Patient education page 4

[Thrakk]

I'm not familiar with any single website that covers all that stuff, so I'm sorry I can't help you out there, NaLi.

I was linked to this video as my own introduction into paleo.
Youtube - Paleo in a Nutshell Part 1: Food
I have a background in biology so the concept immediately clicked with me and I wanted to do further research straight away. It does address the ancestral nutrition thing though, so maybe it doesn't suit your needs. It definitely does explain the paleo principles using easy language though. Give it a watch and see if it'd be suitable to show patients?

Why the hell isn't nutrition a mandatory high school subject? What you are trying to set up is great, but trying to educate people after they've been sent to the ER is a good indicator of how misguided our society is. [/angry_rant]

Oh and try not to get frustrated if you are met with resistance. Fear of liability is a bit of a plague in my eyes, and I can imagine an ER director being real weary before stamping this.

[Damiana]

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.

Oh, there is definitely a wrong way to do paleo. One of my friends' coworker claims to be paleo; for lunch, he eats a few packages of packaged bologna.

[Six String Strength]

I actually just had a great conversation with my doc about barefoot running after seeing her in a pair of Trail Gloves. She had no idea there was a "movement" or whatever behind it, just that she knew it felt better to have little/no heel and sole for work.

I think people need just a little taste or sliver to hang onto that will eventually lead them to the whole concept. The trick is making that first piece applicable to the individual and easy to swallow.

[sbhikes]

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.

I don't think you can find something like this out there. Maybe you can come close with this page: LCHF for beginners | DietDoctor.com . What you might consider doing is making your own website that you can refer people to. Then you can just put as little or as much information as you think needs to be said. Maybe link out to some research or other websites that are almost "not crazy" if you think that is needed for some people, but otherwise keep things simple. Skip the forum because unless you blog like crazy and are a search engine optimization master, you'll hear crickets chirping on your forum.

[Jac]

What about the Weston A Price website? Not paleo, but some very sound principles there.

[shep68]

There's always Loren Cordain's book about the Paleo Diet. It's an easy read and was my foray into this lifestyle. I realize there are some differences between Paleo and Primal, but I consider those to be relatively minor when comparing the overall lifestyles. Look, if you're going to offer patients this advice at some point some combination of the words paleo, primal, caveman etc. are going to come up in their research if they even get that far. And if they do get that far there is at least some interest on their part. They are either going to accept it or not, and nothing you say or do will matter. I think you are right when you state as an ER doc you have limited time and no follow up. All you can do is give your best advice and move on. Like I said before, with most people it will be an uphill battle. Not in your hands or power to change that so I wouldn't worry about it. You made the effort and should sleep well at night.

[Moochy]

Hello,

So, for now, I'll stay semi-closeted. I am interested in hearing your thoughts on this. Also, if there are any paleo friendly doctors out there with experience on formalizing patient education, that would be great.

If you are interested in fellow medical providers, here are a few links I have:

Chris Kresser, Food fascism and the 80/20 rule

Colin Champ, M.D. radiation oncology. Caveman Doctor

Dr. Cate Shanahan Family Physician

Peter Attia, M.D.

Dr John Briffa

Dr. Kurt Harris he no longer publishes but his website is till up

There are many more medical folks out there. All the above are paleo advocates.

[NaLi]

I checked out some of the sites suggested here... Weston A. Price - interesting stuff, but way to alternative for me to propose at work (cherry juice concentrate for gout? fine to try, but there's no way I could send a patient with an acute gout attack home with that advice...). The Whole9 seems interesting, and I'll add it to the list of websites I recommend to patients, but can't refer to it when discussing hospital policies.

I guess my concern is less with patient education (in spite of the title of this thread) but more with education of staff. I went through the sites by medical providers suggested by Moochy, and realised that almost none of them have published much in peer reviewed journals. The only nutrition related article I could find was a review article by Dr. Colin Champ on low-fat vs low-carbohydrate diet in breast cancer patients. Dr. William Davis (Wheat Belly) claims that he barely performs invasive therapy for his heart disease patients anymore because of reversal of disease after changing their diets. Why can't I find anything by him on PubMed? A solid randomised trial might be too costly and not practical, but surely a case series or a concept paper would be easier to write than an entire book? did he write them and was rejected? or did he think incorporating his theories in mainstream cardiology would not be accepted? I am confused as to why MDs would write books aimed at the general public rather than propagating their ideas and theories on nutrition via academia? no funding? too hard? or just no evidence? or financial interest?

I am not trying to discount their work, nor do I disagree with the theories on nutrition. But it seems to me that many MDs seem to have left "mainstream medicine" for holistic medicine or alternative medicine. Is it an either/or situation? I am a conventional doctor and have no intention of becoming an alternative medicine practitioner. I deal with fractures, acute heart attacks, appendicitis and no amount of high quality whole food is going to fix you once you're in this situation. I know doctors get a lot of criticism for pushing pills, but imagine the amount of criticism if we don't prescribe drugs. Would you prefer a doctor who overprescribes or underprescribes? Still, I think there is tremendous unrecognised value in preventative activities and feel there is no reason why this should not be a greater part of mainstream medicine.

I do think, however, that it is still too early for the principles of the paleo diet to be incorporated in conventional medicine from a top down approach. I think that high quality research and hard evidence will not be available any time soon, this is not absolutely necessary. Lots of things we do is not based on any evidence at all. (probably most of what we do...). I'll continue to educate my patients the way I have been, and will probably put something down on paper to hand out to people who are interested. Not sure if it will be frowned upon by higher management, but I'd rather not ask.

Finally, a question. Or a poll. Who on this board educates their doctor? I have read many stories about people getting results and surprising their doctors with it. Does anybody give their doctor information? How do you do it? How do they respond? Would you given them a handout - brief written documentation about the principles of the diet and some websites and publications to reference? I am wondering if this would be a way to encourage MDs to improve their knowledge on nutrition (since it's so terrible) and maybe even recommend it to other patients....

Sorry for the long post, but am curious to hear your thoughts...

[Damiana]

I am a member of a large health network, and as such, my doctor sees me for the current health problem I am having and is completely unconcerned about the state of my health otherwise. I have never been overweight, and I think the health network only cares about the state of my health when I am normal weight and doesn't care if I am too thin. There were no concerns raised when my weight dropped below 80 pounds 5-6 years back (I am 5'4) due to thyroid issues, and I had to come in to get that examined before that was ever a concern, yet when my weight went back up to 127 at its highest, I got a call from a nurse regarding my weight gain and was advised to eat low fat, whole grains, and to exercise, which I had been doing all along. I would not dream of talking about anything besides the current illness whenever I saw my doctor.

[shep68]

I mentioned in another thread somewhere I'm highly impressed with modern emergency medicine. It has become a lifesaver for many and diet doesn't matter in those cases. Where modern medicine seems to be lacking is in the overall health of the general population...preventative-wise. A pill is always the fix. My doc (who I actually like and think is pretty good) basically gave me a vague lose weight comment last year when I went on all the pills. Two months ago when I saw him he was duly impressed w/ my weight loss but didn't ask how I achieved it. I'm waiting for him to ask actually; next time I see him the weight loss is going to be significant. The proof is in the pudding as they say.