Why are so many doctors so stupid about nutrition?

By Marika Sboros

Why are doctors so stupid – particularly about nutrition? It’s a question one of my favourite scientist doctors, US physician Michael Eades, has asked.

It’s a question I’ve asked myself many times. More so recently after a ‘conversation’ with two paediatrician trolls on Twitter. (It was more like a testy, trivial exchange.)

These doctors live far apart – one in South Africa, the other in Canada. They could be twins when it comes to god complexes and willful ignorance about nutrition.

Of course, not all doctors are stupid when it comes to nutrition. And Eades says that stupid is not quite the right word to describe the dear medical souls who don’t know about nutrition. Ignorance is the word.

However, it still unnerves me when paediatricians are ignorant about nutrition. Their tiny patients are, after all, the most vulnerable group, since they can’t speak up for themselves. However, their patients’ new parents are an equally vulnerable group.

Many paediatricians I’ve come across expect instant deference to their superior knowledge from parents. As if it’s their divine right. Yet many don’t have superior knowledge about nutrition.

Cardiologists and endocrinologists are just as culpable. I recall one telling me, with a straight face, that he never talks to his patients about diet. ‘I refer them to dietitians for that,’ he said – as if that were the most natural thing to do.

It’s not natural. Dietetics is a very young profession. Despite that, many dietitians seem to believe that their degree confers on them the monopoly of giving dietary advice to the public. Where they get that delusion from is anyone’s guess. It wouldn’t be so bad were they to dish up scientific advice.

Click here to read: Can you trust dietitians who are in bed with Big Food?

 

Luckily, many people and patients know enough these days to avoid dietitians who dish up dietary dogma. Those are the ones in bed with food and drug industries. It’s an insidious relationship. It does neither side any credit, even as it boosts the profit margins of both.

Many endocrinologists I know are also prone to god-like behaviour. Some also now push bariatric surgery as a ‘cure’ for obesity and type 2 diabetes. The surgery involves stapling or lopping off bits of the stomach to achieve weight loss. Other doctors describe bariatric surgery as barbaric. It can be life-saving, of course. However, it is hugely invasive and its complications can be life-threatening.

The problem is, of course, the dearth of nutrition training for student doctors at medical school. Many receive fewer than 23 hours of lectures in nutrition in all their years of study. Even fewer when they specialise.

And in the few hours of lectures that they do receive, doctors say that they don’t learn about all the evidence. Just the bits that support their orthodox lecturers’ beliefs. That’s not surprising, given the pharmaceutical industry’s well-documented influence on the medical profession and medical schools.

Dr Michael Eades

After they graduate, many doctors live on their laurels. They also choose to live in blissful ignorance about nutrition. They prefer to push drugs as they have been raised on the milk of the pharmaceutical model of disease.

Of course, drugs have their place and can be life-saving. However, just as a deficiency of statins does not cause heart disease, drugs are clearly not the answer for all ills.

Thankfully, many doctors are choosing to educate themselves about nutrition. They understand the wisdom in the ancient Chinese proverb: He who takes medicine and ignores diet wastes the skills of his physician.

Thomas Edison is the man known as ‘America’s greatest inventor’. He said that ‘the doctor of the future will give no medication, but will interest his patients in the care of the human frame, diet and in the cause and prevention of disease.’ He may have hoped that his words would be prescient. Sadly, not.

Here’s what Eades has to say about modern doctors who cling to the past. It’s an indictment of the pharmaceutical industry and the lazy, ignorant doctors who are its prey.

By Michael Eades

I’ve been writing this blog for the past 12 years, I’ve received innumerable comments and emails all containing the same words: Why are doctors so stupid about diet? Statins? Fat? Saturated fat? Carbohydrate restriction? Low-fat diets? And on and on.

I’m not sure stupid is the right word – the right word is probably ignorant. But there is some stupidity involved, especially in those docs who have blown it off as a fad despite having been exposed to the benefits of low-carb by their patients who have done so well on it, or even by other doctors who have given it a try.

Since I have had so many people write me or comment using the word stupid, I decided to Google the term “why are doctors so…” just to see what would come up first. As you can see from the screen shot (right), stupid is the numero uno word, so I went with it.

Since Google ranks the responses in terms of how many people make the query, it looks like doctors, in general, are a pretty sorry lot. Along with stupid, people want to know why doctors are so mean to nurses, why they’re so important, why they’re so slow and so unhappy.

No one asked the question – or at least not in the top five – why are doctors so busy? Having been one for a long time, and having been married to one for almost as long, I can tell you that doctors in practice are really busy.

When you go to see a doctor for a sore throat, the doc comes in, asks a few questions, listens to your heart and lungs, looks in your ears and throat, and probably gets a strep screen. After the results come back from the strep screen, he/she comes back in, tells you the result and gives you a prescription, shot, whatever. It all seems pretty calm.

Click here to read: Death by medicine: doctors who harm more than heal 

 

But the physician probably has a kid with a cut lip that needs suturing, a person having chest pain, an elderly patient with a bag full of medicines needing to be sorted, someone with vague abdominal pain, etc.

All in a day’s work for a typical primary care doc. And always, always, always something comes in that’s emergent, that totally screws up the schedule and throws the doctor behind.

