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Old 07-18-2014, 01:38 PM   #1
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Telling a doctor about a low carb diet

My doctor left and I have to establish with a new doctor, one of the things I hate about Kaiser as this is the THIRD time this has happened in 6 years.

I chose the same doctor my husband is going to, which I'm hopeful is a good thing because he does not give my DH any problems about his cholesterol. DH is not low carb, but he does otherwise eat the same whole foods diet I do (with a moderate amount of sugar and grains), and his total cholesterol is high but his ratios and individual numbers are great, and his doctor is not trying to put him on a statin.

The Kaiser party line remains low calorie, low fat, and at least six servings of carbohydrates a day. They still tell diabetics to eat lots of carbs, including crackers for snacks and to avoid saturated fats in particular. They still tell people to use margarine for the little bit of fat they are supposed to have. (If and when this self-insured health system gets on board with low carb they are going to save BILLIONS of dollars, but right now they are so enamored with their "evidence based" approach which is not even based in evidence, that they continue to follow the CW and drive me up the wall with their "healthy diet" recommendations).

So I've been thinking how I will tell my new doctor about my WOE. My last doctor was cool with it, but other people in the system have been in shock. The endocrinologist said "Where will you get your B vitamins if you don't eat grains?" Hmmm, well maybe MEAT has B vitamins and they don't have to be fortified to have them, either. Scary to have an endocrinologist that treats patients with thyroid issues day in and day out and thinks grains are essential!

Anyway, so this is what I've decided to say:

"I eat a whole foods, low glycemic diet".

It's absolutely true, in that I follow a Paleo diet with whole unprocessed foods, and I keep the carbs low, which means the same thing as "low glycemic", but it doesn't ruffle the "you need grains and starches" feathers or the "fat is bad" school of thought.

I think this is the quickest, easiest way to explain my WOE without raising hackles and getting into a debate with anyone about how I choose to eat. Who could possibly argue with "whole foods" (except the terribly fat phobic) or "low glycemic"? Most won't even know what that means It says exactly enough, but not too much. And I suspect it won't ruffle any medical professional feathers, either. They (are supposed to) want you to eat whole foods and low glycemic.

I used to say "I've cut out sugars" and if pressed I went on to say "and starchy foods". But even that starts getting people's knickers in a knot. "Oh, but that means you can't eat bread, and bread is the staff of life". "What do you eat instead? Oh fat is going to kill you."

When asked what I eat, I'll start with "you know, whole and organic vegetables and fruit, pastured meat and dairy, no packaged foods." That's about as long as anyone's attention span is anyway. Satisfies their curiosity, and I don't have to debate. Win:win.
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Old 07-18-2014, 01:41 PM   #2
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I think it's fine, but I have had no problem telling my doctors I eat "low carb" if they ask (if they don't ask I don't bother, as I don't need their input/advice on my diet). I mean, it's hard to argue with weight loss results (which is an extremely important marker to most physicians). Though I don't venture as far as telling them about the "high fat" part of my diet. That to me would be the real doozy!
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Old 07-18-2014, 01:58 PM   #3
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I like sharing my keto diet, I like to try to educate people if I can without getting preachy.

I have an old DR I want to send some books to!

Dr Eric Westman ( a low carb expert) went on to become an bariatric specialist and devote his life to low carb research after two patients had excellent results

But I really believe this (low carb) is the healthiest way to live, so I am not afraid to be forthcoming about it, even if it is met with skepticism.
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Old 07-18-2014, 01:58 PM   #4
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Just remember this: The doctor works for you and you are not a child.

As an aside, I would get out of Kaiser as soon as humanly possible.

ETA, with all the attention the poor science that went into the diet-heart hypothesis is getting these days there is really no excuse for doctors not knowing better. Recommending a low fat, high car diet is (or should be) malpractice.

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Old 07-18-2014, 02:14 PM   #5
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Recommending a low fat, high car diet is (or should be) malpractice.

