Contributed by Blueskyes2


When Your Doctor Does Not Understand

By Dr. Gil Wilshire, MD FACOG

On a regular basis, I receive emails with the same type of request - how to communicate with a doctor who is hesitant about their patient continuing a low-carb diet. The typical email goes something like this:

Dear Dr. Wilshire,

I have begun a low-carbohydrate diet. I have now lost ______ [(a) 10, (b) 20, (c) 50, (d) 100+ lbs]. My symptoms from _____ [(a) type 2 diabetes, (b) obesity, (c) polycystic ovarian syndrome, (d) metabolic syndrome, (e) fatigue, (f) hypertension) have greatly improved. My requirements for medications: _______ [(a) oral diabetic agents, (b) insulin, (c) blood pressure-lowering agents, (d) ovulation inducers] has been reduced or completely eliminated.

Despite improvements in my blood lipid parameters (i.e. "good" to "bad" cholesterol levels) and the above-noted improvements in my health, my doctor is advising that I return to a low-fat diet.

What am I to do?

Sincerely,
Jane Doe


What to do indeed!

One does not need a medical degree to realize that the low-carbohydrate dietary intervention has improved this person's health. Why is the doctor hesitant to advise continuing the diet? After all, both the doctor and patient are sincere and have the same goals.

Part of the hesitation is due the fact that the dietary regimen is "divergent" from the conventional dogma of diet and nutrition of the past thirty years. A close look at the latest evidence based research available, however, validates why the low carb diet is sound advice! (Please see my other articles on this issue, When Evidence Contradicts the Theory and When Dogma Overrides Evidence)

For patients, I am loath to advise breaking the relationships with your doctors to "go shopping." A friendly, thoughtful doctor is a wonderful, priceless thing to have. My recommendation here is to have you make every effort to continue to build on the trust and rapport you and your physician have developed to work through this conflict.

Begin by educating yourself about the available information. Ask your doctor to read this column and the low-carb nutrition references. Below I provide a starting point for discussions. Here is what we know today from rock-solid medical evidence:

1) Humans absolutely require high-quality fat and protein to live healthily.
2) Trans-fats are virtual poisons.
3) There are no dietary requirements for carbohydrates.
4) Cholesterol is an absolute requirement for normal human physiology

There is no argument about the-above statements - none at all.

There is also a growing tidal wave of evidence for the following statements as well:

1) Total blood cholesterol (TBC) levels (except in the case of individuals with genetic disorders of metabolism) have very little bearing on vascular health.
2) More important blood markers than TBC for vascular disease risk are HDL/LDL ratios, C-reactive protein, and lipoprotein "little a."
3) HDL/LDL ratios improve and lipoprotein "little a" falls on diets high in healthy fats.
4) Lower TBC is associated with higher rates of cancer.
5) Increased protein intake is associated with improved glucose response.
6) Insulin and carbohydrate are the prime factors in generating body fat.
7) The vast majority of dietary studies in the past decades have been confounded by the uncontrolled variables of dietary carbohydrate and trans-fat intake. This gross experimental flaw essentially invalidates most published dietary recommendations.
There is no evidence for a health risk of a low-carbohydrate diet to anyone with normal kidney and liver function.


I could go on and on since the evidence supporting low-carb nutrition is growing very quickly.

Research documents and well-written books on the subject are the preferred sources for your physician. I STRONGLY advise reading primary references rather than watered down reviews or lay articles. Below are starting points for you and your doctor to use to gain a greater understanding of low-carb nutrition:

Recommended Online Articles & Research:

Fatty Diet Not Linked to Stroke
Low-Carb Diets are Working, Study Says
Permanente Journal: Stop Recommending Low-Fat Diets
Atkins Meets with Success
Too Many Carbs in Your Diet?
Got Fat? Exploding Nutrition Myths
Consuming More Protein, Fewer Carbs May Be Healthier
Conference Study: North American Association for the Study of Obesity
NEJM: A Randomized Trial of a Low-Carbohydrate Diet for Obesity

Recommended Books:

The Cholesterol Myths, Uffe Ravnskove, MD, PhD
Know Your Fats, Mary Enig, PhD
Schwarzbein Principle, Diana Schwarzbein, MD
The Fat Fallacy, Will Clower
Life Without Bread, Christian Allan, PhD and Wolfgang Lutz, MD

The most recent addition to the mounting evidence supporting the positive influence of low-carb nutrition on health is from this month's October 2003 American Journal of Clinical Nutrition. I cite the abstract here to start your reading on the subject and hope you will take the time to continue your reading on the subject from those provided above.

American Journal of Clinical Nutrition, Vol. 78, No. 4, 734-741, October 2003

Original Research Communication
An increase in dietary protein improves the blood glucose response in persons with type 2 diabetes1,2,3
Mary C Gannon, Frank Q Nuttall, Asad Saeed, Kelly Jordan and Heidi Hoover

1 From the Metabolic Research Laboratory and the Section of Endocrinology, Metabolism, and Nutrition, Department of Veterans Affairs Medical Center, Minneapolis (MCG, FQN, AS, KJ, and HH), and the Departments of Food Science and Nutrition (MCG) and Medicine (MCG, FQN, and AS), University of Minnesota, Minneapolis.

Correspondence: 3 Address reprint requests to MC Gannon, Metabolic Research Laboratory (111G) Veterans Affairs Medical Center, Minneapolis, MN 55417. E-mail: ganno004@tc.umn.edu.

Background: In single-meal studies, dietary protein does not result in an increase in glucose concentrations in persons with or without type 2 diabetes, even though the resulting amino acids can be used for gluconeogenesis.

Objective: The metabolic effects of a high-protein diet were compared with those of the prototypical healthy (control) diet, which is currently recommended by several scientific organizations.

Design: The metabolic effects of both diets, consumed for 5 wk each (separated by a 2-5-wk washout period), were studied in 12 subjects with untreated type 2 diabetes. The ratio of protein to carbohydrate to fat was 30:40:30 in the high-protein diet and 15:55:30 in the control diet. The subjects remained weight-stable during the .

Results: With the fasting glucose concentration used as a baseline from which to determine the area under the curve, the high-protein diet resulted in a 40% decrease in the mean 24-h integrated glucose area response. Glycated hemoglobin decreased 0.8% and 0.3% after 5 wk of the high-protein and control diets, respectively; the difference was significant (P < 0.05). The rate of change over time was also significantly greater after the high-protein diet than after the control diet (P < 0.001). Fasting triacylglycerol was significantly lower after the high-protein diet than after the control diet. Insulin, C-peptide, and free fatty acid concentrations were not significantly different after the 2 diets.

Conclusion: A high-protein diet lowers blood glucose postprandially in persons with type 2 diabetes and improves overall glucose control. However, longer-term studies are necessary to determine the total magnitude of response, possible adverse effects, and the long-term acceptability of the diet.

Your comments and feedback are welcome at drwilshire@countcarbs.com.

Health and happiness to us all.

Gil Wilshire, MD

http://www.countcarbs.com/advice/LC...tunderstand.htm
Edit:
this site no longer exists, but it says it's "under construction". So I keep the link, just in case, even though it doesn't work.
bluehex

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