Show notes
AIR DATE: March 1, 2012 at 7PM ETFEATURED EXPERT: FEATURED TOPIC: “What Questions Should I Ask My (Non-Low-Carb Friendly) Doc?”
Famed low-carb clinician Dr. Mary Vernon, MD is the co-author of with Jackie Eberstein, RN (who was our very first guest in ). She is a Past President of the American Society of Bariatric Physicians. Dr. Vernon is well-known amongst her medical professional peers as an expert on the therapeutic use of low-carb ketogenic diets on patients to treat a variety of health issues, including diabetes and metabolic syndrome. She is the CEO of which seeks to educate her fellow physicians and medical professionals on how to use science-based modalities with patients. Dr. Vernon has a heart for arming doctors with practical ways to implement low-carb diets where they are necessary for improving key health markers. What better expert could we have to address what questions you should be asking your (non-low-carb friendly) doctor than her!
Here are some of the questions we addressed in this podcast:
KELLY ASKS:My frustration with doctors is they spout the conventional “wisdom” of the food pyramid or MyPlate or whatever it is now, but yet when it doesn’t work for me they say I’m just not trying hard enough – which is without a doubt not true. So I guess my question would be – If something isn’t working, wouldn’t it be smart to try something else? And really – where are the medical studies that back up that a low fat diet is better for my health? Where are the studies that correlate fat = heart disease? If I lose weight (even if it’s a small amount) and feel better and have lower blood sugar on a low-carb diet, then shouldn’t I stick to something that’s working? And is it so wrong that I want to be personally involved in my health enough that I HAVE done research and have looked up the studies and that I might actually have a working knowledge of what is best for my body?
CONRAD ASKS:I am currently in the process of looking for a new Doctor (already checked http://lowcarbdoctors.blogspot.com/) What questions can I ask before visiting to find out if they might support a low carb lifestyle, other than the obvious “Do you support low-carb, high-fat diets?” I have read that I should make sure they perform and understand a VAP instead of standard cholesterol test. Are there any other tests or procedures I should be aware of and ask for?
KATHY ASKS:I just got my lab work back from my doctor and my total cholesterol was 249 with LDL at 171 and my sugar at 103. That’s basically all he said and then of course, “I’d like to start you on a low dose statin, keep eating a low carb, low cholesterol diet”. The cholesterol is up a little and so is the LDL from 6 months ago. I am not a diabetic and have never had problem with that. I wanted him to run an NMR. My doctor called me and had absolutely no idea what the NMR Lipoprofile test was even after I gave him the CPT code. Then he went on to say “size doesn’t really matter and thats for HDL, not LDL. And if I went to any hospital they wouldn’t know what an NMR test was.” So, he is having me do a VAP profile test. He said, “elevated LDL is bad no matter what the size.” Mine isn’t horrible for a women without a risk factor, but it keeps going up. Any suggestions?
MIKE ASKS:How do you have a conversation with your doctor about putting you on a statin drug with and HDL of 75 and triglycerides of 80 when your LDL is 225? I got these numbers in a blood test at my doctor’s office after consuming a low-carb diet.
KATHY ASKS:How should patients deal with doctors who want to follow the guidelines put out by a group like the American Heart Association or American Diabetes Association if that association’s guidelines aren’t in keeping with our own opinions of current best evidence or even n=1 experiments we’ve done on ourselves? Sometimes doctors seem to think they have to follow those association-based guidelines to protect themselves against malpractice, do they have a point? How do we get around that if we believe those organizations aren’t up to date with their evidence or if we think the guidelines are politically motivated or otherwise flawed?
JOHN ASKS:I’m a Type 1 diabetic and I believe I suffer from insulin resistance. I use 18.3 units for basal and my TDD on 10% carbs and 25% protein runs in the high 30’s. Whenever I fast, even for a single meal, I get a major liver dump at the next meal followed by some major cravings which seem to counter any benefits I might have seen from fasting. I’m stuck in my weight loss, and I think Metformin or a GLP-1 would help. Symlin is not an option where I live in Canada. My endocrinologist says my TDD insulin is already much lower than “normal” and refuses to consider giving me a prescription. He’s the local head of internal medicine and is known for not listening to colleagues. Any suggestions on how to proceed would be helpful.
SPARKY ASKS:I would love to go to a doctor and find out what all my lipid numbers and thyroid numbers are. But I dread talking about my diet — I can’t defend it in terms of weight loss, because I weigh only about five pounds less than when I first started low-carbing 10 years ago. (Although a lot of women gain weight during their 40s, so maybe I’m better off than I think!)
There are no low-carb friendly doctors where I am (at least none listed on Jimmy’s List of Low-Carb Doctors blog).
I’m afraid of getting caught in the gears of the medical machinery. For example, what if my cholesterol is “high” and they want me to take statins?
Can you just go to your family practice doctor and say, “I want these tests, please have them done for me”? What exact tests should I ask for? I don’t want just a couple of numbers that don’t REALLY tell anyone anything, which seems to be what most people wind up with.
