Thursday, July 11, 2019

How to deal with doctors

My qualifications on this particular topic are based mostly on my own experience with doctor visits, which are a relatively rare occurrence in my life. My outlook is heavily informed by the the fact that my father was a doctor and our mealtimes were often mini conferences of him and various colleagues, often focused on their resistance to the formation of what we now call Pharmageddon, or the medical-industrial complex and the de-humanization of medicine. Even then, in the early sixties some doctors were seeing how the new developments in pharmaceuticals made doctors into drug pushers fighting symptoms and not helping patients heal and be healthy. My father had scathing criticism for the pharmacological inroads into psychiatry and eventually evolved into a sort of Jungian psychotherapist more than a psychiatrist because he categorically declined to get involved with psychopharmaca. He also would at times serve patients for free or on a sliding scale whenever insurance stopped covering them, he simply would not accept administrative interference in patient relationships.

The Lifestyle Medicine revolution

Lifestyle Medicine is the new form of medicine that is rooted in the Whole Foods, Plant-Based diet and the insight that nutrition is 80% of the work. In other words, acute issues aside, the first order of business is to make sure you are getting the whole benefit of the whole foods, plant-based diet, for it provides an abundance of nutrients, which puts your body in optimal shape to deal with all of the real life challenges, including preventing or reversing the chronic diseases that kill people who follow a modern, industrial Western diet. So, diet should be your first concern, but that does not mean doctors are an unnecessary luxury.

The slow evolution of lifestyle medicine means we have to be innovative in dealing with doctors. The central point is that you are now taking responsibility for your health, for you decide what goes down the gullet. How far you want to go with that is your business, but besides my wide reading in this area, I went and took the certificate in Plant-Based Nutrition from Nutrition Studies. The new relationship with your doctor, assuming he is a plant-based doctor is a partner in wellness, where he/she should be very much your personal subject matter expert, particularly if there are any challenges and together you can figure out any adjustments that may be needed along the way.
Not necessary, but it helps

In most cases, your regular doctor is in a system that pushes him one way and one way only a consultation and a treatment. Even the ones that do sympathize with the premises of lifestyle medicine and the whole foods, plant-based diet are still in that system. So when this year I had some anomalies in my regular annual physical exam, I decided it was time for some extracurricular consultation, and as it was, I went and visited Dr. Robert Graham at He went and took some more extensive tests and together we figured out what was right and what was wrong and some prudent adjustments to make. We are talking about tweaking now, but sometimes it helps to not be guessing and get very specific feedback from a trusted expert who cares.

I learned a lot. Without discussing all the details here, I will highlight one element... just to illustrate why I got concerned with my physical this year.

2015: Spring physical, Total Cholesterol (TC) was 185. My diet was still fairly mixed, although for the most part I did not eat a lot of meat, probably a chicken a week and a hamburger 3 times a year. But lots of eggs, yoghurt, cheese, cheese and more cheese. Still, I always ate plenty of fruit, vegetables and whole grains. I never ate white bread or white rice in my life. I considered that rat food, or window caulking in a pinch. So I probably ate a bit above average. And 185 is not really all that concerning. I just recently read a book about heart disease, "Know Your Real Risk of Heart Disease" by the Australian physician Dr. Warwick Bishop. The book is very well organized, and offers good explanations about how the heart works and what various diagnostics do or don't mean. To him, TC level below 193 would be just fine. In America, regular doctors consider 200-239 the range for borderline concern, so 185 would be of no concern.

And then there is Dr. Caldwell Esselstyn, who says below 150 is heart attack proof. Is he nuts or what? The same Dr. Esselstyn also says again and again that Cardiovascular Disease (CVD) is a paper tiger that need not exist and unless it is absolutely acute and critical, the only intervention we ever need is a whole foods, plant-based diet. He will also point out that anyone eating a Western diet and aged 60 ish will have some level of CVD. And recently, we learned that for our Southeast Asian friends, we could say above 40, for the average age of heart attack victims in e.g. Bangladesh is 43 years of age, because genetically, they have smaller veins.

Here is my personal experience (I wrote about this before when I turned 65):

2015: physical (spring) TC=185
2015: May, re-read Esselstyn's Prevent and Reverse Heart Disease. I decided to quit fooling around and jumped in with both feet.
2016: physical in spring: TC=151
2017: physical in spring: TC=146
2018: no physical
2019: physical in spring: TC=168???
2019: retested three months after my physical, with a more elaborated test (June) TC=145

That was one of a few things that seemed off, and I could not explain except I was probably more religious about going to the gym in 2016 than recently, so time to step up my game, but still.
With further testing and consultation as indicated above, this time TC came back at 145, just two months later. That simply makes more sense given the history, and what I know I am doing with my diet. By the way there was absolutely NO sign of inflammation. Nice to know the diet works, but with the information at hand we figured out I could add another scoop of chia seeds, hemp seeds, (milled) flax seed, or walnuts, to slightly increase my Omega-3 intake. This becomes one of those areas where we're all different, and some may need a bit more than others, but it is important to know that more is not always bettter. It is about the ratio between Omega-6 and Omega-3.

In short, I learned a lot from a very specific consultation that allows me to tweak my lifestyle. It pays not to become complacent. As to diagnostics, initially, here is the only diagnostic you need:

It is a simple self-test for how well you eat based on whole foods, plant-based nutrition criteria. It give you a rating from 1-leaf (slightly above average already) to 4-leaves (you are doing a Whole Food, Plant-Based diet completely) and it is excellent for handholding so you can gradually improve your diet.


If you are doing a Whole Foods, Plant-Based diet, talk about it with your physician. If they ignore it, it may be worth looking for another doctor. That is what happened with me in 2018. I switched away from my old doctor, because he did not know or understand enough about lifestyle medicine and the whole foods, plant-based diet. Of course as soon as I switched my new doctor moved to another state, and I changed doctors again this year.
In terms of doing this diet, for yourself, or for others: don't try to practice medicine without a license, but you can confidently rely on the fact that if you are following the #WFPB diet properly, minus Sugar, Oil and Salt, and plus some natural Omega-3 sources, and your B12 supplement, you are giving your body the optimal chances to heal itself, and many common issues will pass you by unnoticed. Against that background your medical requirements should be extremely modest, and if anything comes up, at least you know you are helping yourself to the maximum.
That latter point is really the theme of the movie The Game Changers, which premieres on Sept 16th (don't miss it!!!). The lead character is a martial arts trainer for the military and he found the whole foods plant-based diet because he wanted to help himself recover from a very serious injury and in his research he stumbled on the fact that the gladiators in Rome ate mostly barley and veggies. That is where his journey started.

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