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From HEALTHINSIGHTUK:

Confessions of a renegade doctor

By Joanne McCormack

Until fairly recently I was a pretty conventional medic. I graduated from Manchester University as a doctor in 1986 and became a GP in 1990. Back then nutrition was very much a minority topic and certainly eccentric interest, while drugs and the pharmaceutical industry occupied the high ground of medicine. Now as far as I’m concerned when it comes to chronic disease, which is what I spend most of my times dealing with, the positions are pretty much reversed. 

Inevitably I learnt very little about nutrition in medical school and didn’t come across the Eat Well Plate until I was already in practice. Back then I just accepted it, but now I can see that much of it doesn’t make sense. 

For instance, even in my limited nutrition classes I learnt that there were essential fatty acids and essential amino acids but no essential carbohydrates (that is starches and sugars).  And yet the Eat Well Plate advises us to fill up with carbs. It is what shapes menus in our schools and hospitals, precisely where you need protein and fats to build new bodies and repair older ones. Watching Public Health England execs still trying to justify the EWP would be funny if it wasn’t so tragic and harmful. Shockingly I’ve even been told that they are aware that they’ve got it wrong but claim they can’t do anything about it.

My conversion to a more nutritionally orientated approach to treating patients was triggered a couple of years ago when I was talking with a group of doctors about what they ate. I’d never believed calorie controlled diets worked well – they certainly didn’t for me – and while I parroted the mantra about “eat less, move more” I’d already found that it didn’t begin to tackle the problem for seriously  overweight patients unless they also greatly altered their diet.

Avoiding sugar is a great way to start

So what should we be eating? A couple of the doctors said their health had improved a lot when they went on dairy and wheat free diets. The reason they helped, suggested one, was that they inevitably meant you ate a lot less sugar.

That made sense to me. If you avoided those foods and didn’t go for the processed substitutes, such as non-dairy yoghurt, gluten free bread and cake, which were usually packed with sugar, you had to eat real food, which had to be better for you.

This set me off on a trail of reading widely about diets and real food for a couple of years. The only healthy diet I’d been told about was the standard low fat one but I soon found plausible alternatives that stood this advice on its head such as the low carb high fat diet and the London AS diet (low starch which can help with a rheumatic disorder called ankylosing spondylitis).

My experience exploring diets then lead me to question the benefit of automatically treating every disorder with drugs. When two of my patients cured their arthritis with the London AS diet, this approach seemed a valuable alternative to the monitoring, frequent specialist appointments and unpleasant side effects that are all part of the multiple drug regime that is needed to achieve the same effect.

Patients who are heavily drugged with little benefit

Then I began to notice that our reliance on drugs didn’t always seem in the patient’s interests. I watched elderly, frail bed-bound Alzheimer’s patients in nursing homes being kept on an increasing number of drugs that did little to benefit them on a day-to-day basis. It seemed a total waste of time when they had such a poor quality of life. The only ones who improved were those who were cantankerous enough to refuse them.

It was only a decade or so ago that doctors were warning about the perils of getting medical advice from Internet sites, but now it is where you should turn if you have a questioning mind. It is a place where the international, free speaking, medical and scientific world cam freely debate scientific papers, guidelines and dogma. A place where we can swap notes on the Key Opinion Leaders, (paid for by drug companies) who run our conferences or the (sometimes) dubious Department of Health target.

Most GPs would acknowledge that their patients are prescribed too much medication, and that it may often cause more harm than good. I’ve only recently realized that there are no trials and so no scientific evidence base for the multiple drugs schedules followed by large numbers of those over sixty.

Unfortunately as GPs our freedom of action is partially limited by the guidelines and incentives we work under. Most important are the QOF (Quality and Outcome Framework) points that GP practices get for hitting various targets every year (not all GPs get the payments though).

The invisible third party in the consulting room

So when you have a consultation, especially towards the end of the financial year, the QOF points system is likely to be a silent third party in the room – encouraging the GP to test and prescribe in order to hit targets which may not be aligned with your goals or needs. These include taking your blood pressure and running various blood tests. Failing to do them make doctors feel they are failing as well reducing their pay.

And the results of these tests are far more likely to lead to drug prescriptions than to dietary or other holistic advice. If you want to know what your doctor’s normally hidden agenda is, you can ask him or her to show you what is “missing” on your QOF file.

