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Thread: Validity of Paleo/Primal? Wheres the evidence? page 8

  1. #71
    reflex's Avatar
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    Quote Originally Posted by fitmom View Post
    I think it would be great if doctors would post this sign in the waiting room: "even if I know of something anectdotally that might help you, I won't tell you about it, because I might get sued.

    The only help you'll get, after paying your outrageous insurance premiums, is a prescription. Then, when THAT doesn't work, you can sue Big Pharma, not me! Win-Win!"

    There's a reason that "good" doctors are so hard to find, and so adored. Good doctors are lovers of information about the human experience, and they excel at sharing that information with others.
    Wow, "fitmom" and "springnr," those are harsh words to write. Either you didn't read my post, or you ... didn't read my post. What is up on this forum? I write a post clearly stating my belief that Primal/Paleo is great, pointing out that I have even helped some patients get off diabetes medications by recommending Paleo living, and seek some help with knowing how to bring this to my patients in an evidence-based way, and I get slammed by two posters. Yeesh! Is this representative of the mentality on the Primal Living forum?

  2. #72
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    Quote Originally Posted by reflex View Post
    background
    • I am a family physician.
    • I was a cross-country runner in high school (6-0 and 140 pounds, running 5k in 17:35).
    • Through my twenties and thirties I would run/cycle/swim intermittently, sometimes completing duathlons, but eventually tore a meniscus snowboarding, and my fitness went downhill from there.
    • My mother was lactose intolerant, and so am I.
    • I love grains: I definitely feel like if a person can be addicted to grains, I would meet the criteria.
    • I hit my maximum weight of 200# about two years ago.
    • I lost 20# like clockwork (one pound a week) on WeightWatchers (last year).
    • This did nothing for my fitness, of course.


    2011
    This year, I read Cordain [The Paleo Diet + The Paleo Diet for Athletes], Wolf [The Paleo Solution], and I just finished The Primal Blueprint. I have lived about 75% paleo for the past 6 months or so. I started commuting to work by bicycle about 6w ago. I am stronger, leaner (BF down from 24 to 19%), and definitely feel better in every way.

    I have seen patients lose massive weight and get off their diabetic medications using the Paleo principles, so I am an "anecdotal" believer in this approach, without question.

    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
    The problem is that both sides cherry pick the damn data and no one is willing to just tell it like it is...makes it damned near impossible to really know what the right answer is. I agree there is some good data about statins - although I'm not convinced yet that the mechanism is truly related to cholesterol - inflammation perhaps. But there is also negative and even data showing harm. Also, I have seen in some cochrane reviews that many of the trials have issues where patients with prior heart attacks were included in the primary prevention group skewing the data. My sister is a physician and I am scientist and we have many people in the family with CAD. My dad has been on statins for years following a heart attack and had done great. But my brother who is 33 has elevated cholesterol - his physician and my sister want him on stains ASAP. I am hesitant. But even reading the primary literature as a trained PhD pathologist I can't frickin' figure out what is right.

    I do really sympathize with you on this. In some ways, clinical medicine is always the last to change because you require the most evidence and are dependent on who decides to do what studies to get your data.

  3. #73
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    Quote Originally Posted by jammies View Post
    I do really sympathize with you on this. In some ways, clinical medicine is always the last to change because you require the most evidence and are dependent on who decides to do what studies to get your data.
    Thanks. We are held to a very high standard. My patients don't pay through the nose for me to tell them, "Hey, I tried something and it really worked for me, let's see if it keeps you from an early grave!" They pay for evidence, expertise, and not for being a cowboy. I listen to my patients, I take into account their family history, social context, psychology, and any supplements they are taking when I offer them advice about management of a disease (which is what doctors do, BTW -- allopaths are trained to diagnose and manage disease, not "care for health," as most people think. The truth is that we don't fully understand what causes heart disease (I was once told that 1/2 of everything we think we know in medicine is disproved every eight years, if not sooner). There is mounting evidence that statins reduce inflammation, and that may be their true method of reducing all-cause death. I am not a researcher, but would love to get involved in a project along these lines.

  4. #74
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    Reflux, my post really was not to rag on you so much as the thought process, your profession must run through to doctor on folks.

    "I have lived about 75% paleo for the past 6 months or so. ....
    I have seen patients lose massive weight and get off their diabetic medications using the Paleo principles, so I am an "anecdotal" believer in this approach, without question.
    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."

    The above could lead one to think that your patients improvements, introduced you to Paleo.
    Not that you encouraged them to try it My Bad?

    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)

  5. #75
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    Quote Originally Posted by springnr View Post
    Reflux, my post really was not to rag on you so much as the thought process, your profession must run through to doctor on folks.
    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!

  6. #76
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    Quote 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.

  7. #77
    Paleobird's Avatar
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    Quote 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.

  8. #78
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    Quote 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.

  9. #79
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    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.

  10. #80
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    Quote 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!
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