When I went to Low Carb San Diego in August, 2017, my post was simply: Adventures at Low Carb San Diego.
I was only learning about metabolic health (and San Diego was where I first learned the term – thanks to Sarah Hallberg, DO, MS – @DrSarahHallberg) then. Interesting that I only learned about it then, we were never taught about metabolic health in medical health, only metabolic disease.
This is not a blog post about what people should eat.
Metabolic Health is what this is
This is not weight loss. It’s not cardiovascular mortality. It’s not even diabetes reversal* (which I’m including in the title only because it’s a more familiar term).
People are not lipid profiles. They don’t wake up in the morning and say “I’m so happy my cholesterol is low.” They wake up and say, “I’m so happy I can provide for myself, my family, my community, and achieve my life goals.” That’s the happiness the medical profession is here for.
Especially the specialty of family medicine – we were born as a specialty of depth, not of breadth. The depth we are engaged in is the one a of a human being and their environment.
*This is not diabetes type 1 reversal. Type 1 and Type 2 have different mechanisms, although both respond to nutritional approaches:
#LCB18 #LowCarbBreck audible gasps time – glucose control for a person with T1 DM and #LCHF diet – presented by @JakeKushnerMD – example of patient controlling their health destiny. pic.twitter.com/vZPU4TAwJM
Speaking of audible gasps, there were many, along with laughs, throughout the meeting.
They were around the wonderment of the human body and what it’s capable of on a regular basis, rather than all of the things that can be done to it.
This was a fun CME (accredited continuing medical education program), which is unusual.
What was usual was that there was robust science throughout. Review my twitter moment to get a small taste.
Metabolic Health is Multi-Specialty
The audience had a significant presence of physicians and health professionals, across specialties. Name the specialty, the body organ, the life experience, and there’s a connection to diet. It’s impressive to me that this connection is now made by health professionals in every field.
The Krebs cycle even made an appearance…
Well patients = Well physicians
I met several family physicians of the most noble/engaged kind – physicians for their communities – who came to the meeting at great expense (time is the most important currency of a community doctor) to learn and share their experiences.
I heard how they were agents of change for themselves and their patients who desire metabolic health. The ability to offer something based on science that works to the people we serve is transformational. I could see it in their faces.
Doctors want to work for health, they do not want to work to manage disease. We have been told that the conditions we are here to manage are progressive and unrelenting. The opposite is proving true. Performing well for the people you serve is a tremendous source of happiness and satisfaction.
When there isn’t an “answer” for a patient, the process is the same, a dialogue, a relationship. Every doctor knows what can be accomplished by understanding people’s needs and avoiding life-draining judgements and comparisons. A focus on metabolic health brings that awareness with it.
#LCB18 #LowCarbBreck Power of shared decision making when it comes to things like statins. The patients ultimately choose – provide the information to make the best decision – @DrSarahHallberg pic.twitter.com/PjcDT90YKv
Taking Control of Health and Life Destinies
The common theme of every (100%) human in a vulnerable population I have worked with or been a part of (e-patients, LGBTQ people, overweight people, women, long list…) is the drive to take control of our health and life destinies. From my observation, it is among most powerful human drive there is. When denied, I have seen many things happen, from the devastation of life lost to the revolution of rising expectations that change everything.
I saw a lot of the latter, people taking control. Not in the medicine cabinet. In the kitchen. It was a wonder to watch and participate in.
When was the last time you concluded a CME in a room of humans taking control of their health destiny – health professionals, scientists, citizens, together. This was my first. I think this #diabetesreversal is actually a thing ✌️#LCHF #LCB18 #LowCarbBreck #ketogenic #FutureStartsHere #CitizensIncluded #FoodIsBetterMedicine 🥓🍖🥩🥦🌷📸
As far as I know, everyone in the photograph above is in full remission from diabetes or on their way, and knows as much about metabolic health as many physicians do.
I have also never gone to a CME where I knew as much about the life stories of the people in the room as I did, due to their extensive podcasting and other social sharing. The asymmetry really drives sharing back the other way, a great equalizer in these conversations.
The hashtag has typically been #PatientsIncluded. I’m changing it here because this isn’t a group a patients. They are citizen scientists across the professional spectrum, from PhD educators, to investigative journalists, to software engineers (lots of great engineers).
#LCB18 #LowCarbBreck citizen lipidologist @siobhan_huggins – appreciation of the wonder of the human body as much as anyone who comes to the health professions 😌✌️👍 #CitizensIncluded pic.twitter.com/fUl32SLFmt
They do not supplant or surrender to physicians or health professionals, they make us better at what we do.
Leading in Health, Accepting anger
Physicians, as healers, leaders, partners, are supposed to lead in health, not the worship-leadership kind, the servant-leadership kind, with empathy and listening.
We also have the ability, and own the honor of, accepting others’ anger, on behalf of the people we serve.
I have enjoyed this experience (accepting anger) in reference to my working to be an ally for LGBTQ and specifically transgender communities – I wish it upon every nurse and doctor in their career.
Listening and empathy
#LCHF #LCB18 One reason I am happy to be here – elephant in the room that's been demystified – LDL increase w improved TG/HDL. @ChrisWebsterSA of @TheNoakesF – now to help physicians improve empathy in these situations 😌 pic.twitter.com/tQH4H9Q8FB
Speaking of health professionals, this was a prevalent theme this time, about physicians’ ability to empathize with patients/citizens/humans taking control.
What I hear and see are stories of physicians conditioned to see the natural course of metabolic disease as unrelenting and unmodifiable. In some cases, there is fear of seeing these conditions any other way, driven by forces internal or external.
This creates tremendous tension and sadness, all unnecessary.
#LCB18 #LowCarbBreck "Patients want the effort they put in and their success to be acknowledged by their doctors." – so much easier than agonizong over "progressive, unremitting chronic illness" ✌️via @ChrisWebsterSA @TheNoakesF
A quote from my implicit bias scholarship and the world around me –
If defensive, notice it and accept the discomfort of unlearning and relearning…this requires a desire to know, motivation to become informed, willingness to correct mistakes.
On most days, in Washington, DC I walk past the place where Thurgood Marshall changed the world, where there are powerful reminders of leadership in a world that doesn’t want people to lead, or even exist.
This is still the decade of the patient
I wrote about the similarities between the LGBTQ human rights movement and the metabolic health movement in this post: Why Doctors should meet patients (and each other) where they are: My intersection of LGBTQ , LCHF, and LetPatientsHelp.
I would now change the hashtag in the title to #LetCitizensHelp.
I resist war analogies because they are unhealthy and inaccurate. There’s just a desire to know, and be there for the people we serve.
On the one hand, that’s never going to change. On the other hand, our generation of physicians came to health care to change everything.
It may be that computers will soon diagnose better than doctors. But the facts fed to computers will still have to be the result of intimate, individual recognition of the patient. (From A Fortunate Man, 1965)
I love this century 🙂 .
Potential conflicts of interest
I am a
cis-gender, euglycemic, formerly fat, normotensive, transaminase-normal, normo-lipidemic, implicitly-biased, pharma- and device- manufacturer honoraria-free, fat-oxidizing, gay, glass 3/4 full, future dwelling, citizen, family physician, Washington, DC, resident, male human.
Everyone in the photos above are social; rather than listing all of their handles, I’ve compiled a twitter list, feel free to subscribe/copy/steal.