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An Open Letter to Doctors


Thursday, July 11, 2013


www.marksdailyapple.com/
an-open-letter-to-doctors/
#ixzz2YlJW2vPw

(See the original article for clickable links throughout.)



I realized recently Iíve 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, thereís a genuine mismatch these days between standard medical advice and effective lifestyle practices. I think we can all do better. Iím not letting patients off the hook here either. (Maybe thatís fodder for another letter.) However, we naturally look to our physicians as our healers, as the experts, as our guides. Unfortunately, weíre not always well served by that kind of faith. Iím 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 Iím 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. Theyíre on the front lines Ė 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). Itís more their job (and billing categorization) to provide general health and lifestyle counseling to their patients. Itís 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 donít counsel their patients about their weight Ė this at a time when approximately two-thirds (yup) of the adult population in our country is overweight or obese. Iím 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 thereís 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 Ė 46% and 59% less likely respectively. Any jaws dropping yet? Pardon me, but does this jive with some version of the Hippocratic Oath I donít know about?

This utterly confounds me. Sure, I get it on an emotional level. Itís awkward. You donít want to make anyone feel bad. But itís your job to tell the truth Ė whether itís convenient or not. Itís your job to steer folks in the right direction health-wise, to educate them in making better choices for their health. No oneís suggesting you call them at home to wake them up in the morning to encourage them to go workout. No one thinks itís your job to write a personalized menu plan.

Nor is anyone saying you have to be a jerk about it. (Please donít.) You really can have a conversation with a patient about his/her weight without shaming or blaming. The thing is, Iíll bet the person already knows he or she is overweight (just a wild guess). Mentioning it wonít dismantle any delusions of god-like svelteness or superhero health. Iíd even venture to say theyíre waiting for you to talk about it Ė as in, their weight and assorted related concerns/questions are already on their minds. Just be honest Ė and professional Ė 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 Ė guess what Ė 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 frontÖ.) I realize Iím not the first one to observe weíre 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. Iím 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 Ė wheat) are an essential part of a healthy diet. The research doesnít line up Ė and never really did line up Ė behind these assumptions. The more our population follows these recommendations Ė 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 isnít an organism that mutated. Weíve 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, itís a matter of reviewing the research, keeping up on whatís being said and shown. I know, I know. Itís difficult to impossible to stay abreast of the latest research Ė especially when you expand the scope beyond the most conventional sources. Itís tough for physicians to stay current on ALL the new research. Itís 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 ďContinuing Medical EducationĒ at the point of patient care Ė 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 curedÖor at least mitigatedÖby lifestyle adjustments. And much of that is diet (although exercise, sleep, 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 doesnít address the larger health issue or seek to remedy it. Gastric bypass isnít 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 Ė the processes we need to be addressing. The same goes for PPIs and SRRIs. Respectively speaking, heartburn is generally associated with too little acid rather than too much. Taking them might alleviate some short-term discomfort, but theyíre contributing to long-term digestive issues and nutritional deficiencies. Likewise, SRRIs 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 canít redo your med school experience. Likewise, itís probably not in the cards to take a leisurely sabbatical during which you get to delve into the sea of research thatís 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. Theyíre relatively easy and decent ways to digest a lot of info at once.

And while weíre 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 Ė no surprise Ė their patients have seen the same kind of incredible results that we see here on Markís Daily Apple every week. If youíre an interested physician, contact me here and letís 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. Iím turning sixty this week Ė yup, 6-0. The thing is, I donít really fit the common image of a sixty-year-old that weíre 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 donít work as hard at it as you might imagine. I donít 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 doesnít 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.

www.marksdailyapple.com/
photos-mark-sisson-age-58/
#axzz2YlHIGrCj


Thank you, by the way, for reading. I appreciate your taking the time and thought to consider one humble guyís opinion. If youíre ever up for some conversation, Iíd love that. Thatís where good things start. In fact, letís make it lunch Ė Primal style of course.






Mark Sisson & his wife, Carrie, age 58






An Open Letter to Taco Bell
www.marksdailyapple.com/
an-open-letter-to-taco-bel
l/#axzz2YlHIGrCj



An Open Letter to Kids & Teens About Lifelong Health
www.marksdailyapple.com/
an-open-letter-to-kids-and
-teens-about-lifelong-heal
t/#axzz2YlHIGrCj


Donít You Just Love Making Doctors Speechless
www.marksdailyapple.com/
dont-you-just-love-making-
doctors-speechless/#axzz2YlHIGrCj









...Because your body WILL take care of itself!

So, JUST DO IT.

UNTIL.



UNTIL. (My 'Just Do It' blog)
www.sparkpeople.com/mypa
ge_public_journal_individu
al.asp?blog_id=3541059



'BEFORE' Pictures (May 31, 2009 - September, 2011) & Continuing PROGRESS (February 2012)! Next pictures SEPTEMBER 2013!
www.sparkpeople.com/mypa
ge_public_journal_individu
al.asp?blog_id=2108514

(I'm now keeping these right under my nose... in addition to being part of every blog I post, they are printed off and taped to my bedroom mirror... and I update whenever I feel the need - likely early September, 2013... to either see for myself what feel like significant changes, or to encourage myself to keep the faith when I feel no change at all despite my efforts)


Measurements, Musings & Motivation to MOVE!
www.sparkpeople.com/mypa
ge_public_journal_individu
al.asp?blog_id=2108455

(UPDATED/rewritten: JUNE, 2012)


I've Reached My Goal Weight!!!!!!!
www.sparkpeople.com/mypa
ge_public_journal_individu
al.asp?blog_id=2108522

