in front of everyone. So that they know, and can reverse it before it becomes too late.

    It works. Stop tip-toeing around the problem.

    KimchiNinja wrote on July 14th, 2013
    • Americans and everyone else also need to be told that fat is an endocrine organ, which grows in size as a result of various biological factors, and not a symptom of moral inadequacy, lazyness, weak willpower, or anything else experienced as shameful from the get-go.

      As long as fat is held as a moral issue, simplistic and ineffective moralising about “eat less and exercise more” will seem appealing, and the true causes of the accelerating global obesity problem will be easier to dismiss. ;)

      Patrick wrote on July 15th, 2013
      • Agree. Inform people they are fat so they know (they don’t know), and then give them the information to correct the problem (stop eating carbs). Unfortunately the Neolithic revolution happened, and the food which exists is what exists. Carbs and misinformation are what’s for dinner. ;)

        KimchiNinja wrote on July 16th, 2013
  26. I am a young doctor in Australia, where our system is a lot different to that in the US (similar to the UK system).
    Please read the responses from other doctors on this post – they are all very informative
    I want to say a few things in response to this post and some of the comment’s people have written:

    – Personally, I did receive around 2-3 months of teaching on lifestyle medicine. Most medical courses I know do have this teaching – it is something that is backed by scientific research!!!
    I remember lectures entitled ‘eat fat get thin’, 5 years of mindfulness/stress management/alternative and lifestyle teaching interspersed through our course and the evidence behind it. ‘Wholistic’ medicine was drilled into us
    We had a lecture where a doctor stood up and showed us his lipid tests before and after 3 months of diet and exercise modification and how they had improved.
    I remember sitting there thinking ‘wow!’ This is amazing! I’m going to treat people without medication!!
    The reality has been really different.
    This discussion board and followers of this blog are people who are self -motivated and have an interest in being healthy. I am sorry to tell you that the HUGE majority of patients I see are the opposite of this.
    If a patient said to me when I told them their cholesterol was high – “I would like to try changing my diet and exercise to fix this” I would actually stand up and do a happy dance.
    This has never happened to me… most people want the easy fix
    People come to doctors and know what it is that they want. If they want a tablet and I don’t give it to them then I am ‘incompetent’. If I offer them a table and they don’t want it then what do people think? My approach is to give people the options and they can take it or leave it!

    There are different stages of medicine. Preventative medicine is one of these stages – and is very important!
    Unfortunately this doesn’t always work – and that is where the rest of medicine comes in.
    – stents for example are needed to open blocked arteries. Just because they have had a stent though doesn’t mean there is not an option there for secondary prevention. I will write a summary to the GP asking them to maximize their cardiovascular risk factors, give them smoking cessation advice, enroll them in cardiac rehab which is a 6 week program which teaches patients nutrition, exercise, and lifestyle advice to try and prevent further progression of heart disease. I will even prescribe fish oil for treatment of high triglycerides and for general heart health!

    – I’m not saying that all doctors do everything right. Doctors have doctors too. I went through a few before I found my current GP who is a great fit for me. She is young, energetic, and willing to openly discuss what I think
    I went to a doctor about weight loss advice after I put on 7kgs post two shoulder reconstructions – he told me ‘truthfully you seem to know a lot more about this than me’
    Everyone has their strengths and weaknesses – there are SO many areas in medicine you can’t know everything. My approach is being honest if I don’t know something and either helping find out or pointing my patient in the right direction.

    – Just because you have an overweight doctor however doesn’t mean they can’t give you sound medical advice. You shouldn’t make this a reason not to listen to them or discredit their advice. On the flip side, I often get told ‘it’s easy for you to say’, when I give health advice because I am healthy!

    – Also everyone is different and needs to find what works for them!
    3 years ago I taught my mum how to eat healthy. We made small changes and she has managed to loose 11kgs, is now in the healthy weight range and has kept it off. She wasn’t ready to give up grains so she eats whole grains only. At least these don’t cause the spikes in sugar levels refined grains do.
    I’m proud of her – it’s better than nothing!

    – It’s not the doctor’s job to fix all your problems or give you all the solutions.
    Go looking for them yourself and stop blaming doctors for your problems!
    If you look at health stats of countries with doctors and without – we cause a lot more good than bad.

    – Lastly, generalizations and personal attacks are not helpful. Doctors are just trying to help. It’s about finding the right doctor for you.
    I congratulate all of you for being interested in your health. You are inspirational.

    paleo_doctor wrote on July 14th, 2013
  27. It was the beginnings of the science of nutrition that promoted an overturning of traditional diets, with their reliance on animal fats, meat and eggs etc., and a new push towards starch-based foods, non-nutritive additives, and especially hydrogenated vegetable fats, which in my childhood was the surefire healthy thing to eat.

    I think this realisation, that ancestral and even pre-literate people ate a better diet, is part of the emotional response people have to incorrect dietary advice, and while the average peasant’s diet of say 1497 was probably far from ideal, the feeling we’ve been sold a pup by those claiming to improve our health is also behind some of the anti-medic comments on here.

    Unfair to individuals, definitely, but in the context of the past four decades in which millions have been crippled and killed by obesity (300,000 deaths per year in the USA – stats from the Surgeon General’s website), understandable, perhaps.

    Patrick wrote on July 15th, 2013
  28. You guys Do understand, that a doctor telling his patient to lose weight is like a pageant finalist wishing for World Peace.

    johnnyboy wrote on July 15th, 2013
    • But as I mentioned above; in a place called NE Asia doctors tell fat patients they are fat in 100% of the meetings. Because that is the driver of the patients problem, so the doctor tells them so. And obesity is 3.5%. Hmm connection?

      So maybe it’s not like a pageant finalist wishing for World Peace, maybe it’s like cowardice and unprofessionalism.

