July 11 2013

An Open Letter to Doctors

By Mark Sisson
256 Comments

DoctorI 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!

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256 thoughts on “An Open Letter to Doctors”

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  1. Ugh, I don’t know where to start. In recent years, I have found doctors to take a bullying/hectoring stance when I’ve refused their medication. I’m sure there will be plenty of patients willing to do as they are told but a genuinely open, respectful doctor is worth their weight in gold, IMO.

    1. So true. I once had a doctor come unglued when I told him I also see a homeopath on occasion. I guess he thought he had a right to yell at me. I told him he didn’t, and I fired him on the spot. If more people would refuse to put up with bullying doctors, we would see far fewer of them.

      1. There’s a vast chasm of difference between the science-backed lifestyle and diet that Mark espouses, and the pseudoscience (read: utter lack of evidence despite a large number of clinical trials) in homeopathy.

        In this case, your doctor was right to yell.

        The whole point of this article is that doctor’s should follow the science rather than fairy tales. Homeopathy replaces one set of fairly tales for another.

        1. BS, Michael. A doctor never has a right to yell at a patient, regardless of the reason. The doctor works FOR the patient and is employed BY the patient–not the other way around. I’ve had other, more enlightened doctors merely ask me what homeopathic remedy and strength I was using, without batting an eyelash.

          Regarding homeopathy, you are parroting what you’ve read and obviously have never tried it. Therefore, you don’t know what you’re talking about. I see you also have a problem thinking outside the box. Didn’t anyone ever tell you that today’s scientific “evidence” is often tomorrow’s debunked theory?

          I’ve found that classical homeopathy (using a trained, experienced homeopath–NOT quasi-homeopathic OTC drugstore preparations–works very well for many things, including vastly superior pain relief. It has NO side effects, in glaring contrast to the drugs prescribed by the allopathic profession you seem so ready to defend. If it didn’t work, millions of people wouldn’t use it.

        2. Can’t really agree with you there when it’s SCIENCE that says that one of the most effective treatments for most maladies today is……wait for it…..a PLACEBO pill. That’s right. It outperforms drugs.

          So, that’s a fairy tale. And it’s a working fairy tale.

          The doctor shouldn’t yell at a patient just because they have a different belief system. That very belief system, no matter how different from the doctor’s, may be the VERY thing that saves them. And there is science to back that up.

        3. That’s not actually true. Most studies show placebos have little to no impact on objective measures. They have variable impact on subjective measures, such as pain, but this is often temporary amelioration lasting up to 30 minutes or so.

          Besides, I’m pretty sure dugar pills aren’t Primal. 😉

        4. Disclaimer to all fans of homeopathy who get defensive when it is attacked by science: You may not want to read this comment. I am overall opposed to the practice, although I concede that there are some good elements to the traditional homeopathic treatment that would improve medical treatment.

          About homeopathy working on animals:
          It has been shown that there are placebo effects in non-human animals, e.g. http://www.ncbi.nlm.nih.gov/pubmed/22871471

          In animal homeopathy, similar factors may play a role as in human homeopathy: the personal care received, the fact that it is more “warm and caring” as opposed to the “cold and sterile” of regular medicine. (These are the mentioned good elements.)

          In addition, there are a number of observational biases, i.e. if the owner/person administering the treatment believes it works, he/she may interpret animal behaviour in a way that matches expectations. This works especially well with animals since they can not express their symptoms or lack thereof verbally.

          I live in Germany, where homeopathy originated and is at least partially covered by universal health insurance, much more widespread and even taught at universities to med students. So here it is pretty much part of conventional wisdom, to the point that I have argued with several doctors who where firm believers – just as I may argue about cholesterol and saturated fat.

          I often see an almost knee-jerk reaction against any CW on these comment boards, which is no doubt often healthy and justified. Here, such a reaction might actually go against homeopathy.

          I am no fan of homeopathy for the same reason that I am a big fan and follower of Marks writing – it is the most rational and scientifically sound position I could find in my years of searching.

        5. Cats respond to special treatment and extra attention just like humans.

          Cats are able to get over illness just like humans.

          Science requires double blind tests with controls – statistically homeopathy perform equally to placebos.

          Placebos and special attention reduces stress ( lower stress helps healing) and comforts the patient.

        6. I find discussing whether homeopathic medicines “work” or not is like talking about whether astrological predictions/statements are “true” or not.

          It smacks of pure superstition. What gave someone the idea that sugar, after coming in contact with some substance or other in the very bizarre fashion prescribed, somehow obtains some medicinal properties? There is no changed property or added substance that anyone knows how to measure on that sugar. It’s just sugar as far as we can tell. Did an alien tell the original practitioner this magic secret? It could not have been determined scientifically, as there is no known scientific way to even know or detect exactly what, if anything, happened to that sugar to make it “medicine”.

          From what I’ve read, no homeopathic “cure” has EVER passed a bona fide double-blind clinical trial. Ever. That says it all as far as I’m concerned. Now, if YOU can dissolve some sugar which has been magically touched by some herb or other substance under your tongue and cure your ills, don’t let anyone tell you otherwise and go for it!

          But, until it can pass a real clinical trial, that could be just about anything under your tongue, as long as you believe in it! IMO, that doesn’t give anyone the right to claim (in public) that it “works”.

        7. 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.

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        1. Dudes, even if ALL homeopathy has done is turn the ability to invoke the placebo response into a fine art, then it has real merit, because triggering the immune system and body to mend itself is the ultimate goal of all medicine.

          Just because there may not be a measurable chemical pathway doesn’t take away from that, and to yell at someone who’s getting pain relief that WORKS – for them, but works nonetheless – is imbecilic scientISM (that which masquerades as science, but clings to dogma, rather than measurable cause and effect).

          The hate spawned by scientism against anything that doesn’t fit within its narrow remit is scary and shows we’re not so far from the dark ages as we thought.

      3. Actually, the doc should have fired you. Without anger or yelling, but just a simple goodbye, have a nice day, would be enough.

    2. I recently changed doctors because my former one was hectoring me to take the convention wisdom meds like statins, and because she yelled at me for taking supplements like fish oil. I am thankful to have found Kathleen King, D.O. in Sacramento, CA. She still has to mention meds like statins because the insurance company is going to ask why I am not taking them. But she has a very Primal-friendly orientation, e.g. testing my D level and wanting me to bring it up.

      Happy birthday Mark!

      1. “She still has to mention meds like statins because the insurance company is going to ask why I am not taking them”.

        And there yo have it. CW is where the money is.

        The system itself will never change. There’s way too much money in “managing” chronically ill people. You’ll have to just buck the system and do it yourself. What really hacks me off is that now in the US I will be forced to pay into a sick, dysfunctional “healthcare” system.

        1. It’s only going to get worse under Obamacare and “outcome-based payments” to doctors–if we’re not meeting our FDA-stated goals for health parameters, we won’t get coverage…or in other words, it’s always been, and always will be DOCTORING BY THE NUMBERS. You don’t take their pills, and don’t meet their numbered goals, then the insurance company can refuse to cover you.

        2. ” You don’t take their pills, and don’t meet their numbered goals, then the insurance company can refuse to cover you.”

          I’m not sure about any of the Obama care stuff. I can say though, that it’s difficult to force people to take medication against their will. They can be bought and then thrown away. Kids under direction supervision have been know to palm them. One of the biggest complaints I’ve read from primary care physicians about patients is lack of compliance with drug regimens. Truthfully, I’m not sure that’s a bad thing except in a few specific circumstances.

      2. Great find Harry. Finding someone around here is like trying to find a needle in the haystack!

    3. Happy Birthday, Mark! My husband will be sixty later this year and I’ve told him he’s in good company. You are a great role model and huge inspiration!

    4. Insurance companies also engage in such tactics. My previous doctor wrote “RMA” on my chart when I refused to take cholesterol medication she wanted to prescribe as a result of an annual physical. It was only 210 and I wanted to try getting it under control through diet changes. She insisted the pills were easier and I would be more likely to stick with it.

      Annual wellness physicals are 100% covered by my health plan but because I “Refused Medical Advice”, the insurance company refused to pay for the physical.

      1. Lol, the last doctor I saw walked out of the exam room while I was still talking to him. I guess he didn’t really care about my opinion. Then his nurse assistant came back with a prescription. My entire appt took 4 minutes. Quality medical care, folks!

      2. So take the pills and toss ’em (responsibly). The $20 copay is less than being billed for an entire physical.

        That’s really unbelieveable, but sadly not unexpected. The shape of things to come.

        1. What’s cheaper is to refuse to pay the bill entirely, although it’s more stressful.

        2. Also, you’d only really need to take the prescription and skip buying the meds. The insurance companies and MDs are surprising blithe in assuming everyone’s following what’s written down.

        3. At the time, I felt I was partnering with my doctor in my health care the way it’s supposed to be. I was under the impression that doctor and patient work together to find the best course of treatment. I wasn’t refusing medical advice, just that particular option. Had my cholesterol been significantly high, I would have considered it a more acute situation and would have opted for meds to gain control, then work on a more long term solution that didn’t require them. 210 is not acute as far as cholesterol is concerned.

          Rather than work with me to find a solution, she made an arbitrary call without my involvement. Had I known what the outcome would be, I would have just taken the script and been done with it.

          As for paying the bill, I decided to get some legal advice. My attorney was able to negotiate a significantly lower bill for the physical. I haven’t been back to that doctor since.

        4. Sadly, insurance companies must think they’re saving money by doing this. No insurance company would willingly incentivise people to get sicker; they’re the only group of people that would stand to profit directly from prevention-based, evolution-based medicine.
          We should start a campaign to send ever health insurance exec. copies of Gary Taubes’ GCBC & The Primal Blueprint… & perhaps Fat Head for those who can’t read them big fancy words Taubes wrote.

      3. “Annual wellness physicals are 100% covered by my health plan but because I “Refused Medical Advice”, the insurance company refused to pay for the physical.”

        I hope that was the last visit to said Doc’s office? (Although there isn’t always a choice.) I’d lag on paying the bill and/or be a pain in the rear with payments (like $10 a month)

        Some Docs are will absolutely shot themselves in the foot professionally/economically to maintain the illusion of control.

  2. Happy Birthday!
    You have brought many good things to my life and I am deeply grateful to you

  3. Excellent article. It’s incredible that you’re turning 60 and look like that

    1. And you can look at the new issue of ESPN the magazine and see a 77 year old famous golfer, Gary Player, that looks incredible too! With all this great info. on MDA, there is hardly a limit to what kind of health we can accomplish.

  4. Mark, at least for me, you have the uncanny ability to hit on topics that are timely. Having this discussion with a friend just yesterday…..

    I’ve resigned to the fact that modern medicine for some has become nothing more than writing a prescription for a daily dose of something to mask the symptoms. I know that’s not a ‘blanket’ statement, there are reasonable, needed drugs for some things. But, MDA is, and many other websites are full of stories of disappearing symptoms that many doctors would have written a prescription for, unnecessarily.

    I always try to give kudos to those in the medical profession that encourage people to look at their diet for some symptom relief, it works a lot of the time. If you’re one of those, good on you.

    1. Almost forgot…

      Happy 60th Mark! I know you’ve heard it a million times, but it’s true….. Your work and words are inspiring!

  5. Perhaps doctors don’t do weight counseling because they see that “eat less, exercise more” does not work well and they don’t know what to do. I used to eat “healthy whole grains”, low fat, etc. but really could never maintain a weight below 165 (5’7″ female) so overweight but better than where I was at one point. I never even thought about getting below that weight until I stumbled upon low carb then paleo/primal. When I cut out grains I lost weight without trying, now at 145 and still expect to lose more eventually. So, the initial problem I see with your open letter is that most docs don’t have the right initial tool to give a patient. Without that, weight counseling will not achieve its goal in the long run and could do more harm than good with standard advice (low fat, calorie restriction).