Since these things always happen, you might ask, how come you don’t just schedule for them? We did. It was called lunch. It was a rare day that either MD or I got to actually sit down and eat lunch because that was catch up time.

You couldn’t schedule for these unexpected situations because you never know when they’re going to happen. And when they do, and you get thrown behind, then all the patients left waiting are aggravated, and you (at least we did) try to spend a little extra time with each to make up for it, which keeps you behind.

Then, invariably, right in the middle of all this chaos, in comes a drug rep to see you.

Click here to read: Medicine’s dirty little secret: ‘drug whore’ doctors

 

Since you want the samples, you rush in to see the rep for a minute to hear the spiel about the latest new pharmaceutical. You get loaded up with samples and head back out to see more patients.

(Incidentally, we love the samples because we would always give patients a starter dose, so they could get started on their meds before they schlepped to the pharmacy to get their Rx filled.)

This frenetic activity goes on all day long. MD and I always had patients waiting for us when we showed up at the clinic and were usually still seeing them till 6-7 PM at night. Most hardworking primary care docs do the same.

We didn’t have a hospital practice, so we kept later office hours. However, those who did, ended up heading to the hospital to round on their patients both before clinic hours and after.

Such a schedule doesn’t leave a lot of time for reading the medical literature.

MD and I tried to catch up when we did get a breather, but it wasn’t often. So, like most busy docs, we flipped through the throw-away journals (so-called because they were underwritten by drug companies and came for free), went to a conference or two a year, and listened to drug reps.

Now there are online sources that weren’t available when we were in practice that physicians can use to keep up with the latest. One such free source is Medscape, owned by WebMD, which comes in a multitude of varieties, one for each specialty. Though designed for physicians, most anyone can get a subscription to any of the versions of Medscape simply by signing up for it.

Which brings me back to why doctors are so stupid. Or ignorant.

Because of the nature of their work day, when they get a few minutes, many docs will slip away and hit their computers. A lot will look at Medscape. I’m not even in active practice any longer and I look at it every day as it arrives in my mailbox daily.

Here is an email I got from Medscape a few days ago.  Notice the very first article:

Were you to click on this link, you would be taken to a page showing short one minute video.

How about that? You’re a busy doc, you take a minute, and look what you’ve learned. All this nonsense about saturated fats not being harmful is just that: nonsense. You knew it all along.

The young doctor on the video says categorically that.

The AHA emphasizes that well-conducted studies show overwhelmingly [my emphasis] that all saturated fats raise LDL cholesterol and increase the risk for heart disease.

If the same doc, who clicks on this Medscape article, happens to catch CBS’s This Morning, he’ll watch a cardiologist confirm the notion that saturated fat is best avoided. She tells viewers that if they replace saturated fat with…polyunsaturated fat, which is things like corn oil [55% Omega-6], safflower oil [75% O-6], peanut oil [30% O-6], soybean oil [55% O-6], you can lower your risk of cardiovascular disease by up to 30 percent, similar to statins… If you replace it with monounsaturated fat, things like olive oil or avocado, that’s good too, but not as good as polyunsaturated fats, but it’s pretty good.

With great confidence, she says that the AHA definitively links saturated fat consumption as a cause of heart disease.  Of course, we know she means that since saturated fat intake leads to increased LDL levels (so conventional wisdom would have it). And since they all believe that an elevated LDL is a risk factor for heart disease, then eating saturated fat increases risk for having a heart attack.

That’s called the lipid hypothesis, which, despite the latest AHA nonsense, is still an hypothesis.

Click here to read: Have a heart! Will AHA or coconut oil kill you? 

But not according to the 2017 President’s Advisory from the American Heart Association. Which is by the God American Heart Association, after all. They should know, right? If I follow their recommendations, I’ll never get sued for malpractice, thinks our busy doc. And, sadly, he/she is correct.

If one of our doctor’s patients has a heart attack, and the doc can show on the patient’s chart that said patient was informed to reduce saturated fat and replace it with polyunsaturated fat as per the recommendations of the AHA, what court would convict? Especially if a statin were thrown in for good measure. That’s following the accepted protocol.

If, on the other hand, our doc had noted in the patient’s chart that it was okay to eat saturated fat and avoid polyunsaturated fat (which is what I would tell my patients), and the patient has a heart attack and sues, the doc is toast.

So, the path of least resistance (and legal safety) is to follow the crowd, not to think critically.

Plus, our busy doc is really too occupied to actually think. He/she just reacts: “I knew saturated fat was bad all along.”

But what happens if someone does actually think?

Well, Gary Taubes wrote a piece in response to this AHA idiocy. Every doctor who is in a position to make nutritional recommendations should – but won’t – read it.

Taubes goes on to accuse the AHA of practicing what he calls Bing Crosby epidemiology. And he’s right. Read his essay, and be a lot smarter than your doctor. At least where nutrition is concerned.

What amazes me about all this is the ‘experts’ seem to agree, despite a ton of conflicting data, that saturated fats are not just nearly bad, they’re really most sincerely bad.

Yet these same experts equivocate on coffee.

On one last note, I’m headed to France in a few days. Once I get settled in there, I’ll put up a post showing some pretty amazing data showing that perhaps saturated fat really doesn’t drive LDL levels up.

And I’ll give you a method of getting your LDL down before your next doctor’s appointment, so you don’t get hassled to take a statin.

Till then, I’ll leave you with this.