Monday, January 28, 2013

Can't see the forest for the trees.

Did I get some of you hooked on Ape Not Monkey last week?  Good, because I have another more informational site to look at, specifically this article on insulin that I came across when researching something else: Undeserved Bad Reputation. 

You've taken time to read the post, yes?  I like this post (and this website) for a variety of reasons; one, it's written in language that make science a little easy to understand.  Two, he backs up his info with links to articles.  Three, he's not pushing a particular diet on anyone, but trying to present the best that science has to offer.  But I also like the post because of how it reminded me about some of the pitfalls that I have when trying to help people be healthier (and I am pretty sure I am not the only health care person that falls into these holes either).

First of all, it reminded me that we as human beings can still tend to think of our body and it's functions and/or excretions as, at best, mysterious and unknowable, and, at worse, completely disgusting and bad.  I am not a philosopher, but I do know enough about the history of western medicine to know that the Greek concept of Dualism has had an impact on how we think the mind/body interact, and sometimes it has been to our detriment (philosophy friends, please correct me or add to that!).  In my opinion, it doesn't do anyone any good to remain ignorant of how your body works, particularly if you or a loved one has a life threatening condition, and it doesn't do you any good to see necessary parts of your body as bad.  Your body requires insulin to live, period.  You need to maintain a certain level of glucose in your body to live as well.    Think of your insulin levels as a river; necessary for carrying life sustaining substance and often beautiful and awe inspiring, but when it overflows the banks there can be trouble.   Seeing the river as evil and making attempts to remove it can result in dried out land, working with the river can help the area maintain its beauty and life.  Same thing with hormones like insulin, they are not bad by themselves, but we do need to know how to work with them.

Second of all, this alerted me to another cognitive error that a lot of health care providers and clinicians can fall into--that what Dr. Peter Palmieri calls "vertical line failure" in his excellent book Suffer the Children: Flaws, Foibles, Fallacies and the Grave Shortcomings of Pediatric Care (even if you don't have children, this book provides an excellent read for anyone interested in science-based medicine.  "Vertical line failure" means that you are assuming that all of your patients have a common condition.   And while reading this post I was alerted to where I fall into this very same problem--my specialty is diabetes, and I have this tendency to think that everyone has diabetes or some kind of insulin related problem, and so a lot of my dietary recommendations are based on that.  Now, don't get me wrong, the numbers that the American Diabetes Association released last year are scary: 18.8 million diagnosed with diabetes, 7.0 million people undiagnosed, and 79 million people estimated to have pre-diabetes--and for those people a carbohydrate controlled approach is likely the best way to control their blood glucose levels, lose weight, etc.  But sometimes the person who comes to see me doesn't have insulin resistance, and they might be able to lose weight and improve their health while including grains, etc.  I can't make that assumption that just because this person is overweight that she has the exact same cause as the next person, I need to take a detailed family history (if they know it!), find out what has worked for them in the past as far as weight loss, and look at their lab work (I very rarely get a chance to look at someone's insulin levels, but other people might get a chance to have their provider order this), find out what lifestyle habits affect their eating, etc, etc.  If I don't do that, I'm putting that person into a box they may not fit in.  And anyone who has been overweight has probably been told something "canned" by a doctor or dietitian--you need to become a vegetarian, or you need to stop being a vegetarian, or you need to eat an apple and drink water before every meal for satiety (yeah, one of my favorite eye-ball rolling moments when I read that in a chart).  And a lot of these people were not bad docs, but because they were human they had trouble getting past a particular cognitive error.  Oh, and those of you who are "evangelizing" on your weight loss plan?  I'm happy it worked for you, maybe you might help someone else, but try not to fall into this logical fallacy yourself.

And third, I think this is an excellent summary quote: "you should worry about whatever diet works the best for you in regards to satiety and sustainability."  In other words, does the food you are choosing help you feel full and satisfied so that you are less likely to overeat later?  (Some people can have 1-2 cookies and walk away, I can't).  And can you live with this type of program for as long as you need too, which might be the rest of your life?  Yes, I've had many people over the years try to "evangelize" me on why their particular choice of diet was so wonderful, only to say "but you can't stay on it."  Now, everybody needs a little encouragement to get "back on the wagon" if the've fallen off, but do you really want to stay on that up and down cycle?  Studies on whether or not you harm your health by weight cycling are mixed (link), but do you really want to go through buying new clothes, seeing your lab work fluctuate, maybe not feel so good, and have that feeling of never getting anywhere.   And even on the best of programs you might have moments of "I can't keep this up," but use that as a way to re-evaluate.  For example, I have know people who have lost weight on a program like medi-fast, but after a while they get bored with eating the same thing over and over again (or they never really liked the food in the first place).  Rather than just give up and go back to your former bad eating habits and weight gain, maybe you want to experiment with some new recipes so you can actually enjoy what you are doing?   Or maybe even think about whether or not what you were doing was actually good for you?  I was one of those people who enjoyed being almost vegan, but when I realized my GI system would no longer tolerate soy, legumes, etc I had to say "this no longer works for me, what can I do better?"

Take home message--don't stop trying to find a doc and/or a dietitian who is willing to individualize nutrition recomendations for you, and learn as much as you can about physiology from reliable sources.

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