    1. Exactly! The one doctor that did tell my non-primal husband to lose weight said that he needed to eat less and exercise more. That was the sum total of his advice.

      1. I got my blood work done because my insurance was going to up if I didn’t. (Really!)

        My total cholesterol was 199 and the sum of my Doc’s advise was “watch your diet”. Okay….

    2. My doctor and his entire staff are thrilled with my progress, and have all said they wish they could bottle what I do.

      Which… is a nice thought, but goes right back to the whole “take this and get well” scenario, when you think about it.

      At least they are supportive.

      1. Sometimes it’s hard even to find supportive. The insecure Docs are quite a treat to deal with. 🙁

    3. Dr.’s receive training in chemistry, biochemistry, anatomy and physiology. Through out their college years they only receive a few weeks of training in nutrition. How can they give sound advice unless they receive more adequate training themselves. Also, the words “dietitian” and “nutritionist” are often used interchangeably, but they are not the same. A dietitian is a Registered Dietitian, which means the person has a degree — that’s what the initials R.D. mean after someone’s name. All dietitians are nutritionists, but not all nutritionists are dietitians. Only an R.D. has the training and the knowledge to give you expert personalized advice based on current nutrition science.

      Getting an RD title takes a lot of work. Registered Dietitians are food and nutrition experts who have to follow specific educational and professional requirements from an accredited program to attain their title, including a bachelor’s degree, completion of a Commission on Accreditation for Dietetics Education (CADE) program, which includes classes in biochemistry, anatomy, and physiology plus a dietetic internship for a minimum of 900 hours. Before becoming an RD, you also have to pass a standardized national exam and complete continuing education credits to maintain your title — meaning RDs have to stay abreast of current trends and issues.

      For the most part, nutritionist is not a licensed title. There is, however, something called a certified nutrition specialist, CNS, which is a licensed nutritionist. This title does not require intensive clinical hands-on training.

      1. For all the training required to get the RD credential, as a retired and reformed RD I can guarantee that RDs don’t know the half of what they need to know to give advice on truly healthy eating. I’ve learned so much since I retired and escaped the blandishments of the food & drug industries, and also had to unlearn a lot. Now I’m 80, in excellent health, and take no drugs. Thank for this piece, Mark.

      2. Why would you want MDs to get more nutrition training? So they can be even more sure of themselves when they spout out their gov’t-approved food pyramid propaganda?

  6. Well said Mark, and happy birthday to you!! Talk about aging gracefully!! You look great and give us all something to work towards.

  7. The medical system is just like any retail organization. Invite them in, take them for a ride, cash them out (until they’re out of cash) and spit them back onto the street with a future appointment already booked (otherwise they’d never come back)

  8. Happy B’day, seeral years ago I had a bad ear infection. I went to the VA. emergency. The Doctor I saw prescribed Zithromax. I told her I had taken it before. That it did not work for me and was expensive. She informed me itwas the re.med and would not change it. I took it for the prescribed 5 days symptoms returned 6th day. She again gave me more. Worked about the same. I never received anything that worked well. Went to CR on vacation, called another MD for suggestions. You an buy most med in CR over the counter, Took a while, but recovered. Not typical of VA, usually they do very good, by me.

  9. Happy birthday Mark!

    I worry about this, because the incentives are all wrong. There’s little money in prevention, and loads in ‘cure’ (especially for chronic conditions). I think what we have here is a massive ‘tragedy of the commons’, and it would require some top-down institution to solve. Or perhaps, if everyone just walked away, Big Pharma would have no customers… ?

    1. I don’t think you state that quite right. There loads of money in managing and relatively little in curing. Taking drugs and all the other stuff conventional medicine recommends is just managing the illness or diseases. Doctors rarely cure you of anything. For the vast majority of problems, lifestyle changes are the only true cure. To make money at that you have to get people to pay for your consulting only. Selling drugs is much easier to make money at.

    2. I am wondering about switching to the prize model rather than the patent.

      Latitude was a documentary about how to calculate latitude. Whoever solved the problem would get a purse, there were charlatans and tests.

      Having prize instead of patent would mean that studies on carrots or vitamin C or going “Forks over Knives” would be funded… rather than putting a pittance towards disputing those studies to protect a patentable medicine.

      I’m not sure how much it would affect actual medical practice, except to stop with the “drugs are the first answer” mentality.

    3. I think you’re dead on, though I would swap ‘cure’ for ‘management.’

      Regardless of who’s paying, the incentives are still bass-ackwards. The article below is written from the point of view of reducing cost, but it addresses the incentive issue and, can you believe it? actually suggests how to fix it. Really great article, but looooong.

      http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande

  10. I wish my doctor would read this. At my last doctor’s visit, he insisted that I start taking a statin, because I have type 2 diabetes and “your cholesterol is a little higher than we’d like for it to be.” He also put me on an incretin medication because my blood sugar was very high. Being a non-confrontational person, I accepted the prescriptions, but didn’t fill the one for the statin. Since that time, I have been striving to eat clean, whole foods, and to eliminate grains completely. I’m also slowly trying to incorporate some very light exercise in to each day. I’m curious to see what my next set of labs will show. The scale is telling me I’m on the right track–12 pounds down (and a LOT more to go). I’m hoping to eliminate the incretin medication if the diet and exercise changes help me to get my blood sugars under better control. I so appreciate the information and support that this website offers.

    1. Janey, I’m positive you’re on the right track. Eliminating the sweets and grains should normalize blood sugar and very likely will eliminate the need for meds. The only “downside” to your approach, if you can call it that, will be needing to buy new clothes in a much smaller size. Best of luck to you!!

    2. I wish my *insurance* company would read this. They have a “lifestyle” website with a bunch of tutorials you can do in order to lower your insurance rate. One of the questions that comes up frequently is, “How often to you eat meals with a lot of saturated fats?” My answer, of course, is “ALL THE TIME.” As a result, I’m constantly being forced to sit through lectures on the food pyramid.

      At this point, I’m just going to start lying. “Saturated fat? Never touch the stuff!”

      1. I got bad marks on my company’s health website for answering “0” to the servings of whole grains questions! Sites like these are well meaning, but perpetuate the nutritional myths and misinformation that put so many people in this country on the wrong path.

      2. sadly you are better off lying, until the “coventional wisdom” catches up. I am working on becoming a RD, ive learned to just nod and smile when my professers talk about how important whole grains are. Saturated fat is too yummy to give up haha 🙂

        1. Alexa,

          If you do not mind please send my a private e-mail and I’ll show you where you can go and improve on our desire to help people with healthy eating.

  11. “approximately two-thirds (yup) of the adult population in our country is overweight or obese.”

    I haven’t read the whole article yet, but I just wanted to point out–to be fair–they tend to base those statistics on BMI, and we all know how unreliable that is. Of course, maybe you’re getting that figure from somewhere more reliable, and it may well be true, but I just wanted to point that out if only to play devil’s advocate.

    1. Ditto to this. There is absolutely a large percentage of the American populace that’s overweight and it’s causing them to head into very unhealthy territory, but most articles I see about this cite BMI or height-weight charts for those numbers. Neither are reliable.
      Based on my experience, when I was first pregnant with my son and before any glucose test was run, a Dr wanted me to “cut carbs” which was refreshing…until I realized that the number he suggested I try to hit would put me at double the amount that I was already eating. He never stopped to think that I might be already eating low carb (Primal for 3 years, thanks!) or ask me what my daily intake looked like, rather he just plowed ahead based on my BMI. Drs need to ask questions of their patients, or at the very least listen to what their patients tell them, when patients offer information.

      1. Dr.’s DONT listen – I told mine I was cutting out gluten and he started sputtering about some WHOLE grains are good for you, like WHEAT and rice…HELLO! I had just said I was cutting gluten!
        Sigh…

        1. I had almost exactly the same thing happen. My dr. wanted me to follow the ADA diet (I’m t2 diabetic) and I refused, stating that I don’t eat grains of any kind. He then went on and on about how there were some grains that would be ok for me, even if gluten was a problem. I politely maintained that I was fine with zero grains. He ended the conversation by demanding that I not eat “starches and sugar.” Really? WTH do you think makes up those grains you’re trying to get me to eat, doc? Last time I saw him…

    2. What ever the real figure is, Mark’s number is being very generous if we accept that one can be “normal” weight and still carry an unhealthy amount of retained abdominal fat (primally speaking). Perhaps a better quote would be “Over 90% of the population (not just adults) carry an unhealthy and worsening level of retained fat, and eat a diet likely to make the problem worse.”

    3. As of yesterday, Mexico stole our crown as the #1 obesity-beset country in the world. So where’s THEIR doctor advice to lose weight and take those pills?

      1. we weren’t number one to begin with. there are several other countries in the world that are per capita heavier than the US is.

  12. Happy Birthday Mark! You look amazing for 60 (actually, you look amazing for 50, 40, and 30)! 🙂 I’m turning 60 in a few months, and thanks to your book and website, I think I’m healthier now than I’ve been in 50 years (primal has mostly cured the chronic migraines and hypoglycemia that have plagued me since I was a teen). Thanks for all you do and for providing so much good info online –all for free.
    Sandy

  13. I haven’t been to a doctor in almost two years because of the attitudes. I have hashimotos and have been on thyroid meds for 12 years. I had to fight just to get a diagnosis in the beginning. My doctor at the time lied to me (said I had mono when I didn’t just to get me to shut up about possibly being hypothyroid), wanted to prescribe anti-depressants among other drugs to deal with the hypothyroid symptoms. I did find an old, Russian doctor in NYC who did a physical and cognitive exam and diagnosed me as being hypothyroid. Since then, I’ve had very few times when I had a doctor who got it. I have had a doctor tell me he would no longer treat my thyroid because my TSH was low (free T3 and free T4 have always been in range). Another who just wanted to lower my meds because “the TSH is the gold standard in adjusting thyroid meds.” I went along with it for two months where I repeatedly got sick and felt terrible. This doctor never even asked how I was feeling with the lowered meds as if “I” didn’t matter as much as a lab value. Years ago another doctor lowered my meds and my thyroid swelled so much that I couldn’t swallow without pain (btw, the swelling has now gone down since eating primal – woohoo!). I am so tired of doctors not caring how I feel. I have developed “white coat syndrome” and just don’t want to go to the doctor.

  14. BOTTOM LINE. If an individual possesses the will and priority to find the truth, they will find it because they are open to it. If you are inquisitive, thoughtful, and refuse to give up on finding “your truth” for living healthy, no one ever fails.

    Choice is a funny thing. Being passive about health and forming dependence on drugs and chemicals to hold back the breaking dam of metabolic breakdown, a person has made a choice to put their life in the hands of someone else, regardless of what path they are told to take.

    If each of us chooses to prioritize our health and never stop LEARNING for ourselves instead of assuming doctors know best, they will inevitably arrive at the primal blueprint or something close to it.

    1. You’re right, patients do need to take more responsibility. However, don’t you also agree that sometimes you need to look them in the eye and be direct?

      “You are X pounds over a healthy weight. The risks to your health are _____ . Statistically, you are more likely suffer from a major health event or death as a direct result of being so much overweight. Every individual is different and there are no guarantees; however, there is substantial evidence that indicates you can benefit from achieving a healthy weight through proper exercise and nutrition.”

      Granted, it’s a bit blunt but is it any worse than your eye doctor advising that you need glasses?

      1. I mostly agree with you except that I don’t think a doctor should say “You are X pounds over a healthy weight” because there’s really no standard weight a person “should” be for any given height. A person could be 15-20 lbs over the accepted weight but still be in excellent health, or could be at or below that number and still be in poor physical condition. What doctors should do is look at a specific set of clinical measures and let you know if they think those numbers are healthy or unhealthy, when combined with other lifestyle factors (diet, activity level, stress level, etc.). The difficult part is coming up with the right numbers. Cholesterol level is one that CW medicine seems overly fixated on these days.