      KimchiNinja wrote on July 16th, 2013
      • You can rest assured that someone who manages to get through medical school, residency and everyday medical work has more balls and professionalism than the average Joe.

        johnnyboy wrote on July 17th, 2013
  29. Thanks for a well-written post and happy Bday! I am a former doctor (derm) and feel like I can see both sides. I quit practicing last year but did try to discuss diet and nutrition with patients as I felt a lot of skin conditions were potentially related to obesity and food issues! But as a physician in the US, there is only so much you can say before you have to tell patients that your opinions are your own and not endorsed by the AMA or by conventional medicine… Or so I felt. Also, I don’t know that what works for me works for everyone – and as an MD, you have a responsibility and sore an oath to DO NO HARM. Doctors take this seriously. Really. So even though I am a fan of MDA and Primal living, as a doctor all I can do is give patients information and options and let them decide for themselves.

    Doctors are people too – and sometimes they are having a bad day or struggling with their own issues. Physicians also want to help – and sometimes get stuck on what they think is “right” and can’t hear other opinions. I apologize to anyone who has felt belittled or alienated by his or her doctor. I also want to say that the education physicians receive about nutrition and health and everything is minimal to nothing! So maybe you can help educate your physician too!

    Sara wrote on July 15th, 2013
  30. I just want to thank you for doing such a great job with your posts and all the links to other blog posts. And I really appreciate the bolded sections; they make it easier for me to catch the most important info when I’m trying to read quickly. You are awesome!

    Sarah wrote on July 17th, 2013
  31. I recently changed cardiologists (had stents placed in 2004) because the guy only knows 2 words, weight and statins. Got a new one who coincidentally is a D.O. (don’t know if that makes a difference or not). I’ve had 4 visits with him in 2 weeks to address an a-fib issue. He asked me what my cholesterol was the last time I had it checked and was satisfied with my answer. No blood work. He mentioned weight once (said it would be good if there were less of it) and has not mentioned statins once. I think he may be a keeper. My PCP does listen to me. He doesn’t always agree but doesn’t get all up in my face. He is more “OK, do it your way and we’ll check in 6 months and see where you are”. That’s all I can ask.

    Don in Arkansas wrote on July 17th, 2013
  32. Thanks, Mark,

    That is very well written and expresses my concerns and sentiments when dealing with physicians. I’m confident that most people enter med school with the intent of helping, but the combination of peer pressure, education biased towards pharmaceutically based symptom relief and the automatically elevated social status accorded most physicians creates a barrier towards adopting views that deviate from the mainstream. I know that the sentiment, if not the outright declaration is delivered to med students this way: “if you don’t learn it here, it’s not worth knowing and likely not based in science.” Ironic that suspicion of new observations soundly based in science is so prevalent amongst mainstream healthcare providers.

    Further argument for personal responsibility and self education, with help from people like yourself. Thanks again!

    Dana W wrote on July 17th, 2013
  33. Happy Birthday Mark!!! You look great. Thank you for writing a wonderful article. I agree with everything you wrote. We just started going to a functional medicine doctor and boy do they care about getting to the cause of your illness. Everything I told the pediatrician my child has, she does have it. All I ever got from them has this look like I didn’t know what I was talking about. They really need to take the time to listen.

    Hope you have a wonderful birthday!!!

    Healthy Habit Homestead wrote on July 17th, 2013
  34. Cooee, Mark! My husband and I and most of our friends are REALLY in the later decades of life, not sixties but seventies and eighties, and some have serious health issues and disabilities. We are starting from behind, but still want to make the best of things. Some advice for us oldies, please!

    Valerie O'Regan wrote on July 17th, 2013
  35. QUOTE
    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.

    END QUOTE

    I already stated my belief that homeopathic remedies can “work”, just as astrological predictions can be “true”. No argument there. However, to truly assign the effect (cure) to the alleged cause (the potentized sugar), would require a properly done clinical, controlled, double-blind trial – or a bunch of them.

    I have looked and was unable to find any. I heard of some done long ago which all came up negative – with no actual effect attributable to the medication

    I’m certainly not advocating pharmaceuticals and take NONE of them. I get what you’re saying about natural molecules 100% – and especially natural molecules which have been around and in use by humans for as long as possible. BUT, this applies to herbs and other products of nature, not so much “potentized” sugar pills IMO.

    I did approach them with an open (hopeful, even) mind on many occasions. But, perhaps not with a strong enough “belief”, because no homeopathic remedy ever did anything for me at all.

    If you know of any proper clinical trials which have been done, please supply links.

    Salim Morgan wrote on July 17th, 2013
  36. You do realise that chiropractors have been saying this from day one! In fact a Chiro by the name of dr. James chestnut wrote the texts books on paleo health, movement, mind and nervous system more than 15 years ago! That’s a lot longer than marks daily apple has been around. Maybe we are not the quacks everyone thinks we are eh? ADIO xx

    Dr. Bryce Fleming wrote on July 18th, 2013
  37. Interesting and heated discussion.However, one thing I’ve noticed from all the comments and replies is that homeopathy doesn’t cure ‘thin skin’.

    Alain wrote on July 18th, 2013
  38. I have doctors in my family…. They say that since most people tend to not change behavior they go with pills. Also Big Pharma offers $ and incentives. Great post :>

    Ziva wrote on July 18th, 2013
  39. Maybe a partnership between Wellness / fitness / nutrition coaches & MDs could be a good mutually beneficial relationship.

    Ziva wrote on July 18th, 2013
  40. I wish my doctor didn’t hector me about my weight every time I go. At 5’5, 185 pounds I could definitely stand to lose a few, but it’s not THAT bad… One of the reasons I only go when completely necessary.

    jay wrote on July 19th, 2013

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