Luckily, there are many fewer targets than there used to be. Interestingly many of those that have been dropped involve cholesterol – silently removed without explanation. The official line is still that raised cholesterol is an important marker for a raised risk of heart disease and there is even a new and very expensive drug called Rapatha on the way which can drop cholesterol levels even more effectively than statins, but does not reduce deaths.

So I’m concerned about the advice patients are getting and I’ve spoken about it to public health directors and consultants about it. While some of them are open-minded enough to admit the government have got it wrong, they seem unable to translate that into practice. The times are changing however and doctors and industry can and will adapt. I’ve had more mental flexibility from key workers on the ground – nurses, doctors and school meals managers – than from the higher echelons of health service management.

Public health managers need to change

Listen up Public Health management – your hands are not as tied as you think! Individualized care and low GI diets are now options, while QOF cholesterol targets are vanishing. These changes allow you to be much more flexible. Train yourselves in nutrition too. The last Public Health Doctor I met told me and a group of diabetes docs and nurses that low fat didn’t work and that healthy fat was fine. So she is certainly more up to date than the EWP.

So when I find the official recommendations for my patients haven’t worked, such as a low fat diet for diabetes, I’m happy to suggest a range of other options and that is fine because government guidelines all say we must take individualised approach and I agree with that. We are each unique after all.

It is not so much unconventional as the beginning of a global movement of doctors and scientists who treat chronic diseases in a non-interventionist way based ultimately on the very simple idea that if a food has been eaten for millions of years, it must be safe, and that non drug methods may have less side effects and be more effective.

I’m also is my own small way trying to encourage a more informed approach to nutrition in schools and by official bodies. Last week I saw an 11 year old child with non-alcoholic fatty liver disease. It had nothing to do with fat intake or alcohol; It was entirely due to carbohydrate in the diet. So I’m working with the local school meals service in the hope I can persuade them to provide more nutrient dense food and avoid junk carbohydrate foods like chips, pasta, pies and cakes, which can cause weight gain, fatty liver, and diabetes.

I’ve been taught to follow evidence based medicine but the clinical trials, the supposed “gold standard” of the system, clearly has a massive problem with unfavourable results going unpublished. Let’s face it: a lot of our medical evidence base has been distorted or hidden, which can make informed decisions impossible. So what do I do?

I aim to give people unbiased information where possible and to encourage them to make active choices of drug and non-drug treatments. To help them I trawl the Internet and highlight the most useful sites and books, and link to them on my websites.

Often an individual and I decide together what the best course of action is, looking at the evidence of what works for him or her, and what does not, rather than blindly following guidelines that may be inappropriate. Beyond the consultation I direct my patients to my websites www.fatismyfriend.co.uk andwww.healthylivingsite.me. So have a look and tell me what you think.

 

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Interesting. And kudos for bringing up the QOF system, as well as for pointing out that studies unfavorable to lobby powers (especially pharma) tend to go unpublished. This is mostly the reason I no longer visit my childhood physician, as owing to third party influences his practice has become virtually a sham, and he has personally become eager to convert everything into profit at the expense of a meaningful ( and indeed, quality) service. It's all about getting as many people in and out the door as quickly as possible, and getting people to take drugs they probably don't need. The rate that antidepressants are administered nowadays is negligent. I have struggled with anxiety, derealisation etc since I was six years old, and what I can tell say with certainty about it all is thus:

A) Psychology isn't real science.  It is window-dressed philosophy, and when it isn't that, this is only because it has stolen evidence from the real sciences of biomed, chemistry, and physics.  It's findings are mostly philosophical, and it cannot make accurate predictions about anything, ever--this is ultimately what separates science from philosophy. That is, being able to make accurate, verifiable predictions which stand up to the scientific method. I am trained in statistics and methodology, and feel completely comfortable in saying that what constitutes a lab report in the realm of psychology is laughably horrendous the majority of the time.Deplorable. Ditto a lot of the ABS stuff, as well as a lot of CSIRO papers in recent years ( this probably has to do with funding cuts and the Abbott administration, the worst thing to happen to science in this country..well, ever).

b) The last thing you ever want to do is take any psychiatric medication unless you're at point critical. If you think you might not need it, don't take it. Do not be talked into taking it.  GP's are incentivised to dole it out and will throw this stuff at you with gay abandon. But the reality is, once you start down the path of psych meds, you will, over time, have to ramp up the amount and potency of these drugs until you are on the hardest class of antipsychotics that exist, and they will turn you into the walking dead.  They will destroy both body, and mind.