    2. I totally agree…except…
      -there are times in people’s lives where they are very vulnerable. If you are struggling with a major health issue there is a lot of energy wrapped up in that. Maybe someone who is naturally inquisitive will want to be able to trust someone to help them with a health issue like weight.
      -throw in all the trash that popular culture has to say about nutrition and honestly…how many years of digging will the average person spend trying different diets before they finally Finally FINALLY find primal.
      -you are assuming that people are used to critical explorative thinking and will pursue a question to the end. I find that most people only ask “Why” once or twice before settling on the most common answer.

      So having a doctor with authoritative health advice is helpful if not necessary for a lot of people to help them make changes in their diet.

      1. I think we’re reaching the point where low-carb, paleo & primal are becoming mainstream enough that people looking for weight loss diets will find it

    3. Yes – but many of us grew up TRUSTING our doctors. It’s a huge mental shift for us to realize the medical establishment does NOT have your best health in mind.

      That transition took me about 10 years, and yes, landed me here. Lots of reading – When Doctors Don’t Listen, Fire Your Doctor, Pain Free by Pete Egoscue highly recommended.

      I haven’t seen a doctor (except for eye exams) in four years. My insurance is a Medicare Savings Plan, which pays the patient about $3k at the beginning of the year, it goes into an account much like an FSA, and keeps accumulating.

      So now, I’m getting paid to keep myself healthy. Not a bad incentive.

      Mark, Happy Birthday, don’t forget to get your shingles shot.

  15. I would rather take diet and lifestyle advice from Iggy Pop than from my doctor. Iggy is 66 and looks better than my doctor too.

    My doctor told me that not eating sugar was a fad idea that would have no effect on my health. I can’t wait to discuss my latest blood panel with him, the one where every measure improved from 20% to 50% after 7 months primal.

    1. (Laughing at your comment)… Doctors don’t know everything. In fact some of them don’t know much of anything, other than how to write prescriptions for toxic crap that any sane person wouldn’t take. Your doctor’s archaic and uninformed notions regarding sugar would be reason enough for me to dump him.

      1. I listen to my doctor because he has a medical degree and I do not and I respect his knowledge and years at university, which I don’t have. I listen to my podiatrist because she has a podiatry degree and I do not. I listen to climate scientists because they have climate science degrees and I do not. I let pilots fly the plane because they have a pilots license and I do not. My cousins’ clients listen to her because she has a law degree and they do not. My clients listen to me because I am a qualified scientist and they are not.

        If I hadn’t listened to my doctor this last week I would be in hospital probably never able to walk properly again. But instead it cost me two quick appointments, some free equipment and a short round of cheap prescription pills. And if I hadn’t listened to him the time before I would be in hospital needing blood transfusions by now.

        1. That’s good you listened to them. What the Dr told you probably sounded to you like the right thing to do for you. People here are talking about when the Dr’s advice flies in the face of what they know about their own bodies. Our bodies are significantly different from machines, the earth’s climate or the law. Homeopathics work for some, and don’t work for others. Eating chocolate may not affect some people, and can totally wig others out.

          I cannot tell you how many times I listened to the Dr through my life and received advice adverse to my body, mind and wallet. One Dr even had me on high blood pressure inducing meds to address female problems that only went away because of me going off his meds, taking things in my own hands and fixing myself. But guess what, I still have High BP. Always had low BP before those meds

          Doctors do not know everything. We are responsible for our own bodies, and it is to our benefit to pay attention to what we can do to improve our health. Also, isn’t it glorious that we do have Drs in case we can’t figure us out? I would be dead if I didn’t go to the Dr when I was young (funnily enough, the diet of the time, the societal embracing of cigarettes and house hold chemicals, and the psychologically-unfriendly home life probably caused my asthma in the first place.)

          Humans. Not perfect – degree or not.

    2. I don’t understand why doctors say things like “eating sugar will have no affect on your health”. If what you eat doesn’t matter, then surely they should agree that NOT eating sugar will have no affect on your health as well? But when you hear a doctor speak, giving up sugar is like a personal affront to them.

    3. I can remember when our eldest was 3 and having lots of physical issues. At an early visit, her pediatrician told me to close the office door, leaned forward and spoke in a low voice (evidently not wanting anyone else to hear) and said, “Don’t repeat this to anyone or I’ll be laughed out of this clinic.”

      She went on to advise that we take dd off all sugar, including fruit juice, as well as artificial colors, flavors, and preservatives.

      This was more than 20 years ago, but it doesn’t sound as if the medical establishment has changed all that much.

      (p.s. Happy Birthday, Mark! Many thanks for Primal Blueprint and this website. You can’t imagine — well, maybe you can, at that — what an incredible difference they’ve made in my quality of life.)

  16. Timely post since I’m currently shopping for a new primary care doctor. The one I currently have balked when I told her I took extra Vitamin D and just recently insisted that I have a pre-op EKG before my upcoming clavicle surgery despite both the hospital and my orthopedist saying that it wasn’t necessary given my age, terrific BP and resting pulse. Thanks for wasting my money…and my insurance company’s.

  17. Thank you for writing this, Mark. The majority of the Dr’s I work with need to read this. Unfortunately, in the acute care setting, weight loss and long term health is the last thing on everyone’s mind. There is extreme pressure from hospital administrators and the higher ups to get people in and out as soon as possible. Sad but true. We usually don’t have time to educate adequately. Acute care is what brings in all the money though. Physicians have a huge incentive to keep their patients sick, and quite possibly, there are some that take that route with job security in mind. Call it negligence. Although, I have been privileged to work with very good, well-intentioned doctors. They are just constantly bombarded with CW.
    There needs to be more of a focus on community health focused groups. Primary care physicians and CNP’s especially have the greatest influence as far as education goes. I would love the opportunity to work in that area and get out of acute care. There aren’t many opportunities though, and the pay is not nearly as good.

  18. The paleo community seems to honor self-expirementation over theories. And since most doctors I know could also lose a few pounds, they should try some lifestyle changes themselves for a few months. Imagine if doctors around the country start experiencing dramatic health increases – – nothing would be better in getting the lifestyle message out to patients.

  19. I posted my first comment before I read everyone else’s comment, but why all the “doctor-bashing?” Let’s just accept that nobody is perfect. It is hard for someone to completely reject CW after they have it drilled into their head nearly every day. Most are just teaching what they themselves have been taught. If you do not take a liking to your PCP, then find a new one. No need to be rude. Maybe refer them to The Primal Blueprint before heading out the door? Seriously… mature, thought-provoking comments would be great!

    1. I for one have tried–even bought my doctor her own copy of The Paleo Diet, The Primal Blueprint, and Gary Taubes’s Why We Get Fat, but she didn’t even open them–she gave them to her college-age kids to read (and throw away). Now all the business she gets from me are the bare basics: annual physical, CBC, and urinalaysis twice yearly–just enough to show the insurance people that YES, I’M STILL ALIVE.

      1. Why does she get any business from you at all (assuming you have a choice)? An unwillingness to walk away on the part of patients is part of the reason why Docs get their ‘tude.

    2. Maybe because most doctors are rude, bullying, jerk-offs to their patients. People are fed-up with the entitlement that most doctors have and the constant misdiagnoses or no diagnosis at all. Not to mention, the corrupt ways of doctors and the medical system in general.

      I have no respect for most doctors and know first hand, that if I hadn’t taken my own health issues into my own hands instead of being doped up be these glorified drug lords, I’d be crippled and on disability.

      I have found most of these comments to be mature and thought-provoking and quite accurate.

        1. HA!! I would never marry a doctor. Quite the opposite. I find rocket scientists to be much more intelligent, not to mention WAY more attractive 😉

      1. well let’s hope and pray you never get admitted to a hospital then, whether through trauma or illness. If you refuse to give them even the time of day, then you are no better off. Maybe in your experience doctors are rude, bullying, jerk-offs, which really is unfortunate. Sure, I have definitely come across several physicians who are just complete jacka***s. I do not comment in their defense because obviously the last thing they should be doing is working with and helping people. But I would highly disagree that “most” are just plain terrible at their jobs and hate their patients. I have been privileged to work with some wonderful doctors who really take the time to listen to their patients and do their best to work towards a good outcome, even if it is through CW. It is truly unfortunate they are just misguided. Give them the benefit of the doubt before trashing their reputation, though. Google search them, too. healthgrades dot com is a great website to see if a physician is worth your time or not. if you defer yourself to a doctor who gives poor care and opinion, it is nothing but your own fault for not demanding someone better.

        1. Clearly the opinions of those on this thread in regards to doctors offends you so greatly. Most doctors are incompetent and that has been a growing trend for some time. Instead of treating each case individually, they lumo everyone together as a whole.

          It takes more than having a good bedside manner to be a good doctor it takes for-sight and logic. Not everything is by the book.

          Going on those sites is not a good indicator of receiving quality medical care, you clearly lack reasonable thought when providing your testimony of good medicine. You think just by going on sites that rate doctors that the system isn’t flawed?!

          before you jump down my gullet maybe yo should take some time to assess why so many people are disheartened with doctors and the medical system in general. Clearly you side with the politics of the medical industry and the stance of keeping people in a constant state of pill pushing coma.

          Many doctors need a wake-up call and the arrogance that sweeps their offices is blinding.

          FYI, I have been in a hospital on more than one occasion and ended up sicker there than outside of one. Hopefully you can wake-up from the ass kissing coma you’ve put yourself in to realize that western medicine needs a complete over-haul in it’s behavior.

        2. ok then Lorraine, enlighten us on your solution to the current sick care system. I would agree with you that it is flawed. I just don’t think there is a perfect solution. It doesn’t offend me that so many people hate their doctors. It just is a disappointment and completely unnecessary. If people dislike their PCP then by all means find a new one.
          I specifically listed one site, and it is the one I used to find my PCP. He has been wonderful. Quality medical care does have a subjective side.
          I don’t push pills. I am a nurse. I work to help people get better while they are sick. Why would I side with the medical industry? It is not my expertise. Your rude comments are completely unnecessary here.

    3. These people get paid large sums of money to dish out bad advice that will kill you faster. Many of them are too stupid to even understand this. That’s why.

  20. I think the letter to doctors is well and good, but ultimately, it is up to the patient to make his/her decision (once the patient is willing to take responsibility for his/her condition). The medical profession, while I do respect what they do, are in a difficult situation with bid pharmaceutical. It is a system that needs fixing. If patients decide they can prevent most illnesses/diseases by preventive measures, then there will be far less medical visits. That means less money for doctors and big pharma, which means, they will adjust to meet the needs of the many.

    1. I agree completely. My parents are in their 80s and their primary care doctor is a pill pusher. Fortunately, my dad is an avid walker but I can’t get mom to get off the couch and off the meds.

      1. Don’t forget, folks like my 80 year old father WANTED a magic pill like many others do. He never wanted to do the work or change his lifestyle and sadly he died after 6 years of Parkinson’s.

        1. One of the most serious problems in modern medicine is the crush of people who WANT magic pills. My Mother is there too, in Magic Medicine Land, and is now in assisted living. My Father retains enough of his common sense to not believe, but really would like to believe.

          The drug culture would disappear tomorrow if people really wanted to be well, rather than pop pills and think they’re getting something for nothing.

      2. My parents are in their 80’s as well. It is difficult to change their habits at that stage, makes me want to live next door and offer to cook all their meals (whilst I throw out all the grains, muwhahahahaha)
        My mother in law was hospitalized and put on hospice because the doctors had nothing left to help her. She thought fine, I am ready to go, so she went off all her meds. They just took her off hospice last month because she was doing so well that she was getting out of bed and even cooking some while sitting on her walker. Seems that the meds were preventing her from living. Sometimes less is more.

  21. Amen! I’m so lucky that I have found a primary care physician that advocates for lifestyle changes first before automatically reaching for her prescription pad. Even so, she was still a little wary of my going paleo, but has kept an eye on my bloodwork and found no cause for complaint. Just the fact that I was able to have an in-depth discussion about my diet with her makes her amazing in my eyes.

