What’s Up With My Doctor?
Context: for every 1 patient like you
(seeking self-empowered healthcare)
your doctor has 999 who just want sickcare:
a pill, and no advice on any diet/lifestyle changes.
If you have
found a results-oriented rogue doctor, cherish them.
But that’s probably not why you found your way to this article.
Why is my doctor hostile about my diet?
Why doesn’t my doctor ever ask about my diet?
Why can’t I get a real lipoprotein or thyroid test from my doctor?
If you find yourself asking for fT3,
fT4, rT3, TPOab, TGab, or perhaps an NMR or Lp(a) test,
and get a non-supportive response, there are
two separate issues here:
1. yes, those tests were not proactively suggested for you, and
2. you may be the first client to ever ask that doctor for them.
This is the modern medical milieu in a sobering snapshot.
We are in a tragic situation that shows some promise of
turning around, but in the meantime, consumers of healthcare
need to be aware of the wider context so as to be able to
identify, seek and interpret effective advice and treatment.
Consensus medicine is the product of Western Civilization,
which many are now beginning to realize has been
in an unhealthy metabolism (full-time grain-laden glycemic)
for all of recorded history and then some. To the extent
that consensus medicine is even aware of low carb (much
less ketogenic metabolism), it considers it an
uninteresting fringe topic, a place where people
like diabetics and epileptics used to live only
because they had no access to insulin and anti-convulsive
meds. And, to seal the deal, low-carb cultures, unlike
even osteopaths and chiropractors, have no med schools
that might represent a formal dissenting view.
In 12 years of pre-med, med and residency, your MD got
than 20 classroom hours on the role of
diet in health, and all of that small smattering was
based on science confounded by the culture’s full-time
glycemic diet. The role of nutrition in health is not
even a topic in med school Boards. That which isn’t tested
tends to not be taught.
Yes, knowledge of nutrition is not even required to become an MD.
Dr. Robert Lustig reports
that 81% of U.S. med schools don’t even teach nutrition.
The situation in Europe is only
slightly less depressing. Only 31% of schools there
don’t teach it, but med students still get a mere
24 hours, and the content may be presumed to be
predominantly consensus nutrition mythology.
Med School Lesson 1: diet doesn’t matter.
How could 80% of my caseload (almost all the non-infectious
chronic stuff) have a root cause in something that was
a med school footnote?
It’s really unsurprising that consensus medicine ignores
diet. In addition to the dismissive attention paid to
it by med schools, what is being taught is incorrect,
so the consensus diet advice students are instructed to deliver
is in fact negatively correlated with health.
Med School Lesson 2: so don’t bother to read
papers on nutrition
…and they don’t:
Anyone Read Medical Journals Anymore?
perhaps most especially nutritionists “…they are handed
a set of stone tablets on graduation from which they are
told to never ever deviate.” The original
Wheat Belly (WB) book has 295 footnotes,
Wheat Belly Total Health has 466, and
Undoctored has 342,
mostly cites from the medical lit, and your MD
is exceedingly unlikely to have read any of them, even
though they are dead-on regarding the business of medicine,
testing, treatment, wheat, carbs and diet
It doesn’t help that too many nutrition papers (not
those cited in WB) are little better than intellectual
junk food - hopelessly confounded, almost never isolating
for low-carb/grain-free/healthy-fat, completely oblivious
to gut biome and circadian issues, using placebos or
controls that are anything but, and heavily influenced
by their funding sources. Most food-fright-of-the-week
headlines turn out to be based on such worthless and/or
Med School Lesson 3: prescribe a
As an MD in training pointed out
on the WBB, the med school focus is on pharmacology -
prescribing drugs. Drug
companies have excess influence
in courseware, and on the “Standard of Care” (SoC) -
the approved treatments for conditions. Naturally,
the solution usually requires that the patient buy a
drug, even when changing aisles at the supermarket
would have a more effective and less adverse result.
Post-graduate visits by cute pharma sales reps, free
dinners and free trips, reinforce the message. There
are just enough drugs that are actually useful that
this state of affairs seems credible.
Med School Lesson 4: liability
The SoC is safe (for the MD). No MD is going to lose
a malpractice case by following the dogma. In cancer,
the SoC is usually fatal, and often has no material
effect on lifespan, but no oncologist gets sued over
it. When you suggest deviating from the SoC, the MD’s
inner lawyer goes to red alert, and the MD may not
even realize it. Treat your glioma with a restricted
calorie keto diet, hyperbaric therapy, exogenous
ketones and elevated Vitamin D? Panic attack just
due to liability.
Aside: this article is about MDs. Any health
care provider with a lesser rank than MD is
dramatically less likely to deviate from dogma.
