“But morning is where you earn your carbs” – said the flight attendant when I declined the processed shortbread. At least the knowledge that a high-carbohydrate diet is not-so-great is changing…
First, some facts about myself that are relevant
- The obligatory flashback. I now remember my first exposure to diabetes. It was when I was in 6th grade, and I was told that my teacher was not allowed to eat candy. I asked why and was told, “He’s diabetic, he can’t have sugar.”
- And then, through my professional journey, all of this got convoluted and people with diabetes were being told to eat sugar, in the form of high carbohydrate diets. It never really made sense.
- I know what it’s like to live as a fat person. It’s a unique experience. As a result, the medicalization of obesity, as a disesase of willpower, that happened in the early 2000’s always concerned me. Now that we have data that the #1 explicit (openly expressed) bias that medical students possess is directed against obese people (greater than that expressed, also openly, against LGBTQ people) my concern level is justified.
The conversation about medical students learning nutrition (and by nutrition I mean, “what to eat,” – there’s plenty on nutritional biochemistry) is not new. It was happening when I applied to medical school, I was aware that we wouldn’t get much teaching in this area, and much of the nutrition science I learned in college. Regardless, I did not go to the gym during the lectures we did have on nutrition 🙂 .
- By the way, I semi-don’t knock medical school for not teaching me about what to eat – there is so much to learn about human physiology and pathology that you can’t learn anywhere else. More importantly, the skill of critically reading the literature is something that transcends medical schools and helps physicians learn throughout life.
- Despite the lack of formal teaching on diet, there were clues in medical school that the evidence base being promoted wasn’t itself based in evidence. I still remember those clues to this day – they were in our medical textbooks, even.
Post-medical school, in several cycles of board certification (for the awesome specialty of family medicine), nutrition is barely addressed, so it’s still pretty DIY, and that means path of least resistance.
- However/and I am not a least resistance person. I live in the future, where innovation happens in the out of the way places. I am usually ahead of my time, sometimes joyfully, often painfully, ultimately happily, glass 3/4 fully. I like change, and I like innovation and I like interacting with people who are also ahead of their time.
Which brings me to the present time and Low Carb San Diego
I came here, to this fully accredited continuing medical education course (thank you @JeffreyGerberMD) because after all that we’ve been taught/told, I keep finding out that
- the evidence base for the low-fat diet (which is basically a high-carbohydrate diet) was non-existent when it was made a national guideline, and
- there’s still no credible evidence supporting the low-fat (aka high-carbohydrate) diet
The challenge is made worse by the fact that many advocates of the low-fat diet are also expert in evidence-based approaches, but interpret the data differently. I’ve commented on this previously, that I can’t know what a study means unless I also read the comments, the twitter feeds, the financial interest statements.
Very fortunately, a lot of the people analyzing the evidence live in social media, unlike so many other health movements (cough environmental stewardship cough), so it’s easy to connect and learn more. So here I came for direct learning, reading can only get a person so far.
Interestingly, people who know me know I am not a fan of sitting in a dark room watching powerpoint presentations, however, I was on the thirsty side when it came to getting information, so this was not a problem for me. A few wall sits and isometric lunges keeps the BDNF flowing.
I am awaiting the presentations and videos, which I actually want to review again, because the breadth of topics and experts was pretty excellent.
Some key points of learning for me
- diabetes and diet
- diabetes and cardiovascular disease (and their inextricable linkage + maybe it’s the other way around)
- diabetes and every other disease including Alzheimer’s (Diabetes Type III)
- Non-Alcoholic Fatty Liver Disease (crazy high prevalence & correlation with glucose intolerance)
- The human and global environment including sustainability (this image is terrifying)
- the power of the medical profession to alternately create change or slow change, sometimes with great results, sometimes with devastating ones
I’ll continue posting as I learn more of course.
A Note About the Medical Profession
As I type this I am sitting next to someone who is obviously a physician, dictating a patient chart note in a public place (hmmm HIPAA…), and it reminds me to remind others to avoid placing blame on the profession or the people in it. I cringe a little when I hear proclamations about what physicians need to do when they have at their base mal-intent on the part of physicians. As the implicit bias literature shows, physicians have the same amount of biases that their community colleagues do, no more, no less. I believe physicians want to perform well for their patients, when it is known what performing well is. This is a community-created issue and is owned by everyone.
Speaking of adventures, I also took a little sojourn into the realm of #TransVisibility at the Port of San Diego next door – again, challenging the norms that society imposes on humans that don’t have a basis in science. It’s all related…
As it says in the photo above, my generation of physicians trained during the most profound ethical crisis in our profession’s history, and when we witnessed what we did, we promised to change everything, in the interest of the people we serve. A part of that work is to know what change is needed. Embrace curiosity/if someone is doing something better than I am, I want to know about it.