  22. Happy Birthday, Mark! Yowzeh, I practically cut my eyeballs on your razor sharp six-pack!

  23. I really liked the article, Mark. I let myself decline for a number of years. There were all kinds of justifications and rationalizations to make me feel good about getting worse. While my doctor would occasionally mention my weight “might be a bit on the high side”, there was never a look-you-in-the-eye-and-be-direct moment. My response was always a dismissive “yeah, I know I should do something.” In the meantime, my blood pressure and cholesterol continued their upward climb.

    At the peak, I was 6′ and weighed 238. Some folks would say that’s not really that bad. Unfortunately, I’m actually a pretty skinny guy so it all landed around my midsection. I was in the store shopping for bigger pants when the light came on and I decided to take some action.

    Yes, it was a miserable experience just to get started but I started. And, I followed all the wrong advice. I crash dieted and spent just about every waking moment on a treadmill (no weight training to preserve muscle was a HUGE mistake). But when I lost 35 pounds in 4 months, I thought I was golden.

    Unfortunately it wasn’t sustainable. I went on vacation, let myself get derailed and started to put weight back on. Then I had a major life event that resulted in a job change and got derailed even further.

    I realized that I needed to get smarter or I’d be pants shopping again. So I studied a broad range of sources, including what the military does for special ops, and things started falling into place. I avoided magazines like a plague. They were one of the main reasons I got in trouble the first time. No one can get washboard abs, squat 400 pounds or get 20-inch biceps in 4 weeks. I’ve been working hard for the last 3 years and am just now starting to see definition in the ab area. (My favorite was an article on how to “Add an inch to your biceps in one day!”. I keep that one as a reminder not to get suckered into being stupid again.)

    Basically, I accepted that it wasn’t going to happen overnight, so I went on a more sensible diet plan and engaged in a wider range of physical activities. And, lo and behold, my body adapted in a wonderfully positive way! I got leaner and kept the majority of the muscle I was building.

    Did I mention I started my trek when I was 52? I’m 55 now and have never been healthier, happier, or more fit. My numbers are excellent for a man of any age, much less in my age group. I workout at least 4 days a week but now it’s more like play. I actually gained an inch in height from my spine getting stronger and my weight is stable between 175 and 180, even if I stray while on vacation. Strength training has been a big part of my training for a long time but I’ve recently discovered the joys of indoor wall climbing and it has become addicting! I actually look forward to doing pullups and frenchies.

    I also compete in mud obstacle course runs and am taking on my first marathon later this year! I even did well enough in an unofficial SEAL PST that I could be considered for BUD/S. (Spending a week at a SEAL Fitness Camp is on my bucket list.)

    Anyway, to make a long story short, even if my doctor had been more direct those many years ago, it would have fallen on deaf ears. It takes huge personal drive to make major changes. I agree that we (society in general) shouldn’t be jerks about it but maybe we (again, in general) shouldn’t be so accepting of being people overweight and having a sedentary lifestyle when they have the power to change.

    1. One thing I forgot to mention is that I’m going pants shopping again. My 34s are too loose. 🙂

      1. Nice work! And I agree – a doctor telling you you’re fat isn’t going to motivate you. I think the only real motivator is desire to change coupled with positive results. Most diets aren’t successful even if a person loses weight, because they don’t necessarily feel any better, have more energy, or see a long-term means of maintaining. Positive results means not only losing weight, but actually feeling great on a daily basis. Otherwise it’s easier for me to be fat and miserable than less fat and still miserable.

    2. What do you mean you can’t add an inch to your biceps in one day? Just duct tape a steak to your arm. 🙂

  24. Correction: SSRI, Mark, not SRRI. CW physicians will take the easy way out, and will hone in on that to discredit your entire treatise.

  25. a few points…
    1- You’re doctor is only ONE tool in the toolbox. Yes, i know we treat them as the be all end all, but they are just ONE person. A very educated person in medicine yes, but one with limitations including which school (progressive/integrated vs old school) they attended, how they approach their practice (with god complex or with an open mind) and how/if they ‘update themselves’. I am lucky that my GP is NOT a know-it-all and has been open to my various approaches to my ulcerative colitis. She wanted to know alternatives so she could suggest them to other patients. Not all the specialists had the same attitude. FOr example, when I was going through a period of depression, her sub basically told me that i should take anti-depressants (i had no past history of depression) instead of, oh, i don’t know, take some time off from work to re-set. I told her I thought i just needed time off. But i had to TELL HER. Which leads me to…

    2- It is hard to find good doctors but this is a ‘take control’ moment. If you’re doctor is not what you are looking for…keep looking. They are out there. But don’t just leave, tell your doctor WHY you are leaving. They might just get defensive, but if they hear it enough, it just might start sinking in. And if for whatever reasons you can’t get another doctor…do you’re own educated research. Make changes to your life. You don’t need a prescription or appointment for that.

    I think a problem we tend to have in society is that others should hold all the answers for us. Whether it’s your accountant, doctor or any other professional. Yes, they are versed in that area, but they don’t know everything. And they should all be open to your questions based on your own research and readings. As Mark mentions, most of them do not have the time to “keep up” with recent findings. That’s where we all have to step up.

  26. Taco Bell is apparently now testing a high(er) protein menu.
    abcnews.go.com/Business/taco-bell-testing-power-protein-menu/story

    1. I bet they just add more soy and chihuahua meat to their existing menu!

  27. My doctor told me that if I didn’t get my total cholesterol number down, I’d have to take a statin — and that my HDL was **too high** and my tri was **too low.** When I requested a VAT test to see the LDL breakdown, my doc refused.

    So high-cholesterol me went elsewhere. I’m quite happy. (Typed while munching Whole30-approved bacon.)

  28. Nanssi. Was thinking same. (discredit for wrong acronym) Would be interested to see Mark’s comments on the fish oil supplement study released today. I just started omega 3 supplementation at the start of the year. I have never believed in supplementation prior to following Primal lifestyle. Now I am wondering. Study seems flawed…but maybe that is because I have invested in a year’s worth of fish oil already ????

  29. Very well and tactfully written Mark. I had actually gotten on antidepressants last fall after years of struggling with depression and anxiety that started almost immediately after being discharged from the army and moving back to the states from Germany. My husband tried to convince me I had PTSD but I knew it had to be something else. I started eating paleo April 1st and dropped 25 lbs and I can’t remember the last time I was this happy and energetic. I started eating paleo to lose weight but it really has changed every aspect of my life. A big thanks to all you bloggers for all the wonderful, life altering information.

  30. Happy Birthday Mark! Thanks so much for all your hard work and for helping to improve so many lives.

  31. Well, I think doctors know well that prevention is everything…but usually patients come with pre-existing conditions that already require medical intervention. In my country doctors simply don’t have time for patients, sometimes they accept 70 patients daily. That’s like 7 minutes on one patient. The discussion is severely limited and although the treatment is excellent, patients feel they deserve more discussion and attention.
    Also, many of the patients aren’t interested in change at all. They just want the pill, to play the hockey game even if they are sick, and come with decisions based on blogs, refusing reasonable vaccination for their kids based on popular scandalous article.

    Also, in medicine, if something is recommended it really needs to be evidence-based and safe. That’s why sprinting or lifting heavy things is usually not recommended. You’d need to pay the trainer for the patient to ensure safety.

  32. Mark,
    Happy Birthday, and a big thank you for this post, this site, and everything you’ve done for our community.

    This post is right on target. I was pre-med in college in the 90’s and decided not to apply to medical school because of the very issues and problems with the system that you describe above. I didn’t want to be a part of it, thus found myself in industry instead. As luck would have it, I relocated to the west coast and discovered Naturopathic Medicine. As a result, I’ve obtained permanent remission of my Crohn’s Disease without any pharmaceuticals. I was so moved and so helped by the counsel of Naturopathic Doctors that I enrolled in and graduated from the National College of Natural Medicine with my Doctorate in Naturopathic Medicine.

    Many people don’t know that in 17 states and most Canadian provinces, ND’s are considered Primary Care physicians. We are a very different experience than the usual MD or DO, though I acknowledge that there are many excellent MD’s and DO’s out there. People in Washington, Oregon, and perhaps some other states are fortunate enough to have ND’s at their disposal that can bill health insurance and prescribe any medication should it actually be necessary, but the focus of any good ND treatment plan will be the stuff of this website. I frequently refer my patients to Mark’s Daily Apple.

    There are also websites like http://primaldocs.com/ that list Paleo/Primal minded MD’s, DO’s, DC’s, and ND’s that are located throughout the US.

    While the mainstream medical community is greatly flawed, especially in the primary care segment, there are excellent options out there if people know where to look. Unfortunately the problem stems to our culture as a whole, as any reader of this post already knows. TV and advertising are, in my opinion, driving most of it. The best favor we can give any friend is to steer them away from taking the mainstream media as gospel, to open their minds to alternatives, and to take everything they read or see on TV with a grain of salt. People like MDA readers know this. We got here by doing our own research, and this is the best advice we can give our friends and family.

    1. Joshua – I live in WA and just started seeing a naturopath in the past few months. You are correct – they focus completely on “functional medicine”, addressing my concerns with dietary and supplemental interventions. Never once was I asked to take any “big Pharma” drugs – the only thing she prescribed was some bio-identical hormone replacement – progesterone only – as I am 46 and in peri-menopause. I spent the past year in a fiery hell of anxiety and panic attacks that no antidepressant could touch. Gee, no one thought to test my hormones until I saw the ND – duh! One month on the progesterone and I was able to get off antidepressants all together.

      An ND will look deeper, ask more questions, order appropriate tests, and NOT follow the party line when it comes to diagnosis.

      I once heard someone say that an MD goes to medical school because he wants to be a *Doctor*, while a naturopath goes to naturopathic school because they want to cure patients illnesses and help folks live a healthier life. I believe this to be true.

  33. Well this is RELLT interesting on (TWO) fronts ..
    1. I just had my cholesterol check couple of hours ago. Its the lowest since high school. When doc asked how I did it I said, “Bacon” (had stop takeN statins)
    2. I”m turning 60 the week after. I will be celebrating on top of Mt Baker ! (or I should say thats the plan) Happy Birthday Mark.

    james t

  34. Happy Birthday Mark!! It’s wonderful to be 60 – got there last year.

  35. The 80% related to lifestyle contains within it the hidden dirty secret of America’s class divide: about 50% of lifespan is associated to economic status. The entire remaining 50% is divided between access to healthcare, genetics, independent lifestyle variable, and independent environmental exposure variables.

    You can’t give health education to an underclass that didn’t get a basic education. Once you understand that economic status is the biggest variable in healthcare, primary education becomes a health care issue, job training becomes a health care issue. These are far bigger issues, frankly, than whether your doctor brings up your weight, a conversation which has zero impact on lifespan. (Yes, zero. There is no arguing this point: weight loss in mature adults has zero impact on lifespan. Well adult visits have zero impact on lifespan. Zero + zero = zero )

    But by all means, lets keep the conversation on the least effective interventions.

    1. “You can’t give health education to an underclass that didn’t get a basic education.”

      Actually, you can if you’re will to step out of the Latin based vocabulary. People who didn’t finish high school aren’t stupid — they just didn’t finish high school.

      “, job training becomes a health care issue.”

      This turns this into a political discussion, but may I suggest that some people maybe low income because they blow opportunities given to them? Some MDs will refuse Medicaid patients, not because of pay, but because they will absolutely not listen to any advise and won’t take drugs regularly, etc. Positive life skills cannot always be taught.

      “There is no arguing this point: weight loss in mature adults has zero impact on lifespan.”

      Of course you can argue this point. And it’s silly to cling to it. Someone who is 100 pounds overweight *may* live as long as someone at a normal weight. However, I’m willing to almost guarantee that the last decade for the overweight feels much worst, all things being otherwise equal, then the one at a normal weight. Number of years in a life is not the only consideration.