Moving on:

When it comes to diet, I refer to our own evolutionary mechanics, and just pay attention to what works for me.  I do believe that diets high in animal proteins, especially red meats, will make you sluggish, make you put on weight, give you bad skin, digestive problems, and a range of other health problems. We are omnivorous, but we aren't really designed to eat lots of meat, and we are meant to have to expend a lot of energy to get it. Think running around after game in the jungle versus buying mince by the pound at coles. Quite a different deal, right? Similarly, if we were meant to eat plants only, we'd have digestive systems like cows. And we don't. We have a few canines and mostly molar teeth. We aren't meant to eat like big cats.

Many may disagree--and with god cause, as there's probably more conflicting information out there in the dimension of the internet than there is relating to any other aspect of diet.  All I can tell you is that I can spot a person who eats a lot of meat without even asking, and when I eat meat only very sparingly, I feel, and look the best. I frankly was astounded that the CSIRO diet recommends eating red meat 3-4 times a week. This is completely bananas. It is insane.

I do agree with you Lissa that fat is is overly bastardized. We're actually made of fat, and not all fats are created equally. My girlfriend ( who is vegan) actually developed some serious health problems owing to too little fat in her diet. Bodybuilders require about 10% of every meal come from fat. The inuit lived and flourished on fat for thousands of years. I don't believe that vegan diets are healthy unless you are 100% dedicated to keeping on the ball with getting everything you need in the way of nutrients, fats, and aminos generally. And I would wager that almost all vegans do not do this.

As for carbs, again, it depends. Are we talking pasta/white breads or legumes and sweet potatoes? Because the latter are completely different animals from the former. Basically, the easier something to is to process, the more readily available the energy cache stored within it is. Since carbs really have no significant nutrient value (merely an energy value) it's probably best not to eat too many simple carbs. Do calorie deficit diets work? Sure, if you want to cut weight--but they're not a long term solution. and most people will fail at them. Again, this is moderated in large part by how many calories you're burning. When I used to train weights, I would eat an ice-cream tub full of tuna bake at lunch, literally. But I was a human furnace back then and was consuming about 3500 calories per day. And I was shredded.

If there's one thing I would urge everyone to take away from this post, it's this:

If you aren't doing much physically, you don't need to eat much at all. You just don't. Don't eat out of habit; breakfast, lunch, and dinner are silly human ideas that have social origins---they are not rooted in logic. Don't eat just because you think you should. And there's no substitute for good, old fashioned hard work--in training, and teaching yourself to eat things that don't necessarily rock your world, but are nonetheless good for you.

Here's what works for me:

A pescatarian diet based on clean white fish, preferable freshwater. Non-processed carbs from things like legumes, and potatoes (white or sweet). Tonnes of coniferous greens, broccoli, kale, beans, silverbeet. Small amounts of acidic fruit like blueberries, acerola, etc. Avoid things like grapes, figs, anything very sugary. This also includes bananas.  Drink water. Avoid over-indulging in coffee.Alcohol is about the worst thing you can put in your body, but I will never stop drinking it ( drink deep of your cup and drown your sorrow, for ye might not get the chance tomorrow). If you are going to drink, mitigate the harm by drinking clean spirits with soda water--avoid alcopops, and drinking alcohol with sodas. Cleave out as much sugar from your life as is humanly possible at all times. It is basically poison.

Exercise. Don't go running, it's actually terrible for all sorts of reasons, especially if you are tall have a large build, or are older. Despite what people say, walking is not real cardio almost all of the time. Ditto yoga, and palates. If you want to know the difference between either of these and real cardio, take one muay thai class. Believe me, that's all you'll need. The golden rule of all training is that if it isn't wearing you out,, it isn't very hard, then it isn't working. You cannot cheat the body. The buddhists have a saying for this ( the mind thinks, but the body knows). Buy a boxing bag. 12 oz gloves, or better a muay thai bag, speedball, and go for it. You can do great cardio sessions in the comfort of your own home.