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Old 07-18-2014, 02:20 PM   #6
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I must live in a bubble, but not one of my doctors have ever asked what I eat.

Even when I was losing, the only thing my primary doctor asked was whether my weight loss was 'intentional' because (as I'm sure you all know), unintentional weight loss is a red flag for doctors, signaling a variety of serious medical issues.

As long as my labs are good, they don't inquire about my eating because it's not medically relevant--from their perspective, based on their training.

I have initiated discussions about my eating with my endo, mainly because all my siblings are Type 2, and I have long eaten like a diabetic to avoid becoming one. I discussed this with him to see if he believed that my WOE has had a positive effect, and he affirmed it, saying that it's probably kept me from developing diabetes--but there's no way to know for sure. I just might have been lucky in the gene lottery.

But normally I would never volunteer information about my WOE to anyone.
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Old 07-18-2014, 02:39 PM   #7
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Do doctors really ask about your diet? Like Leo, mine never do. Most doctors have almost no nutritional education.

In fact, mine won't let me tell him how I eat. lol... He must be scared of what I'd say & rightly so. He just knows I am losing, getting healthy, etc. That is all he cares about.

I would not dream of telling a doctor (or anyone else) that I eat "low carb" or "high fat" or any other label. The only thing that is going to do is cause negative, uneducated comments. If I have reason to discuss my diet (and I really do not with doctors) I will discuss the healthy foods I eat.
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Old 07-18-2014, 02:56 PM   #8
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As an aside, I would get out of Kaiser as soon as humanly possible.
At this rate, I'll get out of Kaiser when I'm dead. When DH took his current job, the only insurance available was Kaiser--I told him to quit his dream job. Instead, they offered him more money to stay. So he did. And since I'm self-employed, this is the only option--I looked into using the affordable care act subsidy, but I would get even less care for more money out of pocket and we already pay $17K per year plus co-pays. OY!

Meanwhile, Kaiser has sucked up almost all the insured patients in my county (70% or more!) and very few doctors are still "out there" taking other insurance. Most have either given up and gone to work for Kaiser or retired. I have a feeling that even when I get to Medicare, I'm going to be stuck with Kaiser as the last man standing--if Kaiser doesn't kill me first (I'm much more cost effective dead).

I will say Kaiser is less awful than I thought, especially because I know how to self-advocate to get most of what I want and need, and I take charge of my own health instead of hoping they will take care of me (hope is not a plan!).

Oh, and there's no "educating" these doctors. Kaiser is a system unto itself and they have a party line each doctor must toe. Everything is standardized and they inundate you with electronic media to teach you proper diet, exercise (mostly cardio), preventative medicine (bug the HELL out of me about mammograms, but wouldn't do a colonoscopy despite my 1st degree relative history of colon cancer until my 50th birthday), etc. It's a little like getting your medical care from Costco. Big box all the way. If Costco doesn't have it, you do without.

My last doctor was great in that he couldn't come out and agree with me or do every test I requested, but he did agree that I was doing a good job and promised to tell me when I was steering off course--he never did. Anyone else would have insisted on statins in a heartbeat, but he didn't bug me about them because my ratios are great.

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Old 07-18-2014, 03:00 PM   #9
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I recently changed doctor (previous one left the practice). I was only one month into LC last time I had seen my previous doctor and still on statins. My first visit with the new doctor, he noted my weight loss and I told him I was doing a ketogenic diet. I told him I was quitting Lipitor and he gave me a weaning schedule. He also cut my BP med in half. Then my lab tests results came back. He was not happy with my cholesterol and left me a note to start back up with the Lipitor. I see him next month to see how my BP is doing (excellent by the way and I'm hoping to stop taking any meds) and little does he know, I never started back up on the Lipitor.