      1. Why is this obsession with lifespan?
        Runaway inflation, exponentially balooning deficit/debt means you are better off bolting before you go too long into retirement!

        1. I agree. I prefer to quality of life over quantity, but she seems to see it differently. 🙂

  36. I want to see what Mark looks like signing up for Social Security! 🙂

  37. Mark, this is the first time I have checked out your blog and I love it! The information you provide is great and I cannot wait to share it with others. I totally agree with you about medicine nowadays not focusing on the source. Everyone just goes for the medication without digging deep to find out the real source of the problem. And of courses, the medicine just covers up the issue and never fixes it. Everyone wants that magic pill! Thanks again for this blog!

  38. It has taken me 25 yrs of evolving toward Eastern practices to put all this together. Intensive practice of Qigong is what really slammed this home. It all became instinctive and intuitive after that and all of what you wrote above about doctors became glaringly, embarrassingly (for them) obvious. The sad fact is that the letter will fall on deaf ears (except to us) because it is the very system that churns them out (American Medical Assoc) that runs the show – and they have big pharma money behind them. So why on earth would they want to set a curriculum for doctors that included understanding that would lead them AWAY from prescribing a pill for the incredible growing number of symptoms? Maybe I’m too jaded, but it doesn’t seem to me like we will see this change in our lifetimes. I know, negative outlook…and I have a GOOD doctor, too!! (naturopath)

  39. As a family physician who preaches the benefits of the low carb lifestyles I know most of my peers do not. Getting beyond that, most that I know preach lifestyle changes routinely to their patients with chronic conditions and in many cases it is as effective as banging your head against the wall. Someone mentioned the “eat less exercise more” advice. I frequently do start with that in patients because it is extremely easy for patients to wrap their heads around the concept. For most of my patients getting more exercise is equivalent to getting any exercise at all. If I can’t get them to eat less of the food they like they aren’t likely to stop it all together. I frequently hear complaints of doctors being pill pushers. AT some level there is truth to that and like any field there are crooked docs out there. Move beyond that. Why do I as a physician start a patient on blood pressure medicine or cholesterol medicine? I don’t get paid per pill prescribed. In all but extreme cases I encourage lifestyle changes first and 90% of the time the patient doesn’t make the changes necessary to improve on their problem. I have to at least offer a treatment that meets the local standard of medical care. The patient doesn’t have to take my advice of course and that’s fine. There are 2 forces acting on me beyond simply doing what I think is best for my patient. First, if I am not proactive in treating diabetes, hypertension, hyperlipidemia, etc. and a patient has a bad outcome I can be sued successfully. Second, prevention and outcomes are now a tremendous driving force with private insurers and if certain quality measures aren’t met it effects me and not in a greedy way, but in a “we will drop you from our provider list” way. WHat percentage of my diabetics have a hemoglobin a1c below 7? What percentage of my hypertensives have a blood pressure below 140/90? WHat percentage of diabetics are on a statin and an ACE inhibitor? Finally, I think its only fair that some of your displeasure is directed towards dieticians and nutritionists who frequently continue to preach the traditional food pyramid.

    1. Thank you for at least doing what you can in an imperfect system. We appreciate doctors like you.

    2. Great point about dieticians and nutritionists. I was referred to a diabetes education class after my T2 diabetes diagnosis, and was told that I should be getting about 45 grams of carbohydrate per meal, plus three snacks a day of 15-30 grams of carbs. I know from experience that my system can’t tolerate anywhere near that level of carbohydrates. I was really shocked at both the advice received and the very perturbed attitude of the dietician when I questioned it.

      1. same experience with me, except I am T1. I had no clue how to eat when first diagnosed, so I was excited to see the nutritionist to get an idea of what was ‘good’ for me. What a joke! They told me to eat 330 carbs/day, as I was surrounded by an office full of cereal boxes and whole grains(almost like a nightmare). I tried their recommendations, and failed miserably. I am lucky common sense prevailed and I was able to educate myself, or I would be 1/2 dead by now(2 yrs later). instead, im the healthiest ive ever been even with T1D

    3. I definitely agree that RD’s have a greater influence on dietary changes than physicians do, especially when you are in the hospital. Just today I heard a RD say “no salt, eat lots of fiber, bread is good, beans are good, rice is good”… didn’t even mention vegetables. Although, it is a bit different for our diabetic patients. At least for their education, they hear the “eat less sugar and carbs overall.”

    4. THIS. My husband is chronically ill. One doctor out of ten will ask him any lifestyle questions. The others offer pills and move on. It drives me nuts.

      I know an endocrinologist that staunchly gives every diabetes patient the advice to change their lifestyle and has in-depth talks about diet. I wish every doctor were like him, but you know what? Staucher makes a great point about the patient problem. For every patient that takes my friend’s advice to heart, there are so many more that come back after a month having made no changes, and wind up on pills or injections. They may complain, they may fuss- but they’d rather do that than give up crappy food. If I was confronted with a career-worth of that kind of feedback loop, I might be skipping straight to the pills too (not that that makes it right).

  40. In addition to doctors not offering weight management counseling, I think a great many Americans ignore it anyway. Recent example: a coworker of mine with a prolific gut regularly wore a knee brace and complained of chronic knee and low-back pain. I asked if he’d seen a doc about his pain and he said: “Yeah, but all he ever does is tell me to lose weight.” Well, bud, maybe he’s on to something…

  41. my boyfriend is really overweight and his doctors NEVER tell him anything. I don’t understand it at all!

    1. Why should anyone tell him anything, isn’t he responsible for his own health?

  42. While I don’t disagree with most of what you have said you do realize that you are preaching to the choir, right? The people who need this information are not reading this letter. Furthermore, a large majority of pts look to their physician to hand them a magic pill to fix it all and when they don’t the pts get angry and find a new doc. It’s a “damned if you do, damned if you don’t” situation. Physicians need to step up their ability to help people prevent and reverse diseases with lifestyle choices but pts need to be accountable for their own health, you can lead a horse to water but you can’t make him drink. Also, have you noticed how many physicians are overweight? Don’t you think they must think “how can I possibly tell this pt to lose a few pounds and have them respect me when I could stand to lose a few myself.” ? it is not as simple as you make it sound. True change has got to come from the pts, the traditional medical training system and the government. We are all accountable in this battle and instead of pitting pts against physicians we need to find a common ground to work together. Just as a pt has the right to find a new doctor physicians are allowed to “fire” pts who will not take an active role in their own health. Clearly, if you are reading this you are not one of the people who needs to get the message but we all know people who do not take responsibility for their own health. Perhaps as good friends and good people we should hand them a copy of the Primal Blueprint and one to their doctor as well. What they do with the information is out of our control but we can, at least, try.

  43. Five years ago at the age of 37 I was overweight and had a nice list of medical issues going. My doc gave me several prescriptions. I declared I wasn’t going to take them and asked if there was something else I could do. She simply said “diet and exercise” and for me to come back in 60 days. Thankfully I was also seeing an amazing chiropractor who told me to do away with wheat, corn, dairy, and sugar and begin walking as much as I could and eat as much meat and veggies as I wanted. I did exactly as the chiro said and when I returned for the doctor’s visit in 60 days I had lost 40 lbs and the health issues were gone. The doc was amazed and said that 90% of the people she has seen who vowed lifestyle changes never change. That is a sad statement. But I believe it’s because people do not know what to do. I keep pointing friends/family to this website and Primal Blueprint. These are great resources and differences are being made.

  44. My understanding of the research on weight loss is that sustained weight loss (for at least five years) is generally successful for only a small percentage of people, and that weight loss in and of itself does not predict future health or longevity. Why then, would doctors make it a priority to discuss *weight* (as opposed to healthy eating or appropriate exercise) with patients? Perhaps they are paying attention to the research in this area? Seems to me like maybe doctors realize that “eat less, exercise more” doesn’t work, so they have stopped recommending it.

    I am hopeful, as are others, that primal/paleo holds the key to sustained weight loss… but it remains to be seen.

    And I sympathize with the writer’s friend, above, whose doctor is not helping with knee or back pain except to say he should lose weight. Too often, I think, doctors blame patients’ complaints on excess weight without looking for other answers. My partner (obese) suffered from foot pain for a decade and got only a referral to a podiatrist, until finally she experienced arm pain (hard to blame on weight) that got a diagnosis of rheumatoid arthritis. Subsequent x-rays showed that the RA had caused permanent damage to her feet. Would have been great to have been referred to a rheumatologist earlier… but it was obviously her weight that was the issue, right? This attitude is so pervasive–we have ourselves to blame as well as the doctor, because we did not pursue a second opinion about the foot pain. It was clearly related to her weight, in our minds as well.

    1. “I am hopeful, as are others, that primal/paleo holds the key to sustained weight loss… but it remains to be seen.”

      No, it doesn’t remain to be seen. Low carb and paleo work long term, as does calorie restriction if you’re talking strictly body fat. (Pure calorie restriction will bring on other health problems, however, if done in a mindless way.)

      The real reason why “diets” don’t work long term most often is that people won’t face the responsibility that their lifestyle has to change. They’ll do Paleo and eat potatoes and/or some Paleo friendly baked good at every meal and wonder why their not losing weight. Life has be okay when 80% of meals are meat (or animal based) and vegetables. Food can’t be the ultimate comfort or never ending party. If people don’t accept that, no “diet” will ever work.

      I’m sorry about your partner’s experience. However, what I don’t see is an explanation of how your partner was actively perusing other options rather than passively accepting the status quo. Truthfully, blaming the weight would be my first instinct, too. If your partner felt that it wasn’t too blame – that there was something else going on – then she needed to keep looking for the answers.

  45. I have been mostly Primal for almost a year now. But despite initially losing some weight, I have gained more. According to the gov websites, I am now officially overweight. Diabetes runs in my family. So, I have been exercising until heal pain stopped that, and eating healthy and even watching my calories.

    I went for a check up with the nurse practitioner last December. Who is overweight by a 100 or more pounds. She did agree to check my thyroid levels because I am cold all the time, my hair is thinning and such. But her main thing was “My Fitness Pal.” Which yes, I am doing. She gave me some B12 supplements for depression. Thyroid levels came back “normal.”

    So I went in again this spring. Male, thin doctor this time. Who said my thyroid is fine. Hair thins every so often. You are just cold. I was actively asking for help losing the weight or finding out why I can’t loose it. And he just said that some people can’t loose it. Period. And that I am 5 pounds lighter than I was a year ago. Big whoop. I work my butt off, eat healthier, lose the grains and over a year I have all of 5 pounds to show for it. And my clothes still don’t fit and I would rather not have to worry about diabetes. Oh, and he was no use at all about my heal pain. Told me to do exercises that I am already doing and have been doing and nothing is getting better.

    So much for the help from doctors. I guess it is good they weren’t pushing pills, but I still think there is something going on with my body that it won’t take off any pounds. And my gut is thinking it is thyroid.

    1. See if you can be checked for an autoimmune disorder; my mother-in-law has been diagnosed with Lupis (waiting to hear from the rheumatologist regarding my wife on the same note) and she struggles with constant pain (which she combats with ibuprofen on really bad days only, and no more frequently than 4 days off 4 days on to avoid allowing it to become inneffective) and with her weight as well.

    2. Start looking for 2nd opinions. The only thing there is to be done is to keep bouncing from Doc to Doc until you can find someone who believes there’s something wrong and wants to fix it.

    3. CrazyCatLady (great name! got the cats? {wink})
      Please go educate yourself at the website Stop the Thyroid Madness — it saved my life! You cannot rely on docs to be able to learn everything known about every disease and syndrome and injury-repair and nutrition and prevention and and and and and…. No human COULD learn it all, even if it were made available, which in med school it isn’t!

