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Thread: Patient education page 3

  1. #21
    sbhikes's Avatar
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    Quote Originally Posted by magnolia1973 View Post
    I think most people would be happier and healthier even if all they did was ditch processed crap, soda and fast food.
    I agree with this. Except that about 3 years ago I found myself sitting in my doctor's office hearing for the umpteenth time how high my cholesterol was, how high my triglycerides were, that my CRP was troubling and that if it wasn't for my ratios being okay, he was going to probably put me on statins in a few years. He said, "You probably eat a lot of red meat and fast food, huh." I said I hadn't eaten in a fast food restaurant for as long as I could remember and that I ate red meat probably less than once every 6 months, and that I ate meatless meals most of the time. Soda never came up, but I haven't been able to drink soda with HFCS in it ever since they invented HFCS.

    What I didn't realize was that it was the "healthy whole grains" and the fact that having a scone with my coffee or a dinner of pasta and garlic bread was worse than having a burger and fries now and then. I doubt the doctor would have thought it was worse, either.
    Female, 5'3", 49, Starting weight: 163lbs. Current weight: 135 (more or less).
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  2. #22
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    The most success I've had explaining my way of eating to the uninitiated is keeping it really simple:

    "Eat veggies and meat. Some fruit and nuts. Good fats. Avoid grains and sugar."

    Follow-ups are usually pretty simple, also. "Nah, fat is really good for you as long as you're not eating grains and sugars."

    If people want to get into more of it, fine, but that's the least offputting way I've found to respond to casual questions about nutrition. I think it doesn't sound impossible or weird to the average person.

  3. #23
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    Good to hear you say this, NaLi. The idea that doctors should slap on a bandage and prescribe some pills and let people go on their merry way has never sat right with me. I feel like there needs to be some medical service that evaluates lifestyle and provides professional advice based on scientific evidence; the ones that I've seen around these days seem to delve into the realms of homeopathy and other pseudoscience. Maybe I can look into the possibility of setting something up myself at some stage.

    If you want to get through to people about lifestyle changes, I think choosing your words carefully is the most important thing. I've tried to explain paleo to plenty of different people, and more people accept what I say these days now that I've had some practice getting my point across. I try to explain that up until the last couple hundred years, the idea of marketing 'organic food' didn't exist. All food just was organic because that's the natural state of it. I also mention that I've been following scientific research and it would seem that the food pyramid most of us were taught about might not be as reliable as we were led to believe. People seem genuinely interested when I start the conversation in this manner, and they are much less likely to reject it.

  4. #24
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    Pushing the "eating whole unprocessed foods" meme WILL NOT WORK. Vegans eat whole foods. Fruitarians eat unprocessed foods. "Whole wheat" is considered a whole food by the vast majority of the population. And most Primal foods are processed just as much as any other type of food.

    Bringing up Grok WILL NOT WORK. Does the patient even believe in evolution? (Surprisingly, many Americans do not. I don't know about Aus.) And if the patient does accept evolution, he probably thinks that 10,000 years of grains is evolution enough. We've been eating grains "forever" and it hasn't killed us yet. Plus everybody pre-1970 was skinny and they ate wheat...

    Primal is so against CW that it takes weeks or even months to convert someone. Do you really want this doctor to get into a semantic argument about why whole wheat isn't really whole, or why bacon "isn't" processed, why coconut oil is good but corn oil is not, despite 40 years of teaching, or who the hell Grok is and why is Raw Meat Paleo Grok is OK but Ancient Roman Wheaties Grok isn't good enough?

    How is anyone going to have this conversation IN THE FREKIN' ER.

    I think the Doc needs to skip the science and go straight to results.

    "I hear that GERD is a sign of gluten intolerance. No, not celiac, just an intolerance. Like lactose intolerance. It doesn't kill you it just gives you gerd. If you stop eating wheat you may not need Prilosec. Sometimes you can have a little, but we need to eliminate entirely first, to make sure that is what is giving you GERD." [also works for arthritis, skin rashes, high BP, and other signs of inflammation.]

    "We've all heard the sugar is bad. Well, pretty much any bread that you eat, or cornbread, or rice, or white starchy stuff, turns into sugar in your blood. Your body doesn't know. We're all eating a lot more sugar than we think. You'll have to cut down on bread and potatoes because it's sugar. And YES, whole wheat still have the sugar in it." [can also relate sugar to blood sugar and use the diabetes angle.]