MDs have a longer leash, particularly when their
off-schedule or radical approach has demonstrable
positive results. PAs, NPs, RNs, LPNs, dietitians
and counselors of all kinds take a severe career
risk in stepping outside the box, so set your
Med School Lesson 5: MD = matriculated deity?
If the student isn’t careful, formal medical education
can afflict them with godlike psychology:
The Big Dirty Secret Every Doctor Knows
Eminence-based medicine is not the exception. It’s the rule.
This, alas, is exacerbated by the tendency of patients to assume
that doctors have the power of life and death. The deeper
into this trap the MD falls, the less open they are
to being mistaken, and especially to being challenged
Post Grad Lesson 0: what that student loan implies
The young doctor may be entirely unprepared to confront
a situation that implies that much of their medical
education, not even paid off yet, almost entirely
omitted a massively important topic.
Similarly, the mature physician is not prepared to deal
with the historical implications.
Post Grad Lesson 1: follow the money
Most of an MD’s income doesn’t come directly from
patients. It comes from insurance providers, who may
refuse to cover non-SoC therapies.
Preventative and preemptive treatment is often
also not in-plan (in large part because little
preventative advice has been effective, and as
we see with WB, effective dietary advice is
pretty simple and doesn’t require 12 years
of training). The various medical specialties
have consequently allowed themselves to be
herded into a posture of fix on failure.
Yes, a dietary revolt by the general public is
going to dramatically reduce the demand for MDs,
but most of those MDs haven’t seen that far ahead,
and that’s not what’s on their minds when you
bring up diet.
Post Grad Lesson 2: Fix on Failure
As Dr. Davis has said several times on his blog,
consensus medicine has allowed itself to get painted
into an acute care corner. It tries (and all too
often fails) to fix things only after they’ve spun
out of control. Prevention is not on the menu,
both because it’s not compensated by insurance,
and also because the consensus guidance offered
is not correlated with healthy outcomes.
Let’s hit that point again: medical professionals
aren’t highly enthused about prevention, both
because it doesn’t pay well, but perhaps
principally because the outcomes have not
been encouraging. The presumption may be that we
aren’t following the advice, rather than that the
advice is incorrect.
Post Grad Lesson 3: I have no map for that territory
When I asked my GP (now retired) to order NMR
lipoprotein testing (that actually measures
small LDL) and full thyroid testing (that
actually directly measures thyroid function,
and not just pituitary reaction), he admitted
that he had never written such an order, and
wouldn’t know how to read the results. To his
credit, he was willing to refer me to an internist
who would order the tests.
Post Grad Lesson 4: guild loyalty
It’s 1850. You propose to your MD that perhaps
blaming bad humours, treated by bloodletting
with leeches, or emetics, might not be an
effective way to address your chronic indigestion.
Another red alert. You are asking the doc to
defect from the fraternity, and join the
rebellion. Even if the doctor is disposed to
consider that, there are substantial career risks
for doing so, as we see in the Noakes
Post Grad Lesson 5: webmd.com
Any physician with an established practice now has
to deal, daily, hourly, appointment-to-appointment,
with patients overflowing with insights, advice,
“facts” and self-diagnoses from the
internet, much of it flat out incorrect. This has
rapidly conditioned them that patients bearing
new/contrary information are mistaken until
proven otherwise by overwhelming evidence, which
probably hasn’t happened yet for your doc, who
confidently predicts that you won’t be the exception.
Post Grad Lesson 6: shock of the new
To update something I said on WBB:
Another aspect of this is that the problem
is extraordinary. As Dr. Davis asserts in the
recent Wheat Belly Total Health book (p137),
less than 2% of what passes for “food”
in the average supermarket is actually fit for
routine human consumption. I can’t think of a
precedent for this sort of thing. So in addition
to the particulars of medicine vs. nutrition, we
have the perfectly normal rational skeptical
response of “extraordinary claims require
OK, here are 466 cites. Connect the dots yourself.
Skeptic MD: “I don’t have time for that.”
OK, it’s been done for you in this book.
Skeptic MD: “That’s a popular best seller,
with recipes! Surely you don’t expect me to take that seriously
(especially when I have a vague subconscious
unease about the wider implications).”
Post Grad Lesson 7: the
overlooked itself has changed, and so what
Even if consensus medicine had paid more attention
to diet, and thwarted the USDA’s suicidal shift to
low fat (1977-1992), would it have reacted to:
- the relatively sudden rise of
semi-dwarf hybrid wheat (1960-1985),
- the sudden rise of cheap sugar (high fructose
corn syrup: 1975-1985),
- the sudden rise of high Omega 6 PUFA
industrial grain/seed oils and
- the only recently banned
Not only do these “foods” present
novel issues in diet, they also, by way of being high
yield and inexpensive, have pandemically infested the
majority of prepared foods over the last 50 years.