      I actually feel sorry for docs — the good ones, the one who WANT to do things right — because even if they do try to help patients, they are under the watchful (evil!) eye of the local medical standards board. If they are wandering too far off the prescribed (<– ha.) path, they will have their livelihoods affected. No one is going to stick his or her neck out and damage their own family's survival on behalf of a patient whose insurance is paying them less than $25 per visit! (Medicare pays my mom's doc a whopping EIGHT DOLLARS! How can he possibly do all he can for her, AND protect his own family?!)

      The biggest systemic problem I see is that most people are too … well, shall I be kind and call them merely uneducated? Nah, let's speak the truth: they're flat-out too stupid to learn enough about medicine and illness to have a icecube's chance in a fire of knowing what is and isn't good treatment. The people on this forum (Happy Birthday Mark, and many thanks!!) are all *self-selected*: smart (and better educated), health conscious, willing and able to spend time and brain power learning what they need to know, and willing and able to speak up to docs, or find different docs, or figure out on their own what to do.

      The vast vast vast majority of folks cannot possibly do this! And as long as medicine is in the stranglehold of Big Pharma, and Big Insurance, and Big Ag — and Big Govt! — most folks will rely on the unthinking and tightly controlled 'treatments' of their local docs.

  46. I want to know more about this version of the Hippocratic Oath you can ‘jive’ with… :b (I guess you means jibe.)

  47. Turned 60 a couple of months ago. This forum and Leangains have made a huge impact on my health, people cannot believe how fit and … well … lean I’ve become even though I’ve been pretty healthy and fit my whole life. As far as the medical profession goes, my wife has been in Medical Education for something like 30 years … the stories I could tell. What do you tell a physician or friend who steadfastly denies that your diet, lifestyle and discipline is why you are so fit, it’s because of good genes or luck? The best you can do is lead by example, I don’t try to evangelize at this point.

  48. Mark,

    Just 3 Chapters left to go! Given the responses here, I think the book well be well-received and quite an eye-opener.

    People…your doctor does not work for you. Your doctor works for big government and all of the rent seeking NGO’s it has spawned. The tripod of big med, big agra and big pharma has produced so many seriously ill patients that even the best doctors are buried in symptom management. Patients with the mindset of MDA followers are less than a fraction of 1% of the average primary care doctor’s practice. Most will not even conceive of a lifestyle change.

    Practicing medicine is a lot more like the recent movie “World War Z” than you might believe.

    Watch the trailer from the documentary Code Black (codeblackmovie.com) to see what life is like…not just at LA County, but in ER’s all across the country.

    1. Sounds like there’s no answer:

      People in general don’t want to change.
      Doctors ( people too) in general don’t want to change.

      Doctors won’t change because people won’t change.
      People won’t change because doctors won’t change.

      Next generation follows the last.

      The cycle continues….

    2. BRAVO!!! Dr Doug!

      Just watched your YouTube speech on medicine and life at the 21 Conference — SUPERB! (Loved your list to these young men on how to stay out of the “belly of the beast”!) (I used to be medical affairs director for an ambulance corps — ER docs are my ALL-TIME fav docs!!)

  49. As long as enough Americans have the belief (and unfortunately there is more than enough who do) that everything I don’t like must be banned and everything I like is a human right that must be paid for by others, we’re going to have ever growing problems cascading from such a belief.

    Medicine is a product like a Mercedes or a beach ball or toothpaste. Products aren’t rights. No one is right to demand free-to-them medicine.

    Employers write off their expenses related to the perq of medical bills insurance (wrongly parroted as “health insurance” by the clueless) and thus taxpayers who can’t avoid taxes with write-offs always have paid for the insurance of the insured through employment. As long as adults involve politicians in their matters of exchanges of money and credit for products of any kind, adults are going to end up suffering the consequences.

    It’s wicked adults using politics to enrich themselves without competing and becoming efficient by corrupting enough with free-to-them stuff that screws up everything for everyone.

    Mark needs to talk more about the politics and less about the science of nutrition if he wants to get the heart of the matter of the practice of medicine.

    1. Jackie,

      You have hit the root cause for all of the medical system’s woes. I think you will really appreciate the forthcoming Primal Rx.

  50. You are asking a lot of modern medicine, in my opinion. It’s not your doctor’s fault that the government and large agencies bought the “conventional wisdom” about losing weight, and there is a lot of money behind corn etc. The articles we all mention (and by the way I AM a doc) are swamped by the ones that parrot the CW. Diabetes and obesity are only two diseases among 2,500 that we need to keep up with.

    The vast majority of docs want to do the right thing and are in medicine primarily to be helpful. There are so many negatives to medicine (hours, demands, no family life, regulations, communicable diseases to catch) that if you don’t have the call to help people you tend to get out despite the (mostly imaginary) huge paychecks. Look up the average pay of an internist or pediatrician or family medicine doc.

    Whose responsibility is your health? I think it’s mostly yours and I am here to advise, help, prescribe, use my expertise to assist YOU. Do the primal thing or the low carb thing and come back 6 months later with results. Bring your doc a copy of The Art and Science of Low Carbohydrate Living (it’s written in doc language.)

    Yes there are some bad apples in the Doctor basket but not that many. We are human beings, struggling against mighty forces, doing our best in an overwhelming world.

    and on the alternative medicine front, there are two types of medicine: tested and untested. Many alternative approaches may work, but they are mostly untested for safety and efficacy. We have a lot of techniques to overcome the placebo effect and find out what really works; it’s a fumbling, trial and error process but if you have pneumonia, many kinds of cancer, celiac disease, or a whole slew of other problems you are a lot better off in the good old US healthcare system that you would be almost anywhere else in the world. Go ahead and use homeopathy or another alternative medical technique, just have your eyes open that there is probably no real science behind it. If there is real science, mainstream medicine will take it on sooner or later and it will no longer be “alternative.”

  51. When my now 4 year old was an infant, he had eczema. I suspected it was a sensitivity to dairy in my diet (he was exclusively breastfeeding). I brought him to the ped to confirm it was eczema and told her of my plan to remove dairy from my diet to see if it would help. She insisted that it would be much too difficult to meet my nutritional needs without dairy and gave my a prescription for a steroid cream for my son. So, even though I was the one offering to make a change to treat the CAUSE of his symptoms, she tried to talk me out of it in favor of slathering my newborn in steroids everyday to mask his symptoms. She’s a nice lady and I’m sure her attitude is a result of dealing with other people who are not willing to make changes, but it’s hard to be met with so much resistance. I’ve learned to educate myself for most things and save the medical professionals for things like infections that don’t improve with our own treatment and sewing body parts back on. 🙂

    1. And I should add that my son’s skin cleared up with my dietary changes, which I stuck with for nearly a year. After that point we tried slowly introducing dairy back to my diet and he did well. We waited longer to give it directly to him, but now he eats it just fine. In my primal/paleo research I’ve come to think I likely had/have a leaky gut that was the underlying cause of his troubles.

  52. I guess I’m lucky. When I told my doc I was switching to a paleo/primal diet and lifting more instead of doing cardio, she just said “I keep hearing about that. keep me posted on how that works”. She seems quite open to the whole thing and told me her approach to diet is to let patients experiment on themselves because she may have an MD, but different people do better on certain types of diets and that isn’t her area of expertise. All she could tell me is that she agreed that I needed to lose some excess weight.

  53. I am a primary care physician (GP) in the UK – things are a bit different here compared with the US healthcare system! Firstly, you register with your local practice and all your care is needs-based and free, you don’t ’employ’ your doctor and you don’t pay for consultations, referrals, investigations, and in my area (Scotland) prescriptions are free too. The GP contract with the government is based on money received for each patient (a per capita allowance) and an allocation of money based on the Quality and Outcomes Framework (QOF) which is a series of ever-more-complicated clinical, social and administrative hoops through which each practice has to jump in order to achieve a high enough score to make enough money to exist and provide a service. There are bits and pieces of money to be gained from offering other services and meeting prescribing targets (i.e. using generic medications rather than branding etc) but the main stuff comes from QOF. Obviously a lot of the money comes from taxes but it’s not guaranteed, we have to work very hard to get maximal points so we can provide the best care for our patients.

    I work in a relatively deprived area where a very large proportion of my patients are on benefits, live in council houses and do not pay taxes. There is a pretty high level of obesity, morbidity, depression and drug and alcohol problems. I’m sure I’ll be unpopular for saying this, but I suspect the vast majority of MDA readers are fairly middle class, reasonably affluent and pretty well educated, and I do feel that a reasonable level of education is necessary to understand a lot of the science behind a primal diet – a lot of my patients left school at 15 or 16 and are not university educated. I’m not saying that not having a higher level of education precludes people from following a primal diet, but it definitely helps.

    When I am asked about dietary issues, which I sometimes am but I have to say not all that often, most of my obese patients don’t admit to eating more than lettuce and soup and are completely resistant to any suggestions about altering their diet. I feel a lot of pressure to advise a CW diet and medication because firstly my patients just don’t want to know about ways to change how they eat – they are generally very resistant to any suggestions I have to make (what with the I-only-eat-lettuce denial and all) so the only way to minimize the damage from their medical conditions is to prescribe, and secondly our whole healthcare system is funded based on meeting targets of CW prescribing. So we’re over a barrel a bit.

    I try to hit a middle ground of advising people eat a diet of minimally processed foods, based on fruit and vegetables and whatever they can eat that is as close to its natural state as possible, and hope for the best – as with any profession, I can offer advice but I can’t force people to take it.

    There seems to be a lot of anger and animosity directed at doctors throughout the comments – it’s a shame so many people seem to have had bad experiences, and I’m sorry that’s been the case, but I have to insist that the vast majority of us try to be as caring and empathetic as possible, keep up with the latest research and do the very best for our patients. There also seem to be a lot of ‘I know better than my doctor’ feelings – while I acknowledge that patients are experts in their symptoms and their experiences, they don’t always know or understand what’s best for them, they frequently over- or underestimate the severity of their conditions, and they do need advice, and I guess that’s the point of me and my 12 years of training – to identify worrying symptoms and investigate and treat them accordingly, to educate about the things to look out for, to reassure when the ailment is not serious and to empower the patient to live the best life they can.

    Sorry this was a long post…I’ll stop now!

  54. The question that the government, media, corporations, professionals, academics, and the general public are afraid to ask:

    How healthy is the average health professional?

    1. Important question to a point I guess, but surely irrelevant in a lot of situations – would you refuse treatment from a doctor who you knew had a lifestyle-related medical condition if they were treating you for your MI/trauma/surgical problem? Would you refuse treatment from a dentist because they had a filling? Does that one thing negate all their knowledge and experience?

  55. I don’t think that we should castigate the medical profession. A very close relative struggles with diabetes and obesity. She sees a doctor for her insulin and he spoke to her about the fact that in 90 percent of his patients, the root cause is emotional and psychological (in addition to diet and exercise). He also said that with high patient load he does not have time to spend unpacking all of that with them but offered it as a consideration.

    Like most people with obesity, she is aware of all of that and as Jo mentioned making lifestyle changes is very challenging.

    As a medical professional, they are obliged to reduce the harm and that means prescribing medications. Clearly, most, if not all doctors, know that is not the core but this is what they can provide.

    For our part, we need to support and care for people in positive health directions and MDA is a good place to start.

  56. In order to thrive and survive in the latter years of our lives we must REFUSE to do what most doctors want us to do … doctors might actually be doing far more harm than good over the last few years. There is NO CHANCE of them listening to you/us rather than the drug-company reps. What we need are strategies allowing us to convince the doctors we’re doing what they suggest when we’re doing the opposite. Leave them to it. There is no MONEY in our way, for them.

  57. I think the reason so few doctors actually take the time to talk about weight management or losing weight is because they have the same problems as the rest of the general population. I know I wouldn’t take weight loss or exercise “tips” from most doctors I’ve been to. Many…not all, are the just as out of shape or worse than their patients.