    "I found out wheat and corn are what really make you fat. I know this because I stopped eating grains and".... lift up shirt to reveal six-pack. That tends to get a LOT more attention than biochem.

    "I heard that Paula Deen lost 32 pounds by cutting out bread and potatoes. Can you try that?"

    "you heard about all the low-carb diets? And how hard it is to count carbs? Well if you knock out the high carb starches, it's a LOT easier to stay under that carb limit."

    Keep it simple, relate it to something they already know, as a stepping stone.
    5'0" female, 43 years old. Started Primal October 31, 2011, at a skinny fat 111.5 lbs. Low weight: 99.5 lb on a fast. Current weight: skinny-fat 106.5 lbs because of sugar cheating.

    MY PRIMAL: I (try to) follow by-the-book primal as advocated by Mark Sisson, except for whey powder and a bit of cream. I aim for 80-90 g carb/day and advocate a two-month strict adjustment for newbies. But everybody is different and other need to tweak Primal to their own needs.

  5. #25
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    Quote Originally Posted by RitaRose View Post
    I'm really not trying to be whiny, but when you have food intolerances on top of Primal, it can make you a little crazy. Throw in low carb when I'm frustrated and end up binging and gaining weight, and now you have a crazy, bitchy lady that just wants the %$&@ donut, preferrably NOW!
    Snap, RitaRose - this describes me so well it made me snort .

    I'm a nurse, and describe my eating plan in general terms as eating what my grandmother ate when she was a kid. That rules out almost all of the nasties and encourages fresh veges, seasonal fruits, meat and dripping.
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  6. #26
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    Wow, thanks for all the comments! hadn't expected that.

    It's good to hear from other health professionals and their problems with patient education. It's hard enough with the bits that aren't controversial (I still find myself trying to convince patients that smoking is not good for asthma), let alone something like a non-conventional lifestyle.

    The advice that I have been giving, similar to oxide's suggestion, goes something like this "some people may be more sensitive to certain foods, and this sensitivity can manifest as obesity/diabetes/rash/joint pain/depression/anxiety/bloating/gerd etc etc and the best way for you to find out is to do a trial elimination diet, starting with eliminating grains and sugars for 6 weeks and then see how you feel". It can be both satisfying and uncomfortable at the same time. If patients respond positively, it's a much nicer discharge than "all tests are normal, there's nothing wrong with you, go home". At the same time, I find myself choosing my words very very carefully and also not documenting anything about this conversation other than "dietary advice given" for fear of being told that I should stick to the conventional dietary advice, as well as fear of complaints if patients don't like the advice. Also, what used to take me 5 minutes, now takes me 45 and that is not a good thing in a busy emergency department. And since I can't follow up, I don't know if I am just wasting my time.

    Some respond well, especially the "nobody can find out what's wrong with me" subgroup, and if they're interested I go into a bit more detail and suggest some websites. It's not an easy diet to explain though. It sounds easy: "avoid all grains, sugars, processed foods", but the reality is a bit more nuanced and I would bet that everybody on this forum has ended up giving the diet his or her own spin according to personal needs and results. I consider this a good thing, but this it does assume a significant amount of initiative and personal sense of responsibility, and a lot of people just don't have this.

    What I am looking for is a website to refer to that:
    1. explains the paleo principles,
    2. in a language geared towards people with no scientific background or interest,
    3. without referring to paleo/primal/grok/ancestral nutrition logic,
    4. that is not owned and moderated by a single person (especially if this person has a financial interest in promoting this diet or appear mildly insane), but rather a non-biased not for profit organisation,
    6. with an active and friendly user forum (like this one!)
    7. that I incorporate in a formal patient education policy for review by the Director of the Emergency Department and other units (and the hospital kitchen!) without appearing too subversive. Or too crazy.

    Any suggestions?

    or should I just try and stay under the radar and continue to do my own thing, one patient at a time?

  7. #27
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    Yay I also enjoy threads like this. Most of what I wanted to say has been said now but I'll add in my two cents any way.

    I work part time in admin at an A&E, and I do the late and weekend shifts where we basically only operate for emergencies.