I'm going to a Duke facility and you would think that my doctor just might be aware of Dr. Erik Westman, right? Well like Gina said, doctors work for us and we are not children. I've decided I'm not going to try to convince a doctor into seeing why I'm doing what I'm doing for my health. I will however mention that I think he should call his colleague, Dr. Westman, and have him explain my lipid panels to him.

Seriously though, if he doesn't get on board, I'm firing him. I need my doctor to be part of my team not working against me.
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Old 07-18-2014, 03:02 PM   #10
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I've had doctors tell me to lose weight, but most haven't really discussed my diet beyond that. One time I had a doctor who noticed I'd lost a lot of weight and he did ask about my diet and I told him, Atkins. He just said, well it's working.

Another doctor told me to lose weight and I said I was on a diet and she asked which one, and I said Atkins. She just said something like oh, ok....but she didn't say anything else.

I would have no problem telling them what I'm doing if they ask. I know it works for me and that's all that really matters. If they want to tell me about a low fat diet I might just listen politely and not say much back.
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Old 07-18-2014, 03:19 PM   #11
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Oops. Wrong thread.
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Old 07-18-2014, 06:55 PM   #12
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Do doctors really ask about your diet? Like Leo, mine never do. Most doctors have almost no nutritional education.
Mine sure does! But maybe because weight is always an issue with me even though I don't have high cholesterol or blood pressure.
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Old 07-18-2014, 07:14 PM   #13
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When asked what I eat, I'll start with "you know, whole and organic vegetables and fruit, pastured meat and dairy, no packaged foods." That's about as long as anyone's attention span is anyway. Satisfies their curiosity, and I don't have to debate. Win:win.
This sounds perfect to me! I think my doctor likes to give her no processed foods lecture to patients because I have a few friends who also see her and we've all heard the exact same thing. She gives it to people who are overweight and people who are at a healthy weight. She starts out with "describe your meals in a typical day..." With me, she's only suggested a few additional servings of fresh fruit a day, which I disregard, and stick with berries and cantaloupe occasionally.

I'd just tell your doctor the truth and be specific about what you eat. I agree with GME, that your doctor works for you, so don't be afraid to be completely honest.
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Old 07-18-2014, 08:34 PM   #14
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My doctor asked how my diet class was because she sent me to a nutritionist who put me on a low calorie, low fat diet. I said its going good now that I gave up on the low fat and started on low carb instead. She approved and said low fat diets don't work. I was happy she approved, but confused since she sent me to the low fat class. Guess she didn't know what was being taught in the class. I didn't plan on telling her, but since it came up I did.
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Old 07-18-2014, 08:44 PM   #15
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I like sharing my keto diet, I like to try to educate people if I can without getting preachy.

I have an old DR I want to send some books to!

Dr Eric Westman ( a low carb expert) went on to become an bariatric specialist and devote his life to low carb research after two patients had excellent results

But I really believe this (low carb) is the healthiest way to live, so I am not afraid to be forthcoming about it, even if it is met with skepticism.
I like sharing it too, when I'm questioned about it, and sometimes put on the spot about it---by which I mean the sad looks I get from folks who watch me eat my double order of bacon, while they eat their waffles, syrup, fruit, toast, whipped cream AND bacon.

I am not afraid to be forthcoming about it WHEN I am faced with judgement and skepticism. If everyone else keeps their mouths shut about what we're eating, then I do too.

BUT, if I feel my woe challenged by inference, or a superior chuckle, then I DO speak up. I keep it short and sweet---LOL, the only sweet I allow myself most days.

Janknitz---it is so scary and frustrating that an outfit as huge and well known as Kaiser, founded in such a forward state in so many ways, is still pedaling this kind of junk fact and advice.

I say "junk" because if ANYONE really reads into this, you know what "junk" advice it is. And it's incredibly aggravating to know that there are folks on this board who know more about the ins and outs of a LC diet than those who are being paid a whole lot at Kaiser to give advice contrary to this woe.