 

You have put a lot of thought into this DM.

Just for the record, I put these articles up as conversation starters and to get people thinking. They don't always reflect my exact personal way of thinking. This one comes close though.

I eat a lot of veg - as much of it home grown as possible. Some fruit. Very little carbs of any kind - I just don't like them though that hasn't always been the case. I also eat meat of all sorts (with fat on it) and dairy - I love cheese. I've never been on any kind of special wight loss or fad "diet" in my life (apart from having to follow a GF diet for the last 25yrs as gluten makes me incredibly sick). I just eat what seems right for me and keeps me feeling healthy. 

I do drink alcohol each evening. It's my little treat as I don't have other food or drink vices. I just don't have vices. I'm a bit boring that way. I don't touch softdrinks or coffee. Coca Cola is poison in a bottle.

In my youth I played a lot of sport. In my 20's and 30's I did a lot of aerobics and weight training - both of which I loved. Then I got a job that was full on physical and didn't have the time for those anymore but I was very fit. I kept up this type of work up until I turned 50. Now at 60 I have another physical job which keeps me fit. I've become a bit lazy as I've gotten older but the job takes care of that problem. 

I support people doing what suits them. Just because something suits one doesn't mean it's going to suit all. I will continue to do what suits me. 

I like the idea of a primitive diet. Eating the way our hunter gatherer forebears ate - seasonally. Not that I've looked into it too deeply. 

Seasonally is fine as is home-grown. It's the fad (aka fake) Paleo that gets me going. You remember that Paleo restaurant we went to? As if our forebears in caves ate gourmet food!

Hey, the food there was good lol.

Eat organic home grown food and you can't go too wrong.

A very good and interesting read, so pleased I still have my 80 year old Vietnamese who wouldn't bought by any major Pharma Company. He was a true rebel in his day, and has been my doctor for over 40yrs. He was the only one who diagnose my Breast Cancer when I was only 25. I dread the day he retires.

The Bacon was totally tasteless. How can bacon not taste like bacon? Small portions, high prices. Organic home-grown, you betcha!

Thanks Lissa for a very interesting article. It is always difficult to sort out fact from fiction, and I believe that the medical profession as a whole are quite straight jacketed in their training and therefore thinking. It is always good to hear from people like the author who has been able to see through the mire and who recognises the deficiencies that the push from profits of drug sales brings. I am not anti doctor, far from it, but agree with the author that we need a much better approach to nutrition. Nearly all of our members are probably onside with his arguments, about nutrition, this is why I /we garden and grow organically.

I really believe that we are a lucky generation, the things that are in the main killing us now are of our doing. We can have a very positive effect on our health by growing and eating as much of our food as possible. Not only is my garden a source of nutrition but also a means of exercise, and mental stimulation. As I get older this website is also a vehicle of social interaction and stimulation. Seeing what others do and grow is a source of inspiration to us all.  

I am lucky to have my grandfathers genes. He gardened on an allotment in England, lived to 96 and was even riding a bike into his nineties. They lived a frugal life, but were healthy (Gran lived to 94) and happy. They lived longer than my parents who were both heavy smokers and who both died earlier due to smoking related sickness. We know so much more about health these days, and it is great to see so many people getting into the exercise thing. I am a reader of women's health magazines,( because men's health magazines are all about body building, and I am a lost cause as far as that is concerned), and keep interested in health issues as much as I can. Good health can be a matter of luck, having good genes is a good start, but we can all help ourselves to maintain better health by our eating and exercise habits.  

I meet very few people who still smoke into their 80's and sometimes 90's. They're all dead before then and in horrible ways, like cancer or emphysema. Alcohol on the other hand, if drunk in moderation, can be done. I know lots of older folk who enjoy their tipple each day.

Good genes needed yes. Moderate exercise and a healthy diet - all help. 

Yes the health sector, especially in the US, is unfortunately massively compromised by corporate interest. A non profit and corporate independent nutrition website I like to use as a reference is nutritionfacts.org. It bases it's advice on scientific studies (and includes links to the studies) unlike most sites. I just ignore some of the more zealous commentators but that goes for most sites.

But in the end as Roger has written above you can't go wrong eating as much as you can from your own garden and the benefits are not just nutritively.

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