    Since I have lost about 26kg / 58lb or so, I have had discussions with a few of the docs. One of the female doctors wants to lose weight and was telling me how all she eats is protein....
    Of course, when I talk to them, I do not want to start saying paleo and grok etc. because they'll just immediately close their minds and think I'm on a fad diet. Also the fact that they are doctors and I am not makes the conversation a bit lopsided as I'm sure they feel they already know about nutrition (despite the fact that they are being unsuccessful with their own weight management...)

    So I have started saying it as others on here have mentioned. I say that I don't eat grains, vegetable oils, and soy. Basically, I don't eat processed foods, and I enjoy natural and animal fats as a way to remain satiated and because I have seen research and discussion that I believe disproves the whole low-fat movements' ideologies.

    I then tell them I reversed my type II diabetes and my cholesterol went from pretty damn ugly, to pretty damn gorgeous... and then I just leave it at that.

    They can see the results in me every day, once I tell them my spiel there's not much point continuing on about it. If they ask me more then I give them this website.

    I am actually going on leave for 3 months and when I get back (In Feb/March) I imagine I'll be down around 170-180lb and the conversations could begin again (as it's always more of a severe change when you haven't seen someone at all, so when you see them again they REALLY don't match the image you had in your head).

    I think over time, the research will point this way. It's just a shame that it's going to take so long... in the mean time we can al continue being the silent army that we are, enlightening one willing mind at a time
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  8. #28
    nixxy's Avatar
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    Quote Originally Posted by NaLi View Post
    I would bet that everybody on this forum has ended up giving the diet his or her own spin according to personal needs and results. I consider this a good thing, but this it does assume a significant amount of initiative and personal sense of responsibility, and a lot of people just don't have this.
    That, indeed, is the biggest problem.

    I have found that it does take interest, and commitment. If you don't care about health very much, this kind of thing really isn't going to appeal because it does take a bit of effort. You do have to pay more attention in the supermarket, maybe put in a bit more effort when cooking, spend time researching if you can still eat your favourite food, and how.

    Also the self-responsibility... some people don't have it and don't care.

    The thing is, if these issues didn't exist, we wouldn't even be having this conversation. Everyone would care about their health, and would be passionate enough to have already researched and discovered these principles themselves.
    How to make people take an interest though?
    Current weight lost: 82.9lb (37.6kg)

    Current PRs:
    Bench: 45kg/99lb
    Squat: 100kg/220lb
    Deadlift: 120kg/265lb

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  9. #29
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    A lot of it is the lack of impulse control (head injuries) which leads to eating junk, which leads to me craving junk, which leads to me craving more junk. And then, even when I don't eat junk (which is incredibly hard), then there's no difference. And I can't treat myself with some bacon or a glass of wine or some dark chocolate, so then I have a pity party and "Hello donuts!"
    I got ya, so physically, you can't have red wine or chocolate (I assume it's an allergy or reaction), but can have donuts.

    I understand that frustration from when I did Whole 30. LOL, I discovered dates.

    I think just the whole foods is a good message. I know people hate grains, butI think in some contexts, they aren't that bad. I can't remember ever overeating whole grain anything. Refined flour... yes, very good. I think a day that goesatmeal, chicken on salad with a whole grain roll and a steak and sweet potato is a far better day than bagel, Mc Donalds and pizza.

    I do wonder about some aspects of primal/paleo, mainly the fat, and is the fat still OK if you buy normal meats. If the pastured is really critical, I can't see many people paying for and sourcing pastured animals. I would worry about people eating increased amounts of factory meat. Is a plate of Hormel Bacon, factory farmed eggs, cooked in butter from a cow that got hormones actually BETTER than a bowl of oatmeal? You run the risk of making "junk food paleos" like the junk food vegans that eata soy hot dog on a white bun with a side of chips and call it healthy.

    I guess dietary education requires more than a one minute elevator speech.

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    Check out my blog. Hope to share lots of great recipes and ideas!

  10. #30
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    Have you looked at the Whole 9 website? They explain everything in layman's terms and address a lot of other lifestyle issues other than eating whole, unprocessed foods. I think it meets your criteria, although it is owned by a husband/wife team. They do market a book, but almost all the information in the book is available for free on the website. There is a good forum and some amazing success stories.

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