  58. Let me start by saying I am definitely on Mark’s side. However, as a soon-to-be college grad who is currently applying to medical school, I think there is another side to this. I can’t think of anyone who becomes a doctor for the money. The money for primary care, geriatrics, pediatrics, and all the others we need more of just isn’t that great. For example, I want to do primary care. In texas, the average PCP makes about $120,000 a year, but also acquires 170,000 in debt. How are we supposed to pay this off? Doctors take about a half a semester of nutrition in medical school. This should be expanded. Also, doctors should have more freedom and electives to be able to explore alternative and nutritive therapies. If no one is telling doctors this, how can they tell you? I shadow several doctors across many fields, and I am constantly disgusted by patients reactions when the GOOD and SMART doctors tell them…hey, you can’t eat bread and processed food at every meal and expect to feel good. So many patients say, isn’t there a pill I can take? Talking to people about nutrition is worse than talking to them about religion or politics. What we need is for government subsidies of the corn that makes high fructose corn syrup to end. If LOBBYISTS for big food companies weren’t allowed, maybe our representatives could make decisions based on FACT instead. There is a study for anything you want to prove, so maybe more long term studies are in order. I guess I’m just saying this is a much larger problem. Even if doctors are more educated, how do we make people LISTEN to them?? Drug non-compliance is already a huge issue. Lets work on changing the big picture, and the little stuff will work itself out 🙂

    1. Then why are you going to become an MD if you want to do primary care? The economics are hitting you over the head: you’re going to under up over-trained. Med school only makes sense for specialists (and not even for some of them) and surgeons.

      Become either a nurse practitioner or PA if you’re serious about primary care. Less training (and more appropriate), better hours, cheaper, and less overall stress.

      The other thing to remember is that healthy people avoid medical care. How often do you suppose Mark ends up in an MD’s office? I go for my annual checkup every decade or so. There’s a selection bias in the people you’re seeing because they want “magical pills”. I wouldn’t even take the older kids except that outside orgs insist a Doc give them a clean bill of health.

      1. Great advice Mark. I have a daughter who is a PA specializing in oncology care and I would trust her advice over most ‘specialists’ in a lot of areas. I see a PA and my wife sees an APN. I have no ‘quality of care’ issues with either of them. Plus, the PA route can have someone on the job, helping people, in 4-6 years less time.

  59. Hi Mark! Just realized we are the same age this year.

    HAPPY BIRTHDAY!!

    Great letter! I always have to do (mental) battle with myself before seeing a new primary care doc. I have seen many in my life and never have any of them been (apparently) able or willing to work with me about thinking outside the conventional wisdom box. I’ve had much better luck with internists for some reason.
    Thanks for such a great letter, can’t wait to see what the response is.
    ShaSha

  60. I’m an MD family doctor in Des Moines, IA and come from a family that farms using conventional methods. I recommend to my patients, multiple times every day, to get Primal. I’ve written http://www.marksdailyapple.com down nearly a thousand times. I’ve recommend books like The Primal Blueprint, The Truth Behind Statins almost every day. I took 2 people off statin medicines today, and have probably taken 6 people off statins already this week. It is my intention to always give people the tools they need to make lifestyle medications and to always inform them about the negative effects of the pills they are taking. I think 75% of my patients are overweight and I give my weight loss talk probably 10 times a day. Some people are willing to make changes, unfortunately way more people aren’t willing to and just want the pill. I can’t tell you how many times I’ve literally argued with patients about the fact they don’t need an antibiotic. I’m gearing up to open my own medical clinic in the future where I can attract the type of patient that is looking to do what it takes to get healthy and doesn’t just want to take pills. It is easy to rag on the doctors, but doctors in the clinical role rely heavily on the standard recommendations put forth by societies like the AHA or ADA. If the “experts” who supposedly have gone over all the research with a fine toothed comb say that diabetics should be on a statin to get their LDL below 100, it takes some cajones to advise patients otherwise. Luckily, some doctors like me do think for themselves and can see thru the BS.

  61. Don’t blame it all on the doctors….

    To understand where they’re coming from you need to understand where/how they’re getting paid. They don’t get paid for the time, they get paid per the visit thanks in part to how insurance reimburses them. So yes, unfortunately, they don’t discuss weight. But that’s not the only issue. It’s multifactorial. What if a doctor is seeing a patient for diabetes and the patient is hispanic and the doctor tells him he can’t eat beans or enchiladas as much? Or the patient is Vietnamese and the patient needs to cut out rice big time. There are so many cultural barriers to this that makes getting weight/nutritional education at a doctors office a multi-hour task.

    There needs to be a shift in healthcare to preventative medicine to include others such as nurses to play a part in healthcare education. The sooner the insurance companies get on board, the sooner we’ll have better education.

  62. To reiterate what Spencer said, the system does not encourage good lifestyle therapy. All doctors and our professional societies emphasize lifestyle changes as first line for all that is being discussed. For more focus, patients should see Obesity physicians, endocrinologists, cardiologists, etc who have more education in those matters. So help the movement to improve the system instead of trying to blame the physicians. We are all on the same team!

  63. Dear Mark,

    I love you! I’ve been fighting with doctors ever since I was pregnant and refused to drink a bottle of sugar water for a gestational diabetes test. (Yes, that would do my baby so much good right?). I took my son to the Dr. recently and was told that he was overweight (his BMI was 0.3 over the limit for normal weight, hes a healthy not-fat 10 year old) and the pediatrician told him he: did not eat enough grains (he is gluten free and doesn’t really like bread) and to drink low-fat milk!!I told her we do the “modified paleo thing” and she told me that “that’s why he’s overweight” and ….wait for it…..SHE’s fat! I’m a size 2 so I had to bit my lip to keep from being rude. I can’t tell you the amount of obese children who are being raised by poor people following bad advice from Drs. Its nuts. You’re awesome, happy birthday. I love my primal lifestyle!

    Mia

  64. I LOVE my Naturopath. She gives out fabulous nutritional advise and lifestyle guidance first, spends time with you to listen and is personally available, She’ll recommend and run tests and prescribe herbs or pills when needed. I pay out of pocket because my emyployer-provided health insurance won’t cover it, which is a shame considering how much she has done for me and how much money it has saved them.

  65. My doctor used to bring up my weight and cholesterol often, but he was confused by what I presented to him. I was slightly overweight with fairly high cholesterol but I was 10x more active than most people he had ever met and a vegetarian who hadn’t set foot in a fast-food restaurant in a decade. All he could say was maybe I just drank too many glasses of wine and had hereditary high cholesterol. He never prescribed anything, thankfully.

    I found primal and have lost a little weight but I am a muscular woman thanks to all the lifting I do and will never fit in the BMI charts. Even though I think I can wear a bikini without complete mortification nowadays, I probably weigh well over the limit for ideal weight. I can only imagine the ridiculous conversation if my weight “problem” was brought up. I’d have to pull down my pants to flex my squat-sculpted thigh muscles or deadlift the patient table or something.

  66. Well, one thing that is very sure with this article is that you have raised is that a number of very controversial issues have been hinted at.

    One, you talked of the mismatch between standard medical advice and simple lifestyle practices.

    What I will say is that it gets to a point when the lines become really blurred, and making clear distinctions between the two is all but impossible.

    You also stated that a majority of doctors do not really advice their patients, especially the adults patients on issues relating to their weight.

    I would have countered that but I see that you backed up the assertion with the relevant statistics.

  67. It doesn’t have to be like this. Primary care physcians should stop taking insurance. They need to quit working for hospital groups, and go back into business for themselves. Read up on Direct Primary Care. We need to kick the insurance company bureaucrats out of the exam room. It’s suppose to be the doctor-patient relationship, not the doctor-insurance company-patient relationship. Most people should have a catastrophic care plan and cover their primary care themselves.

  68. Happy 60th Mark! You’ve helped scores of people turn their life around (like me!) without ever meeting them. Your blog is worth its weight in gold. Still thinking about starting up a podcast? If so, I am there.

  69. Happy Birthday, Mark! It’s about time for you to adopt the “Primal Calendar” in order to calculate your metabolic age. Take your age and subtract it from 100. The result is your “Primal Age”. In my case the result is 37. Bonus….next year I will be another year younger!

  70. 3 years ago I started getting kidney stones.
    I asked my urologist how I could prevent them all he could tell me was drink lots of water.
    First year after my first stone I drank so much water I thought I would have to strap a bag to my leg if I wanted to go anywhere!
    I had two attacks that same year even with all the water drinking.
    At the same time I was getting bad leg cramps at night and found I was low in magnesium.As soon as I started taking the magnesium,the cramps went away.I started reading about magnesium more and found some studies where magnesium was the cure for kidney stones.
    2 years later I am still stone free.

  71. After struggling with my weight for since 8th grade (I’d loose, be healthy, then bad times would come along with the weight…only with more). After 33 years of struggle with undiagnosed depression and anxiety, I met with a counselor, which led to prescriptions, which led to weight fluctuations (again) and horrible side effects. I now weigh over 200lbs and I am so ashamed of my weight. I’ve lost 20 lbs. just because I got off the last psych med and I’ll never touch the stuff again. But when I was injured at work I was prescribed different pain killers and muscle relaxers to deal with the sciatica flare-ups…which led to other digestion and emotional effects that have started to put the weight back on again! Not to mention loss of any motivation or energy. (Not taking them anymore after realizing that was happening)

    My point in sharing this is there is a lot more to being overweight than diet counseling from a doctor can fix. If modern medicine doesn’t start to consider the whole person and look closer at the side effects of their treatments on people, then a lot of doctors are going to get frustrated at their patients and patients are going to see themselves as failures.

    I realize you want to help overweight people realize a healthy lifestyle. I wouldn’t be here if I didn’t believe you have very valuable information and encouragement to get where I want to be someday. I just hope you realize that there’s often more to the story than a lifestyle choice.

    Thank you for your website!

  72. though I agree with most of the rhetoric here I can disagree with one thing. I have never seen a placebo cure cancer and I’m a fourth year med student. On the argument that weight is not addressed in a health maintenance check by your primary care is just ludicrous it’s often a topic told to many patients otherwise we would not track weights and bmi.

  73. This is all very true unfortunately. As a medical student, it frustrates me when we are tested on the drug regimes for certain lifestyle illness’. Drilled and drilled and drilled we are, like good abiding little children. What a load of nonsense! The “nutrition” we do learn is taught by chubby dumb nutritionists who come in and preach the virtues of the processed food industries food pyramid. It’s all a load of crap, and just makes you sick when you think how simple it should be.

    I’ve forwarded this on to my mum who has been a GP for the last 30 odd years. She deserves a medal. She has seen the results of, and has been totally in line with the Paleo lifestyle for some years. Many of her patient’s have vouched that she has changed their lives for it. Like you Mark, she and I too are totally disillusioned by the ‘quick fix with a magic pill’ emphasis in medicine today.

  74. Mark, could you write an article on how to find a doctor? I see the network websites, but none of the live nearby. What kind of questions should I be asking? How can I tell they are going to be easy to work with?

  75. 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. .

  76. Amen Mark. Happy early birthday. You are the man. All other claims to being the man are erroneous.

  77. 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.. 🙂

  78. 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.

    1. 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.

      1. 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.

  79. 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!

  80. 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.

    1. You’re awesome and I wish you every success in your practice! Made my day! 🙂

  81. 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.

  82. 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.

  83. 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.

    1. 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.

    2. Amen! Totally agree. Very skewed population here in the best possible way!

    3. 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.

      1. 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.

        1. 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.

  84. 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.

    1. 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.

  85. 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.

    1. 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…

  86. 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.

  87. 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.

  88. 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.

  89. 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.

  90. 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.

  91. 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!

  92. 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.

  93. 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

  94. 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.

    1. 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!! 😉

      1. 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.

  95. 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.

  96. 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!

  97. 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? 🙂

  98. 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.

    1. 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! 🙂

  99. 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.

    1. 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. 😉

      1. 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. 😉

  100. 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.

  101. 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.

