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Validity of Paleo/Primal? Wheres the evidence?

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  • #76
    Originally posted by reflex View Post
    Thanks. Primary care medicine is more and more difficult to deliver: patients expect more than ever, doctors expect more from themselves, regulatory agencies demand more, and the amount of data available is astounding (though information is lacking). My goal? To be as healthy a father/husband/doctor as possible, to provide the best care possible for my patients. If Paleo or Primal or whatever can help me get closer to either or both of those goals, then ... great!
    I also didn't mean to be harsh with you. But I have had great doctors who gave me tons of information about anecdotal, new, possibly not workable interventions....but ones that really couldn't cause much harm. I think we all appreciate the horrible avalanche of paperwork, regulations, insurance and student loans doctors work under these days. But still. A doctors appt., for me, is a quest for information about whats happening, and how I can help myself.

    I am paying a doctor for information about health and healing. I have a fantastic doc. But when I go to anyone else, I'm always shocked at how little they have to offer.

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    • #77
      Originally posted by springnr View Post
      Also PaleoBird your right, and that check up counted as three visits to that Doc. First, Last, and Only.
      (even if she was talented at DREs)
      I just think that there is way too much "doctor bashing" (not necessary you but in general) that goes on on this site and we need to check ourselves there. If we want to see change in the medical community, we have to be active participants in our health care and be willing to "vote with our feet" i.e. go someplace else if we are not getting the care we want.
      Just ragging on "The Medical Establishment" and dragging out the tinfoil hat conspiracy theories about how doctors want us to be sick (?), just makes the paleo/primal community look like a bunch of kooks.

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      • #78
        Originally posted by reflex View Post
        background

        BUT, I have to be able to justify my recommendations to my patients within my profession. It is malpractice (successful lawsuits) to not prescribe (or at least offer) statin drugs to people whom I see with elevated LDL cholesterol.

        My issue with Sisson is when he writes things like: statins have "minimal, if any, direct benefit."

        The number one killer of people in the State of California (and many others) is heart disease. This is NOT true for Kaiser patients, anymore. This drop in heart disease deaths is attributed to aggressive statin use. There is good evidence for their use (Arch Intern Med -- Continuation of Statin Treatment and All-Cause Mortality: A Population-Based Cohort Study, February 9, 2009, Shalev et al. 169 (3): 260).

        So, while I believe Primal/Paleo is brilliant and logical and the "right path" for most chronic diseases I see in my clinic, and I see some evidence supporting this approach, we don't have the kind of longitudinal research (whether rigorous, or not) to support Paleo or Primal as legitimate medical advice.

        How do other health care professionals deal with it from this perspective? The OP question is key -- having this approach work for ME, or everyone on this forum, isn't enough "science" to put this into practice without raising quite a few eyebrows.

        - JP Atkinson
        I'm a fellow primal physician (Neurology), and agree that it's incredibly difficult to deliver what I'd consider the best care within the confines of the current system. Just today I was sent an email from our malpractice insurer about a multimillion dollar decision against a physician who hadn't prescribed a statin for his patient with high cholesterol. The same exact thing could happen to a physician who advocates a high fat diet for their patients.

        But the problem goes beyond the need for medicolegal reform. For every patient who appreciates the 30 minute conversation I have about diet and lifestyle change as a solution to their problem, there will be 20 who leave the office irritated that I didn't just prescribe them something to fix it. I absolutely LOVE when a patient is actually interested in diet/lifestyle changes they can make, because it is such a rare thing.

        And then there's the issue of alienation within the medical community for those with a minority opinion. Most doctors take it as a given that a low fat, low cholesterol diet is optimal for prevention of vascular disease (stroke, MI, etc.), for example. If I advocate something entirely different, I'm likely contraindicting every other doctor my patient has been in contact with. As a consultant, if I'm seen as discrediting the very physicians who send me patients, I'll find myself with nothing to do all day very soon.

