Talking diet with your doctor
I’m always amazed at the number of comments this blog gets from readers who are worried about discussing health issues with their doctors. Most are a variant of this composite of many comments I’ve read:
I’ve been on a low-carb diet, and I’m afraid my cholesterol is going to be up a little and my doctor will want to put me on a statin. How can I show him/her that I’m really on the right track?
Another common variant:
I want to go on a low-carb diet, but I’m sure my doctor will be against it. What should I tell him/her?
I’m always puzzled by these comments. I’ve been on the other side of countless doctor-patient conversations, so I know how doctors (at least this one) think. And I’ve been in countless doctor-doctor conversations, so I know how doctors think about their patients. While there are a few old, crusty it’s-my-way-or-the-highway types still out there, it’s been my experience that most doctors are willing to work with their patients.
The important thing to remember is that you – not your doctor – are the one ultimately in control of your health. I can guarantee you that if you have been reading this blog for any length of time or have roamed through and read in the archives, you are much more nutritionally savvy than the vast majority of doctors out there. The old saw is absolutely true: doctors get very, very little nutritional training in medical school and even less in their post-graduate training. In my own case, I got exactly one lecture on nutrition in medical school, and that was from a registered dietitian, which should tell you all you need to know. And it wasn’t even a lecture on nutrition; it was a lecture on how to write orders for various diets for hospitalized patients.
Virtually all of my nutritional knowledge was self taught. And most doctors don’t bother – I didn’t bother for the first five years of my practice. I said all the same ignorant things and gave the same terrible advice that most doctors still give today. Had statins been available then, I would have been giving them to everyone who walked through the door with elevated cholesterol levels. I would have been telling patients that these drugs were a gift from the gods and that the evidence was conclusive that they worked. And I would have been dead wrong.
Which brings me back to my first point. You are in control of your own health. And you likely know at least as much about nutrition as your doctor does. So, why worry about what he/she thinks or says about nutritional issues? Besides, he/she is working for you, not the other way around.
But, it’s pretty apparent that many people are concerned about this issue, so let me tell you how to go about discussing diet with your doctor.
First, don’t bring a copy of Protein Power or some other diet book in and tell your doc to read it. Just seeing a diet book makes the ‘fad diet’ warnings go off in a doctor’s head. Plus, your doctor will never read it, so you’ll be wasting a perfectly good book. And don’t bring in magazine articles or copies of posts from this blog because they will scream the same ‘fad diet’ message.
Instead, bring in a short medical article. I’m going to give you one you can print and use. I’ll describe it a little later. I’m going to provide you with a published case report, which is about all most physicians can read. It will probably surprise you to learn that most practicing physicians don’t know how to and virtually never do search the medical literature. (Academic physicians do know how to use the medical literature, but for the most part, don’t know how to take care of patients.) So, if you bring in a long New England Journal of Medicine article, it will never get read. A case report is what you want.
Then tell your physician that you’ve had friends or family that have been successful on this diet and that you are planning on giving it a short-term try. And that you want your physician to monitor you.
If it’s a statin issue, you can do the Nancy Reagan and just say no. Or you can say that you’ve done so well on your diet in other respects that you want to give it a little more time. Or you can leave with the prescription and simply not get it filled if you don’t want to take the drug. If you continue on the diet, your cholesterol will probably fall before your next visit anyway, and you can say that you decided to give your diet a little more time to work. (If you want a lot of information to really discuss statins with your doctor, simply enter ‘statin’ or ‘statins’ in the search function of this blog and you’ll find plenty.)
I’ve got an interesting (and short) case report in my files that was published in the journal Aviation, Space, and Environmental Medicine, the official journal of the Aerospace Medical Society and sort of the unofficial NASA journal. Here is a downloadable pdf file of this paper suitable for presentation to your physician.pp-diet-in-an-aviator-av-spc-envir-med-2001
The paper presents the case of a 54-year-old army helicopter pilot with high-blood pressure (controlled with medications), obesity, diabetes, and elevated cholesterol. When he presented for his annual flight physical, his blood sugar problems had worsened from glucose intolerance to diabetic proportions, and he was removed from flying status. This pilot decided to go on Protein Power, and his flight physicians monitored him. Here is the brief history of his dietary journey:
After documenting normal renal function, that patient adopted a recovery plan of exercise and a high-protein diet. His exercise consisted of walking 2 mi 3-4 times per week. He kept his daily carbohydrate intake below 30 gms, but otherwise did not count calories. In a 3-mo period of time, he lost 35 lbs. His cholesterol was lowered to 204, his triglycerides [which had been greater than 500] lowered to 238, his fasting blood sugar lowered to 100, a 2-h post glucose load lowered to 122, and he discontinued his hypertension medication and remained normotensive. The patient has continued the high-protein, low-carbohydrate diet with a gradual increase in the amount of calories from carbohydrates and for 1 yr has maintained quarterly hemoglobin A1C in the low 5 range. He reports feeling better than he has in many years and has successfully returned to flying.
The article goes on to describe specifically the Protein Power diet in a comprehensive way. It’s a much better short description of our own diet than one I could have probably written. The paper then confirms the data we presented on the superiority of the low-carb approach with one other paper (there were more out there at the time, so I don’t know why they quit with just this one) that you can read in full text or download in pdf here.
This is the kind of case report you can simply give your physician and tell him/her that you are going to try this diet. Your doc probably will read this one since it’s only two pages and reads like one doc writing to another, which is what a case report really is.
When you do go on the diet, your results should speak for themselves. Your physician will then be as surprised as the docs were who wrote this case report. Why do I know they were surprised? Because you only write case reports on unusual or surprising findings. You’ll never see a case report that says the patient came in with strep throat, we treated him with antibiotics, and he got well. That’s an everyday occurrence. It’s only the stuff that makes you sit up and take notice that inspires a written case report. Your doc will be pleasantly surprised at your outcome just as these doctors were surprised at this aviator’s outcome.
Then maybe, just maybe, your doctor will want to know more. And then you can give him or her the book.