Nothing against low fat, low calorie, exercise a lot advice---for those who it works for over the long run, GREAT. But the fact is it just doesn't work for most, and Kaiser should know that by now, as should most of the nutritional/medical industry.
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Old 07-19-2014, 07:15 AM   #16
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Doctors have little to no training in nutrition usually. Even if they did have training in that area, it would likely be the conventional wisdom.

I have had the same doctor for many years and he is excellent in many ways but he does not understand weight loss/nutrition. We have had conversations about it over the years. The most recent one, he ended it with saying that it is all about calories in/calories out. This was after discussing hormones play and how to manipulate them through diet. Okay - discussion over. He doesn't need to know how I eat.

He is still a very good doctor on other levels that really matter.

If I needed to meet some criteria in respect to following some party line, I would simply say that I don't eat grains or sugars. If a prescription for statins is advised, take it and then don't fill it. Your doctor should be your consultant but not the boss of your health. You ultimately pay the price and you are the boss.
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Old 07-19-2014, 11:36 AM   #17
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one time my cholesterol results came in. The doctor said "what are you eating?"

I said...hesitating....."atkins"

she said: "Keep it up!! your cholesterol results are excellent!"


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Old 07-19-2014, 11:42 AM   #18
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Doctors have little to no training in nutrition usually. Even if they did have training in that area, it would likely be the conventional wisdom.

I have had the same doctor for many years and he is excellent in many ways but he does not understand weight loss/nutrition. We have had conversations about it over the years. The most recent one, he ended it with saying that it is all about calories in/calories out. This was after discussing hormones play and how to manipulate them through diet. Okay - discussion over. He doesn't need to know how I eat.

He is still a very good doctor on other levels that really matter.

If I needed to meet some criteria in respect to following some party line, I would simply say that I don't eat grains or sugars. If a prescription for statins is advised, take it and then don't fill it. Your doctor should be your consultant but not the boss of your health. You ultimately pay the price and you are the boss.
I have a prescription in my medicine cabinet sitting there as we speak.

she keeps asking why I'm not taking it. I told her I read some things, and she hasn't argued with me yet
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Old 07-19-2014, 01:40 PM   #19
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I can deal with a doctor doling out the same ole low fat, calories in, calories out...crap, but I'm tired of having harmful drugs pushed at me because a whole industry decided to believe the drug companies knew best.

There are doctors that will "fire" you for non-compliance.
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Old 07-19-2014, 02:10 PM   #20
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I can deal with a doctor doling out the same ole low fat, calories in, calories out...crap, but I'm tired of having harmful drugs pushed at me because a whole industry decided to believe the drug companies knew best.

There are doctors that will "fire" you for non-compliance.
This is why I stick with my current doctor. I've been fired several times for being proactive. This one may not agree or approve of all my decisions but he "allows" me to say no. And he tells me that he is impressed with my health/fitness progress.

Even though he doesn't (usually) admit it he is learning from my choices. I suspect he might even do a bit of research after some of my surprise decisions & comments because he has occasionally altered his opinion at a later date. I wisely say nothing when this happens.
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Old 07-19-2014, 03:27 PM   #21
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I was never asked about diet until blood work showed high cholesterol (and they only tested total cholesterol).

Well actually wasn't really asked, the doctor just told me to eat less fatty food. I just nodded and didn't really wanna go there.

The funny thing is that I was barely getting any fat at all at the time and was living on cheap high carb food like bread and pasta. My blood work improved once I went on a high fat diet. I never told her I did though. (it's a doctor I only went to twice, I have a different one now)

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Old 07-20-2014, 08:27 AM   #22
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I had to find a new doctor last December when mine moved out of state. Despite the fact that I weigh 140 and my A1c is down to 4.8...and I've maintained my weight for (at that time 9 months...now over a year), my new doctor wanted to put me on statins because my cholesterol was a bit elevated and she was freaking that my diet was about 70% fat. I *knew* this was going to happen so I just handed her my little 3x5 card with my reading list and told her that the studies in these books are why I will continue with the plan I'm on and why I won't take statins (and made sure to tell her that studies show statins have no effect on women anyway).