        And this is really just the tip of the iceberg - there are just so many mechanisms in place that reinforce the status quo in the healthcare system it's already difficult to see a way out. And with the reforms that are coming, the situation will likely get worse. The primary reason the government/Medicare is pushing electronic medical records is because it allows for easy monitoring of the treatment decisions doctors make. The goal of this is standardization and homogenization of healthcare delivery - a worthwhile goal if our evidence-based guidelines are grounded in high quality evidence/science and if a one size fits all approach to patient care was optimal. Neither of these things are true, of course, yet doctors who deviate from the evidence based guidelines will see their reimbursements decline or their insurance contracts terminated. Those with perfect compliance will be promoted as the highest performing doctors. Even now, if I don't prescribe every stroke patient a statin at the time of their discharge, our hospital will lose its JCAHO certification as a primary stroke center (which means lost dollars in revenue, etc.).

        So it is very discouraging to see the doctor bashing that is so common here - the situation is far from the black and white way it is usually presented in these forums. Most docs I know are just doing what they think is in the best interest of their patient's health - it's fine to disagree with their reasoning in certain situations, but to question their motivation is very unfair. We're all after the same thing in the end, and need to lose the false "us versus them" mentality if we're ever going to make real progress.
        sigpic

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        • #79
          I won't wade thru this whole thread but will suggest Taubes' Why We Get Fat, one of the shelf full of books I bought at the Border's fire sale. Direct references to the type of studies you're looking for, the bad science behind conventional dietary advice and the historiography of the subject from the mid nineteenth century onward. Footnotes and bibliography if you wish to delve further. All written quite clearly for a layperson such as myself.

          It is the Cliffnotes version of his tome Good Calories, Bad Calories( which has been described here as rather dense and somewhat long as Taubes writes himself in the shorter book) which may be more up your alley.
          Wheat is the new tobacco. Spread the word.

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          • #80
            Originally posted by jturk View Post
            I'm a fellow primal physician (Neurology), and agree that it's incredibly difficult to deliver what I'd consider the best care within the confines of the current system. Just today I was sent an email from our malpractice insurer about a multimillion dollar decision against a physician who hadn't prescribed a statin for his patient with high cholesterol. The same exact thing could happen to a physician who advocates a high fat diet for their patients.

            But the problem goes beyond the need for medicolegal reform. For every patient who appreciates the 30 minute conversation I have about diet and lifestyle change as a solution to their problem, there will be 20 who leave the office irritated that I didn't just prescribe them something to fix it. I absolutely LOVE when a patient is actually interested in diet/lifestyle changes they can make, because it is such a rare thing.

            And then there's the issue of alienation within the medical community for those with a minority opinion. Most doctors take it as a given that a low fat, low cholesterol diet is optimal for prevention of vascular disease (stroke, MI, etc.), for example. If I advocate something entirely different, I'm likely contraindicting every other doctor my patient has been in contact with. As a consultant, if I'm seen as discrediting the very physicians who send me patients, I'll find myself with nothing to do all day very soon.

            And this is really just the tip of the iceberg - there are just so many mechanisms in place that reinforce the status quo in the healthcare system it's already difficult to see a way out. And with the reforms that are coming, the situation will likely get worse. The primary reason the government/Medicare is pushing electronic medical records is because it allows for easy monitoring of the treatment decisions doctors make. The goal of this is standardization and homogenization of healthcare delivery - a worthwhile goal if our evidence-based guidelines are grounded in high quality evidence/science and if a one size fits all approach to patient care was optimal. Neither of these things are true, of course, yet doctors who deviate from the evidence based guidelines will see their reimbursements decline or their insurance contracts terminated. Those with perfect compliance will be promoted as the highest performing doctors. Even now, if I don't prescribe every stroke patient a statin at the time of their discharge, our hospital will lose its JCAHO certification as a primary stroke center (which means lost dollars in revenue, etc.).

            So it is very discouraging to see the doctor bashing that is so common here - the situation is far from the black and white way it is usually presented in these forums. Most docs I know are just doing what they think is in the best interest of their patient's health - it's fine to disagree with their reasoning in certain situations, but to question their motivation is very unfair. We're all after the same thing in the end, and need to lose the false "us versus them" mentality if we're ever going to make real progress.
            Great post jturk! Thanks for sharing your perspective!

            I've been fortunate to find care providers who are very open to my health choices. I've absolutely switched doctors multiple times to find the right fit for me, but its been worth it!
            My Before/After Pics
            Are you new here? Be sure to check these links FIRST, before reading anything on the forum! Succeed & PB 101

            "I am a work in progress." -Ani DiFranco

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