I suspect thyroid issues (20 extra pounds of fat won’t go away, cold hands and feet, dry skin). Also, one hand or the other occasionally gets a pins-and-needles feeling — I have no idea what that could mean.
I just turned 50 and am in excellent health overall. I have regular periods, no change in that regard. I haven’t had a checkup for nearly 8 years, since my last postpartum checkup. I’ve never had cholesterol tested or a glucose tolerance test. Blood pressure has always been around 90/70.
I’ve eaten mostly real, whole foods since I was a teenager (including 17 years of vegetarianism), and mostly low-carb/Paleo/Weston A. Price for the past several years. I keep the carbs to around 25-75g and rarely eat wheat or other grains.
PENNY ASKS:While my mother’s doctor always congratulates her on her steady weight loss (and better blood sugar level control) he never fails to tell her that cutting back on her carbs is going to cause more problems in the long run. He points out that her cholesterol levels are elevated above normal, caused by eating too much saturated fat of course, and her refusing to take statins, which caused her muscle pain in the past, is leading her to a massive heart attack. She never knows how to respond to him so I thought perhaps giving him a book to read might be one solution. I was wondering if Dr. Vernon might suggest a book that she could give to her doctor that he might read? I know there are many books out there written for the average person who does not have a medical background. Is there a book that perhaps would carry more weight with an MD and not just be seen as a fad diet book? Because the doctor is probably not going to read that type of book.
BRIAN ASKS:My low-carb doctor may lean even too far away from statins and other medications. When should I really think is the right time to take a pharmaceutical drug — in other words is there a risk of having too much of a low-carb friendly doc?
JOCELYN ASKS:So, my friend went to see her doctor yesterday. Her HDL is 57, her LDL is 135. She got a heart scan a while back and got a value of 19. Her doctor prescribed a statin for her. My friend asked her Doctor to do a VAP test and the doctor said that she already knows that she is starting to have some heart disease starting, so she doesn’t need the VAP test. My friend has been starting to read Robb Wolf’s book and other Paleo people’s information, so, she’s getting wild ideas like saying no to statins. Her doctor is slightly insulted that my friend is ignoring her advice. “When you get heart disease will you go to your friends and the internet for help?” I told her to find another doctor, but she apparently wants to stay with this doctor. How would you approach this doctor? But, how would you educate a doctor who already seems to be on the defensive about learning new things about cholesterol and statins?
ROCHELLE ASKS:I did attempt to speak with my doctor recently. I had recently gotten some blood work back and he said, for someone with such a high BMI (30) I didn’t deserve such good numbers.
Total Cholesterol 222, HDL=90, LDL=118, non-HDL=132, Triglycerides=68, Glu=84, HbA1C=5.1
I told him that I had started eating Paleo.
He did note that I still needed to lose some weight. I’ve lost about 30 lbs since starting Paleo. I asked him how he would suggest that I accomplish that.
He said he recently decided that he needed to get his BMI down. He did what he tells his patients to do. He restricted his calories and exercised more. It’s painful, but it works.
I asked him what he ate. He said a bagel in the morning. A yogurt for lunch and a regular dinner but no dessert. I asked him if he’d read “Good Calories, Bad Calories”. He said no, I don’t care about that. It doesn’t matter where the calories come from, you can eat 1200 calories of whale blubber and you’ll lose weight. I told him that I cut out the grains and sugar and it was *not* painful. He said, “Come back when you’re at your goal weight and we’ll redo all those numbers and we’ll talk.”
He is about ready to retire. Should I even bother trying to talk to him about other ways of eating and getting healthy? Or should I find a new doctor? I looked on both the Paleo physicians network and the low-carb doc site and there are a couple of oriental medicine practitioners and a chiropractor. They don’t seem to be on my insurance plan.
So…what’s a woman to do?
DAN ASKS:I’m a type 2 diabetic who has been on low carb (Dr. Bernstein’s Plan) for about 6 years. Last year I found a low carb doc from Jimmy’s list. He favors South Beach phase 1. The only problem is that he believes in the lipid hypothesis. At my last visit, he told me that, as a diabetic, my LDL needs to be 70, even though my cholesterol would be “normal” for a non-diabetic. He said that controlling my blood sugar will not prolong my life. Only getting my LDL down to 70 will prolong my life. The strong implication is that I will die an early death unless I get my LDL down to 70. He is very pushy about statins, though I have resisted the pressure. I tried to tell him that the studies show no conclusive benefit to statins, but he won’t buy it. Do you have any suggestions on how to handle it in addition to being stubborn in refusing to take statins?
HAROLD ASKS:I am a Type 2 diabetic. At the time of my diagnosis two years ago, my triglyceride/HDL ratio was 6 to 1. Now, after carefully watching my postprandial glucose levels (rarely, if ever over 110) my triglyceride/ HDL level is down to 1.6 to 1. My cardiologist couldn’t care less about my triglycerides and only focuses on my LDL (which were 120) and wants me on statins, I refuse them. Here’s my question, what can I use to convince her that controlling my diabetes and my trigs/HDL ratio are greater heart risk factors than LDLs.
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