  102. You guys Do understand, that a doctor telling his patient to lose weight is like a pageant finalist wishing for World Peace.

    1. 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.

      1. 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.

  103. 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!

  104. 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!

  105. 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.

  106. 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!

  107. 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!!!

  108. 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!

  109. 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.

  110. 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

  111. Interesting and heated discussion.However, one thing I’ve noticed from all the comments and replies is that homeopathy doesn’t cure ‘thin skin’.

  112. 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 :>

  113. Maybe a partnership between Wellness / fitness / nutrition coaches & MDs could be a good mutually beneficial relationship.

  114. 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.

  115. I have to say I am glad doctors aren’t imposing “obesity counseling” as much anymore. Before anyone yells at me, I have three reasons for this.

    Reason one: A doctor who’s willing to offer an unsolicited opinion about a patient’s weight will do so in *any* circumstance. Break a leg? “You need to lose weight.” Caught the flu? “You need to lose weight.” This gets irritating after a while–we’re fat, not stupid, and we can see the mirror just fine, thank you. And can you imagine going through this with a new doctor after losing 75 pounds but you’re still not at goal weight? Can you just picture how frustrating that is?

    Reason two, relatedly: A doctor who will yell at me about my weight without first checking my labs is not a doctor I trust to be right for me. If my labs say I’m healthy, that’s the end of it. Especially when they refuse to test your hormone levels or anything else other than the standard bloodwork unless you threaten their next of kin, and usually at that point you just go to jail instead.

    (Yes, I’m being facetious. You laughed.)

    Reason three: Chronic disease IS NOT CAUSED BY OBESITY. There are people out there with metabolic syndrome who are not fat. I knew of one guy who drank lots of Mountain Dew and ate lots of PB&Js and was skinny as a rail but he’s got mental illness and high BP. Yes, mental illness can be caused by metabolic issues (*raises hand* I have BEEN THERE…) but aside from that, of course high BP is a symptom of metabolic syndrome. What did he think? Well, he got lots of exercise on his bicycle so it must be hereditary. Right, whatever. Then there was the slender guy in Men’s Health some years ago whose slender dad died of type 2 after an amputation, and who wound up with type 2 himself. And these are not aberrations. How many success stories have you had here from people who didn’t have weight problems but who had other diet-related physical issues? I know you’ve had at least one; I read it in the past 24 hours. Anyway. Obesity is a *symptom* of metabolic disorder. Duh… if your metabolism were working right, you wouldn’t get fat! But you can get other problems as a result of it not working right as well. Hell, you can have fatty liver disease without having a beer belly. It does happen. Be vigilant.

    So whatever reason these docs have for not lecturing… I’m *glad* they don’t lecture. If all they’re going to give is verbal abuse and bad advice (like “eat less meat” or “avoid fat” or “eat hearthealthywholegrains”), it’s not going to do anyone any good. And really, I am over slender people thinking that the only reason fat people have a weight problem is because no one told us we were fat. We’re already contending with losing our looks and losing our health and being treated differently by society. The verbal abuse on top of that is going to be more than some of us can take. And I thought you wanted us to get healthy, not depressed or dead.

    Something to think about anyway. Feels like I’m going blue in the face sometimes.

  116. I read through as many of these as I could stomach (not all of them) before I decided to reply. I am probably too late to the show for anyone to actually read this but, it makes my heart ache so I am responding for my own mental health at this point. I am a primary care physician who understands firsthand the broken medical system we face in the United States. And, there is so much physician-bashing on this blog that it is no surprise to me that the bright-eyed medical students I currently teach at one of the finest medical institutions in this world have a greater chance of burnout and career dissatisfaction than thriving in the career they entered with the self-proclaimed purpose of “helping people.” You bloggers are not alone in your distrust and adversarialism toward your physicians. But, it astounds me to no end that you all think that we (I and other physicians) somehow have an alterior motive to offering you “our drugs” or pushing “our treatments” on you or refusing treatments that you are positively sure you need (like antibiotics for a viral illness). Do you think I am offering you the professional advice YOU actually solicited from me for my own edification? Well, I’m not (and neither are my colleagues). We do it for you. We do it because it is what we believe will benefit YOUR health the most. Whether you agree or disagree with the advice, whether you understand it or not, I can virtually guarantee you that unless you run across a rare sociopath of a doctor, your physician has YOUR best interests at heart.

    My second point is to address the actual article content. There is much we don’t know about nutrition and much we do. There are many controversial areas. I often tell my patients that every single thing they put in their mouths is either helping them or hurting them–no in between. That is true but that is about all we know for certain. Dietary knowledge among physicians is overall poor because of this lack of certainty in the data. It is difficult to study a single food or point fingers because it is often the entire picture that matters–the outcomes on eating animal-based cholesterol/fat are very different for people who consume modern diets (including sugars/salt) and those who eat only the animal fats and veggies (Atkins-type diets) and those who also incorporate exercise. Nutrition is a complex beast and nutritional needs/abilities vary from patient to patient. It requires LOTS of time to discuss these issues with patients and the yield (number of times I successfully change a persons dietary behaviors) is very low. I have TEN-FIFTEEN minutes to address what my patient wants to address (because I and other physicians are graded based upon patient satisfaction) and THEN get to the dietary stuff if I have a minute or two left. Do you wonder why rates of weight discussions have gone down? You can point fingers but it isn’t productive, it just fuels the fire, burnout, and pain among physicians who already feel overworked, under appreciated, and overly criticized. So, until you have actually had your go at working as a primary care physician seeing patients (most of them are not like you, most of them are obese, many of them severely undereducated about health, many of them NOT interested in dietary/exercise change), being graded on how much they like you, and doing it at a clip of 4 an hour for 8 hours, please don’t flippantly suggest that we can just stop being lazy or avoidant on the issue and add it to the schedule.

    1. As a 3rd year medical student I want to thank you for this response. I have found these comments truly disheartening, and a real let down from Mark readers.
      I think its also important to acknowledge that the issue is so much bigger than just diet and exercise. From my (comparatively limited experience) primary care physicians are the last line of defense in a long line of lifestyle issues. Asking them to fix it, while dealing with everything else is almost impossible.
      I would also like to note, that for THE VAST majority of people I would be willing to speculate that eating less and in general reasonably is more important than what you eat. Its not the whole truth but its a place to start. I have found that patients understand the “plate method” of portioning and a “no seconds” diet. Do they stick to it or not, I don’t know.

  117. My friend sent this to me, and I wrote maybe the longest email I’ve ever written with my comments on this. I’m a 3rd year allopathic medical student, I have been seeing patients, generally in a primary care setting for over a year, and I am doing research on lifestyle modification:
    1) Physicians shouldn’t yell at patients… its not effective
    2) Homeopathic medicine may, or may not work, acupuncture has documented benefits, everyone thought St. John’s wart was incredible, until it turned out to have side effects. natural does not equal healthy.
    3) It has been my experience, physicians put the patient before anything else, I am sure many people have had a different experience, but in my experience that has not ben the case.
    4) I don’t think that physician education is the issue. I think there are lots of issues. There are pretty basic lifestyle ideologies that for most people are a big step forward for them. Most patients diets, the standard american diet, is so poor, just basic changes make a difference, forget about carbs vs meat. I’m just talking less food period and certainly less sugar. Or as the physician above stated- ANY exercise. I know all of those things are hard. But we have to get out of the mindset of having people eat perfectly (especially since we don’t know what it is), and into the mind set of getting them to eat/ live better. It would be one thing if patients came in and said “doc I follow the food pyramid exactly and i get 30 min of moderate intensity exercise 5 times a week. its not working”, but thats generally (there are always exceptions) not the case. Additionally when you give people the knowledge, the tools, and the community- retention rates moving forward are generally pretty low. i.e. people smoke, even when most know they shouldn’t.
    5) What we really need are lifestyle medicine experts (there are primary care physicians that do this), these people need training in dietetic, physical training/therapy, and psychology, to help guide people through this who are having problems. We need societal change at every level. From how we supplement agriculture, all the way to how those people who stick to perfect diets view people who don’t…
    6) Thats right even the people here are part of the problem, lets encourage everyone to take 1 step in the right direction instead of judging them for not being at the end of the race.

  118. Ok, for thoughts from an MD. I am a specialist, not primary care, but I approach alternative medicine the same way I approach Western medicine- with a critical eye. Mark, I have a lot of respect for MDA, because you also provide a balanced perspective lacking in most alternative med websites. I eat a primal diet because it makes good common sense and I feel great. My non-MD husband agrees! I recommend primal principles to all my family and friends who ask for advice about weight loss and athletic performance.

    Here’s what I get crazy about when I read alternative med literature. 1. Vaccines. I’m not saying everyone benefits, but your doctor is not trying to poison you or your children. Consider the risks and benefits. I get my shots and so does my kid. 2. Leaky gut syndrome. You are wasting your money on live blood analysis. I look at slides for a living as a pathologist. There are not yeast in your blood. This practice is total BS. 3. Sun exposure. I get as much sun as I can for Vitamin D and mood, but I don’t let myself get burned- that’s just silly. A little sunscreen is better than painful red blistering damaged skin. 4. Prescription meds. You might need these sometimes. Be sure to ask about the risks and benefits, and keep an open mind.

    That’s all. Use common sense, think critically about extreme claims, and self experiment! Grok on.

  119. Ugh, my doctor and nurse that takes the stats before I see the doctor ALWAYS harrass me very rudely about my weight. Granted I do need to lose some of this excess bodyfat, but 1. I’m not THAT overweight, and 2. I own a mirror, I know exactly how overweight I am, THANKS for telling me what I already know. Ugh!

  120. Nice article, but it brings back terrible memories. I was in the minority of having a doctor who mentioned my weight, although it was definitely more bullying and useless information. When my weight was mentioned during a visit for a case of bronchitis I knew it was enough. I was told to go to a particular website for diet info and start working out. When I came back and said I’d joined a gym and was going 5 times a week, I was criticized for paying to workout. It made me feel like it was all my fault and any efforts were hopeless. People know that they are overweight. They try to lose weight. The problem is they frequently get bad information (the food pyramid) or cliches (eat less, move more). It took me a very long time and the support of some forward thinking people equipped with solid information that has helped me conquer my weight. Whether I’ll ever conquer those past traumas is a different question. Thanks for writing about an important topic.

  121. Holy cow. That’s a ton of comments already! I just wanted to tell the story of my own experience with medical experts. Once, (gentlemen, please close your eyes), I knew I had a yeast infection and went to a new doctor (I had recently moved) to get some care for it (this was before the days of god bless ’em OTC fixes). I said to him “Doctor, I believe I have a yeast infection.” His response? “I’m the doctor. I’ll be the judge of that.” (Imagine the most pompous voice you could ever hear). The next week I drove 4 hours to see my old doctor who said “WAS THE MAN BLIND?”

    Another story (of many): I had intense abdominal pain and went to an ER. Xrayed all over the place and eventually they suggested an enema (citing constipation). Whatever. A few days later I got a call that told me one of the xrays revealed a “spot” on one of my lungs. I had to leave for a business trip at that point but upon my return I called back to discuss it. As it turns out, the spot was in reality, . . . (wait for it) . . . a nipple.

    So while I am sure there are doctors and medical professionals who are wonderful people, my own personal experiences reveal there are few of the many who really have a clue.

    I’ll take Primal thank you. Too many issues seem to be addressed by removing offending foods and beverages from my diet. Statins? No thanks. BP meds? No thanks. I’ll live long enough and drop dead.

    Happy birthday, Mark. I turn 57 this month.

  122. As stated above, this is a two-way street. The patient need to unshackle themselves from conventional, spoon-fed, medical “wisdom” and advocate for their optimal human conditions.
    It is blatantly obvious that our societies medical hierarchy is designed to keep the most important part of the system, the patient, in the dark. Simply due to a “lack of education.”
    Congratulations on writing this open letter Mark. It will be shared to the best of my ability.