NOTE: My weight tracker is NOT a truthful representation of my weight. Instead, I am using it as a tool to help me visualize my goal as though it's already been achieved!
(Tom Venuto)


DONE Girl Love...
www.sparkpeople.com/mypa
ge_public_journal_individu
al.asp?blog_id=3694266

(the footsteps into which I place my own feet)


Leaving NORMAL... In Pursuit of Happiness
www.sparkpeople.com/mypa
ge_public_journal_individu
al.asp?blog_id=2232914



Why I'm STILL here... my SparkJourney Saga
www.sparkpeople.com/mypa
ge_public_journal_individu
al.asp?blog_id=1656330





(quote by CHRISTINE MASON MILLER)
simonemesham.files.wordp
ress.com/2011/06/handwritt
en-journey-life-life-quote
s-path-quote-favim-com-384
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Words CAN Be Enough... page 3
www.sparkpeople.com/mypa
ge_public_journal_individu
al.asp?blog_id=4932741



Paleo... Do you really know what you're talking about?
www.sparkpeople.com/mypa
ge_public_journal_individu
al.asp?blog_id=4964697



Comparison Chart: Primal/Paleo/Ancestral, etc.
www.eat-real-food-paleod
ietitian.com/support-files
/dietcomparisonguide.pdf



Breakfast is Served! (RECIPES)
www.sparkpeople.com/mypa
ge_public_journal_individu
al.asp?blog_id=5018597






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I'm going to be one of those Friday Success Stories!!!




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Member Comments About This Blog Post:
CARPEOMNIA 7/22/2013 9:42AM

    Yes...reinterating what THOMS1 said...often patients CHOOSE not to listen to their doctors. They are, indeed, looking for a magic pill...not advice that would have the patient making an actual physical effort.
Often folks just don't want to talk about what the real issue is...it must be their thyroid...let's get a pill for that. It must be a slow metabolism...let's order up this amazing new product derived from a never-heard of fruit. They want the magic bullet.
My own mother refuses to listen to her physician who advises a daily walk...nope...ain't gonna do it.
I don't believe that a person will listen to anyone....until they are ready to.

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TIRED49 7/14/2013 1:17AM

    I love this blog! Can you be my doctor? emoticon
I have not been to a doctor in over a year simply because she looked down her nose(literally) and said I didn't have any control of my weight, needed help blah, blah, blah, and sent me on my way.

Bravo on your letter and your good habits.

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_NONNIE02 7/13/2013 4:30PM

    Hello, dear one! I have been offline since March-ish? On complete mental and emotional overload with the move and Tom's job loss. Better now.

Regrouping and jumping back into the fray.

Hope all is well with you!! xo

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CRAFTSFAN1 7/12/2013 5:45PM

    You are completely right. I just hate to go to a doctor to get pills. What I want to is to be diagnosed, to know the mechanic, physic, and chemistry factors of my illness, in other words, to learn what I can really do to heal. Also, the approach that some doctors use, is not very valuable. YOU NEED TO LOOSE WEIGHT, is not enough. It would be better if patients are told why is the weight showing that the body needs more nutritive food; that the weight is showing that some food we are eating is affecting our systems like diabetes, high blood pressure, arthritis, etc.
RAMONA, I like your blogs very much because they make me think and reason in new ways.

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NUTRON3 7/12/2013 8:22AM

    good letter

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NEW-CAZ 7/12/2013 2:47AM

    We are fortunate to have a weight loss nurse at our GP practice and she has had a lot of success with some very overweight patients.
She has the right attitude and outlook to keep everyone positive.
She also doubles as the diabetic nurse- and we all know how the two often go hand in hand.

Great blog Ramona, as always, love to you and Miss O emoticon

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RUSSELL_40 7/12/2013 1:16AM

    I was diagnosed with CHF in 2001, and diabetes in 2003. I decided on my own to do something about my weight in 2009, and have lost 140 lbs on Atkins.

Not once in all that time did a doctor even hint at me losing weight. They were focused on my heart, and diabetic issues. Within a year of starting low carb, I was off all diabetes meds, and now I am off cholesterol meds, and take half the dosage of my heart, and BP pills, and Lasix.

Plus I am much healthier today, all started because I started low carb, reduced cravings, and started eating a sensible amount of food. All of these diseases were caused by food, so a correction of your diet would be a much more logical solution, than a pill, but requires a doctor to pay attention, instead of scribble a script. Most of our health problems could be avoided with simple dietary changes.

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JUNEAU2010 7/11/2013 9:13PM

    Love it, as I always do (your blogs, that is!)

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CALGIRL80 7/11/2013 5:25PM

  As I talk with friends trying to find a "good doctor", I am realizing how amazingly lucky I was with my previous two doctors. Neither were afraid to discuss anything including weight loss/gain. Some medication have made me gain a weight. However as we talked about this, my doctor emphaisied also the importance of not solely focusing on the number but rather what my body could do, particualarily after having traumatic neuropathy in my left leg. Thank you for another timely reminder of the importance of a GP who is willing to talk about all aspects of health.

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TXTOAD9970 7/11/2013 4:16PM

    My doctor told me I needed to lose weight last August and I immediately came home and searched for low-cost diets on the internet (and found Spark People!). It's funny, my doctor didn't tell me anything I didn't already know, but hearing him say it made it a "real" health issue for me and less of a vanity issue.
I looked at your progess. You're doing great! You should be proud of yourself. Keep up the great job! Thanks for posting!
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THOMS1 7/11/2013 2:52PM

    Good letter. It's just too bad patients choose not to listen to their doctors when they do try to discuss weight issues. I have had doctors tell me numerous times how their patients have fired them for wanting to discuss those problems. emoticon Later...........

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