Saturday, November 6, 2010

About your Doctor...

I was recently posting something in an exchange on Facebook (yes, I'm on Facebook, and no, I don't feel bad about it) and I commented that most doctors don't know anything about nutrition.  A friend of mine, who happens to be a physician, rightly called me to task for this, so I thought it worthy of some discussion.

There are people out there who will argue that your personal physician is corrupt, or evil, or in the pocket of the pharmaceutical industry.  I'm not one of them.  I absolutely believe that most doctors want to do their best to help their patients, but there are a handful of things preventing almost all of them from doing that effectively.

First of all, your general practitioner or internist or whatever needs to know a lot of information about a lot of things and keep up on a lot of information.  They need to know the symptoms for a whole array of diseases, from the everyday to the obscure, and the standard of care for all of them.  If they don't, and some patient come in with a bursting appendix and doesn't get the right care, the patient dies and the doctor's in big trouble.  After learning all that stuff there's not a lot of time left to cover nutrition, especially obscure areas of nutrition.  Most medical schools offer just a few hours of nutrition coursework to their students.  So when I say that I know more about nutrition than your doctor, I'm not necessarily just being an arrogant prick.  I've spent a whole lot of time studying nutrition.  Your doctor has to spend a ton of time studying a ton of things that I know nothing about, leaving most of them with very little time to compare the effects of coconut oil to olive oil on your health.

In addition to having limited time, there is tremendous pressure on physicians to apply the standard of care to all their patients in all situations.  What I mean is that there are boards and organizations that publish papers and textbooks about what should be done for patients in specific situations.  If your doctor personally disagrees with the board's recommendation, and they go with their own feeling in a particular situation, and the outcome is bad, they risk serious lawsuits or losing their license.  If your cardiologist puts you on a high fat diet and you die 3 months later they could be in trouble.  If they put you on Ornish's program (low fat, high carb) and you die 3 months later, they're untouchable - they gave you the standard care for heart disease.  It takes overwhelming evidence to convince a doctor to go against the standard of care, and with the lack of good research done on nutrition (real double blind studies, which are almost impossible) doctors just don't have time to accumulate that evidence.

Now you  may be wondering why those boards and organizations don't do the work themselves - surely a handful of people whose job is to publish those papers have time to do the relevant thinking.  There we run into some combination of lack of research (the right research just isn't done) and a powerful political lobby that fights against it.  There is a tremendous amount of money behind the grain industry in America, and they have a LOT of money to spend to make sure that no government body looks too closely at anything that might lead them to think that a grain and carbohydrate based diet isn't the best thing for our health.

It would be nice if those people - who work for the government, for the most part, either directly or indirectly - would do what's best for the American people.  But they aren't really held responsible for making people healthy.  They answer to professional politicians, who know even less about nutrition (or just about anything other than how to raise money and get elected) than regular people, let alone dedicated researchers.  It's so much easier to tell a congressman that you're going to go ahead and put grain at the base of the food pyramid, making his corporate sponsors happy while complying with the conventional wisdom, than it is to explain why "heart healthy whole grains" is an oxymoron and telling him he should go without the fat check corporate farms are writing him.

So people get fatter and less healthy, and instead of revisiting the government's nutritional recommendations (which doctors mostly have to follow for reasons I explained above), people write papers crying about how much worse things would have been if the feds hadn't started telling people to eschew fat and eat whole grains.  And people like me tear our hair out (really, I have no hair left).

What would make things different?  I think there are probably lots of good ideas about this, many of them better than mine.  I'd like to see doctors specializing in wellness care.  You only see them if you're completely healthy, and they help you get healthier yet.  They wouldn't need to know anything about any illnesses, sort of, just cutting edge nutrition and lifestyle information.  They'd be the ones you go to for your annual checkup.  They'd also have to be protected from most litigation - if you could sue your wellness practitioner every time you got sick, the profession would die out pretty quickly.

This obviously isn't going to happen, and it's entirely possible that it's not a good idea for reasons I haven't thought of.  I see no realistic way the American health care system will change in the near future.  Which puts you, the reader, in an awkward physician.

If you get shot or get an acute pain or get really sick, see your doctor.  Seriously, they're good at dealing with gunshot wounds and influenza.  But you can't assume that your doctor knows how to keep you healthy or make you age more slowly if you're not sick.  That's become your job.  And it's not easy - there's a lot of conflicting information out there and it's hard to sort through.  I've spent a ton of time on it and there's still plenty I don't know (some of it because nobody knows it, some of it because I just haven't found the right answers).

The other choice is to go ahead and follow the government's recommendations.  But the track record isn't good - people just aren't getting healthier.  The people who tell you to eat whole grains are basically the same people (the same sort of people, I don't mean they're the same individuals) who told us to switch butter for margarine and stop breast feeding in favor of infant formula.  I think in 30 years we'll look back on the whole grain based food pyramid the same way we look back on baby formula - as a massive error in judgment.  But in 30 years you can do a lot of damage to your body.

There was a time when your family doctor might have known mostly everything there was to know about health.  That time is, sadly, long gone.


  1. Very good thoughts. They reflect much of my own. And as a nurse specializing both in Emergency and medical weight loss, I see it. I see the cause and I see the results of our American diet.

  2. Thanks, Bill! I can imagine the weird stuff you're faced with daily. So many people throw their health away because they'd rather eat Twinkies than be healthy... or maybe because they're addicted to sugar and/or gluten. I see no easy solutions, but I figure blogging about it and spreading the word of good nutrition can't hurt.