The history of medical societies is dominated by
resistance to change, even when they are paying
attention, and in the case of diet, they haven’t
really been paying attention.
Post Grad Lesson 8: Too Much Too Soon
Grain-Free LCHF can’t be correct, because that
would imply …
In the specific case of Low Carb High Fat diets (LCHF,
and the WB recommendations are presently very low carb,
borderline keto), getting your doctor to accept the
benefits of LC also implies accepting that HF is at
least not harmful. You’re asking them to toss overboard
multiple major features of the consensus diet (namely:
get 60% of calories from carbs, low fat is “good”
and high fat is “bad”).
This dot connects itself to another: consensus heart disease
etiology is also upside down, and based on a
defective theory supported by studies
recently revealed to have concealed
data that falsified their conclusions.
Fat isn’t the problem; it rather looks like carbs and inflammation are. …amylopectin A to convert
(via the liver process of de novo lipogenesis, the process also
responsible for fatty liver) to triglycerides that fill VLDL
particles, the number and composition of VLDL particles are altered
and are less able to contribute to unhealthy effects, such as
triggering formation of small LDL particles..
This is a top candidate for the real cause, and Small
LDL-P (NMR LDL), the crucial
measure, is almost never measured. Instead you’re most likely to get
an archaic crude
approximation (LDL-C), and a reflexive prescription
for a statin
which artificially distorts this symbolic
“cholesterol” number that doesn’t matter, but
does screw up your CoQ10 pathway, which actually does matter.
Inflammation? What those old now-debunked papers actually
identified was that Omega 6 linoleic acid,
the main fat in so-called healthy vegetable oils, is a
health disaster. We need it in our diet, but in a near
1:1 ratio of ω6:ω3. Thanks to consensus nutrition
advice, intake is more like 18:1 in most places now, and results in
shorter lifespan, just like those old trials tried to hide.
If a consensus advocate furthers take the time to figure out that WB is
borderline keto (Nutritional Ketosis), they are quite
apt to confuse that with DKA (Diabetic KetoAcidosis)
or even starvation ketosis. DKA is only a hazard to
advanced diabetics who produce almost no insulin.
This is quite a bit to swallow for someone taught
the inverse, and that none of it really mattered to
Look at the trend chart for any of the leading
non-infectious chronic conditions,
Type 2 diabetes being perhaps the most
disturbing - not just high, not just
rising, but accelerating.
You’d think that Conventional Medicine would
be in a panic about this, and willing to consider
quite radical theories on what the cause is, and
actually try some different approaches.
And big pharma merely sees it as an
attractive revenue stream.
Post-Grad Lesson 9: The Future Isn’t What It Used To Be
Knowing 5% of 50%
Perhaps less than half of the cells (by cell count) in our
bodies are human, and this article so far has been
about feeding the human cells. The other half (maybe
more) are the microbiomes, principally the gut biome,
a diverse collection of bacteria, eukaryotic parasites,
fungi, protozoans, yeasts and viruses. These produce
critical nutrients and provide important protective
functions. They have specific nutritional requirements.
Consensus medicine presently knows even less about this than about
human diet. Knowledge of biome fine tuning is exploding,
and leaving consensus medicine in its dust. By the
time the subject gets even equal time with diet in med
schools, self-empowered citizens will be decades ahead.
What Was That About Thyroid?
From consensus medicine you can expect
ø dis-interest (in flagrant symptoms),
ø mis-testing (TSH only, maybe TT4),
ø mis-diagnosis (“normal”, when it is really hypo), and
ø mis-treatment (T4 only, if anything).
This is a common topic on the Blogs.
There are entire web sites devoted to the scandal.
bit players are writing books about it.
Consensus medicine is pretty useful for many acute
conditions, like trauma injuries. In my view it is
dangerously useless on all metabolic conditions
(T2D, obesity), most chronic cardiovascular conditions,
and key endocrine conditions. It is merely expensively
useless on auto-immune conditions and many cancers.
If you have a chronic non-infectious ailment, be
prepared to do your home work and be your own case manager.
This is a really awful
moment in history to be a classically trained MD.
In addition to what grain-free low-carb high-fat
low-inflammatory gut-flora-attentive diet implies
about a huge black hole in their training, they
are straining under the yoke of universal sickcare
regimentation and rationing, and its cookie-cutter standards of
care (which care nothing for actual outcomes).
All of the above does not excuse knee-jerk resistance,
denialism and general freak-out when you raise the
topic of diet with your doc, but may at least explain it,
and prepares you for the likelihood of encountering it.
Bob Niland [disclosures]