She was actually quite shocked that I'd gone from 330 to 140 and an A1c of 10.5 (at one point it was 13.5) to 4.8. At that point, she just looked at me and said, "Well...can't argue with results, can I?" I think I fell in love with her at that point.

While I might not take the time to educate other people (based on the attitude I get back initially), I always take the time to educate my doctor. I hope that something will get through to them that will change their mind on how they approach their other patients. I can't change the world, but I can change my little corner "one starfish at a time".
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Old 07-20-2014, 09:16 AM   #23
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My doctor knows that I do a whole foods low carb diet and keep track of calories but I am also thin and have excellent blood test results so he doesn't question it because he sees the results.

I don't know if I would be so forthcoming and enthusiastic about my diet if I was still overweight and unable to get to goal and had negative blood test results- because to me it would show that maybe the diet wasn't working for me and I need to try something else. Right now I believe in this diet because I have good results but without these I would start to question it and would probably take my doctor's suggestions and research other plans, as long as I was still doing a whole foods/mostly unprocessed diet. Because no matter how many people say it works for them and how many books say it's great, I still need it to work for me.

I find that I also need to explain my version of low carb since many people say they are doing low carb/Atkins and they are eating almost no vegetables, lots of processed low carb products and fast food and I don't consider that healthier than a mainstream SAD diet.
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Old 07-21-2014, 05:46 AM   #24
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I had to find a new doctor last December when mine moved out of state. Despite the fact that I weigh 140 and my A1c is down to 4.8...and I've maintained my weight for (at that time 9 months...now over a year), my new doctor wanted to put me on statins because my cholesterol was a bit elevated and she was freaking that my diet was about 70% fat. I *knew* this was going to happen so I just handed her my little 3x5 card with my reading list and told her that the studies in these books are why I will continue with the plan I'm on and why I won't take statins (and made sure to tell her that studies show statins have no effect on women anyway).

She was actually quite shocked that I'd gone from 330 to 140 and an A1c of 10.5 (at one point it was 13.5) to 4.8. At that point, she just looked at me and said, "Well...can't argue with results, can I?" I think I fell in love with her at that point.

While I might not take the time to educate other people (based on the attitude I get back initially), I always take the time to educate my doctor. I hope that something will get through to them that will change their mind on how they approach their other patients. I can't change the world, but I can change my little corner "one starfish at a time".
Would you mind sharing what you have on your index card? I have an appt. next month and I know the subject will come up. I love this idea.
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Old 07-21-2014, 05:51 AM   #25
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My doctor knows that I do a whole foods low carb diet and keep track of calories but I am also thin and have excellent blood test results so he doesn't question it because he sees the results.

I don't know if I would be so forthcoming and enthusiastic about my diet if I was still overweight and unable to get to goal and had negative blood test results- because to me it would show that maybe the diet wasn't working for me and I need to try something else. Right now I believe in this diet because I have good results but without these I would start to question it and would probably take my doctor's suggestions and research other plans, as long as I was still doing a whole foods/mostly unprocessed diet. Because no matter how many people say it works for them and how many books say it's great, I still need it to work for me.

I find that I also need to explain my version of low carb since many people say they are doing low carb/Atkins and they are eating almost no vegetables, lots of processed low carb products and fast food and I don't consider that healthier than a mainstream SAD diet.
I think that's wonderful that your blood tests results are excellent. That's not always the case for all low-carbers during the weight loss period and it has nothing to do with eating low carb processed products. There are doctors who can vouch for this, but many main stream doctors are so entrenched with the statin dogma, that they have no desire to entertain new info.
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Old 07-21-2014, 07:11 AM   #26
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The question of 'what is working' is an interesting one and as Grneyedldy points out, some 'blood work' such as 'cholesterol' panels are subject to interpretation and the newest information is evolving a way that to make a decision on subject while in weight loss phase would be folly.

