Clubhouse (@JoinClubhouse) is an interesting new social network that’s described elsewhere (in many other places). Yesterday we brought a group of well-regarded clinicians with a diversity of backgrounds to a discussion about low-carbohydrate diets. Significantly, the discussion was held in the Virtual Grand Rounds club, where all clinicians/physicians congregate, rather than the many and proliferating clubs devoted to diet/nutrition approaches. This was intentional.
With a birthplace in silicon valley, I have noticed many of the design elements and conversations in the app are biased toward assumptions/false dichotomies around diet and nutrition – for example, the idea that the only healthy eating pattern & “wellness” synonymous with being plant based (science doesn’t support this), or that a low-carbohydrate diet and a plant-based one are opposites of each other (they are not; one describes a macronutrient distribution, the other the source of those macronutrients, two totally separate things). This is definitely changing as several low-carbohydrate and ketogenic diet clubs are being created on the platform. However, the physician related discussions have tended to be one-sided when nutrition comes up…..
An opportunity for balance (and science)
My/the co-organizer, Linda Anegawa, MD (IG: metabolichealth4life_md) set up the room, re-set it up during the conversation, and led a collaborative discussion about therapeutic carbohydrate restriction. Most pleasing to me is that this discussion, in a clinician space, not a nutrition space, was not centered on whether this approach is valid or not. Indeed, in 2021 many/most major medical associations including the American Diabetes Association (see: Slide Update: American Diabetes Association New Nutrition Approach, Heart-Check Still Awarded for Sugar Sweetened Cereals, and now Diabetes Canada (see: Just Read: Diabetes Canada backs away from the Carbohydrate Table : Position Statement on Low Carbohydrate Diets for Adults with Diabetes), are now endorsing this approach as such. The need, in my opinion, is to build community and discuss successful approaches within this paradigm, because individuality is still critical. Individualizing therapy based on patient preferences, values, and health status, is where clinicians shine, always and in all ways.
Participation included obesity medicine specialists (Linda’s expertise), cardiovascular surgeons, PhD exercise physiologists, dietitians, and citizen scientists, and stayed focused on the science through Linda’s leadership. Some of the conversations I’ve listened to in Clubhouse I’d call “quasi” or maybe “sprinkle of” science, which is concerning on the one hand, expected on the other in a new social network. As any good physician should, Linda does a great job of keeping things centered on science and not personal medical advice or instructions.
Low-carbohydrate medicine – still too “DIY” – I see many parallels to LGBTQ health
There were lots of clinical pearls shared in the conversation, and also what struck me is the still-very-uncomfortable “DIY” nature of low-carbohydrate nutrition. This is similar to what I’ve observed in LGBTQ health, where patients are exhausted and frustrated from having to teach their physicians about their specialized care needs, or that they need to be welcomed into care at all.
In my own experience I have to an extent “trained” my own personal physician on my health needs while on a low-carbohydrate diet, and I don’t mean that in a pejorative way – every patient ultimately trains their physicians on the depth of their person. These situations must be handled with great care, though, because every patient deserves a physician who will celebrate their achievements AND challenge them with information in a respectful way. The patient shouldn’t be responsible for driving the relationship, or worse, dominating it, without input from their health professional partner. I personally exercise caution in evaluating results of tests, being judicious in my requests, and always asking for feedback. Patients definitely do not deserve a physician who belittles their success, whether it’s taking a hemoglobin A1c from 11 to 5, or finding a same-sex soulmate for life. These things are still happening, and, well, they are inappropriate on the one hand and unethical at some level. It’s important to remember, as I was taught, every life giving/saving quality outcome is dependent on the patient – it is they who decide to be in care, to receive preventive interventions, to follow-up on care gaps. The person who is not respected on their health journey is the one who never comes back, and as we see in LGBTQ health, the one who dies of untreated breast, prostate, colon cancer.
For people interested in success in low-carbohydrate nutrition as patients, I like the advice of Dr. Richard Bernstein, world-class diabetologist, who struggled himself as a person with type 1 diabetes to receive respectful care. He just announced that 2021 is his 75th anniversary of being on insulin. He always says, “find a nice family practice doctor who will listen to you.” Note that he’s not saying “find a nice internist” or “find a nice endocrinologist.” I believe this is intentional (and I agree with the approach) – he’s saying – “find a respectful relationship with a person trained in the depth and breadth of humanity who can advocate for you everywhere in medicine.” As a family medicine specialist myself, I know that’s what we do (see: I am a Family Physician. What does that mean (and why should you care)? – Part 1 of 3).
One day, every internist, endocrinologist, family medicine specialist, dietician, cardiothoracic surgeon will treat low-carbohydrate nutrition, metabolic health, diabetes reversal, as a part of the diversity of their practice expertise. Until then, It’s good to bring the cornucopia of people who already think this way to the spaces where a lot of people don’t…yet.