The other blood work indicators that should be of value are A1c, triglycerides and maybe fasting b.g.. These indicators should show improvement by the 3 month period and any low carber could consider this is an indication the diet is 'working'.

I am not going to go through the very extensive list of health improvements that low carb (defined as less than 50g per day) can and do bring because it is already known to most who read here but just a few are:

Cessation of intrusive thoughts of food (i.e. cravings), depression, fatigue, joint pain, GERD, IBS, and improved mental clarity.

Just a few but by anyone's standards, pretty important things to concider for quality of life. Weight loss is most often what brings people to low carb but I don't believe it is the thing that makes them stay in many cases.

The field of ketogenic diets is expanding on many, many health issues including cancer, Alzheimer's disease, diabetes etc.. There are clear causal evidence that all of these diseases can be avoided or delayed with a good keto diet.

So to say that a diet 'isn't working' because a weight goal has not been met seems to me, to be missing the point.
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Old 07-21-2014, 09:23 AM   #27
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I am another one who tells my Dr. what I will and won't do. She's tried to do the statin thing several times and I just ignore her. My cholesterol has always been high, but my HDL is high and my ratios are excellent. She did do the VAP test once I requested it and hasn't mentioned statins since. They are not God (in my opinion) and I know more about how I am feeling and what my body needs over someone I may see once a year for a physical. If I develop a serious illness at some point then I will revisit my willingness to listen more to them.
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Old 07-21-2014, 11:50 AM   #28
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I have to see a cardiologist every 5 years because I have a congenital heart disorder. It's always a new one--specialists really don't last that long in the Kaiser system. When the most recent one initially saw my cholesterol levels he was totally on board, because I have VERY high HDL (100) and low trigs (55). But a few weeks later he told me he wanted to prescribe a statin because of my "high LDL cholesterol" of 120. What that indicated to me, is the HMO powers that be got to him.

What I told him was that if he had to prescribe a statin to "look good" to his superiors, then go for it, but that doesn't mean I have to fill the prescription and take it. He gets to check off the little box for "high cholesterol, prescribed statins" and if the HMO wants to call me "non-compliant" so be it.

But I will fire any doctor who pushes me to actually take the statins. It tells me that they get all their training from the drug reps and toeing the Kaiser line instead of looking at ME. He admitted there were NO studies to see if statins were helpful for middle aged women with congenital heart disorders (very different from acquired heart disease). He knew I knew what BS it was to suddenly decide I need statins despite my good numbers, and that he could only go so far. And as it was, he didn't prescribe the statins.
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Old 07-21-2014, 12:14 PM   #29
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Most doctors just come off as salesmen for the drug companies rather than, well, doctors. Plan A is always medication. It's scary how common it is these days for relatively healthy people to be on 10 different medication.

I do think it's slowly changing to more diversity, but slowly.
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Old 07-21-2014, 01:46 PM   #30
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There's a reason that "Plan A is always medication" for most doctors in the U.S.

First of all, that's their training--treat patients with medical solutions.

But the major reason--which I've been told by most of my doctors, including friends who are physicians--is that MOST patients want Rx--not suggestions for lifestyle changes. And if given those suggestions, most are non-compliant.

I've posted here before that my endo admires my weight loss and WOE but told me that he cannot get his diabetic patients to eat low carb. They would prefer to add meds than to adjust their eating.

I have a close friend who is a lifelong smoker. She is now 68 and takes a variety of Rx. Her doctors have ALL told her that she'd be med free if she stopped smoking, but she doesn't want to--i.e., she doesn't even try. This is an intelligent woman (retired teacher) who refuses to give up a pleasure for her health. She is not unique.

People on this board are a self-selected group who are aware of nutritional issues, but we are not the norm.

Bashing doctors is easy, but there's another side to all this.
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