Teach Doctors Nutrition, Then Let Them Practice Medicine

To become a med­ical doc­tor in the Unit­ed States, you need to get a bachelor’s degree, with many cours­es in biol­o­gy and oth­er sci­ences. Then, you need four years of med­ical school. Then, you need to do an intern­ship and res­i­den­cy. Yet after all those years of train­ing, you might still know prac­ti­cal­ly noth­ing about nutri­tion and dietet­ics. Also, you often won’t get to decide what care your patient can get. Those deci­sions will be made by accoun­tants at your patient’s insur­ance com­pa­ny. The accoun­tants may insist on a “fail first” approach to treat­ing many seri­ous dis­eases. As a result, many patients have to get bad care before they can get good care. To improve health­care while con­trol­ling health­care costs, we must teach doc­tors about nutri­tion and then let doc­tors, not accoun­tants, make the med­ical deci­sions.

Fail First” Is Bad

Often, insur­ance com­pa­nies refuse to pay for an expen­sive treat­ment until the doc­tor has proved that all of the cheap­er treat­ments have failed to help that patient. This pol­i­cy is called “fail first” or step ther­a­py. Unfor­tu­nate­ly, a patient with a seri­ous con­di­tion could die or end up per­ma­nent­ly dis­abled unless the right treat­ment is used right away. As a result, doc­tors have been spend­ing more and more of their time hag­gling with clerks at the insur­ance com­pa­ny. Most of those clerks are not doc­tors, and none of them have a doc­tor-patient rela­tion­ship with the patient. To solve this prob­lem, we must make some improve­ments in med­ical edu­ca­tion and then give doc­tors more pow­er.

Stepped Care Is Good

Step ther­a­py is a bad ver­sion of stepped care.  In stepped care, patients with a less urgent or less seri­ous case get treat­ment of a low­er inten­si­ty, at least at first. For exam­ple, many patients should try a change to a healthy diet before they take pos­si­bly dan­ger­ous med­ica­tion. If the patient needs med­ica­tion, they might start with a cheap, old drug with a known safe­ty pro­file, rather than start­ing with a an expen­sive new drug whose long-term safe­ty is unknown. Yet even in stepped care, doc­tors do not need to start with the bot­tom step. In seri­ous cas­es, they can start with a mid­dle step or even the top step.

In stepped care, the doc­tor and the patient make the med­ical deci­sions. But in “fail first” or step ther­a­py, the bean-coun­ters at the insur­ance com­pa­ny make the med­ical deci­sions. By requir­ing “fail first,” insur­ance com­pa­nies ensure that a lot of patients will have treat­ment that fails. In con­trast, doc­tors are sup­posed to pick the ther­a­py that is most like­ly to suc­ceed.

Diet First!

Most of our main caus­es of death and dis­abil­i­ty in the Unit­ed States are the result of eat­ing an over­ly rich diet. Thus, dietary man­age­ment should be the first step in man­ag­ing those dis­eases. Yet even dietary ther­a­py can fol­low a stepped care approach. A low-fat veg­an diet solves most diet-relat­ed prob­lems. Some patients need an even more restric­tive diet.

For arthri­tis patients, the first step is to remove all ani­mal foods and all fats and oils from the diet. Ani­mal pro­teins and fat­ty foods pro­mote arthri­tis. Ani­mal pro­teins look a lot like human pro­teins. If a bit of undi­gest­ed ani­mal pro­tein gets into your blood­stream, your immune sys­tem may make anti­bod­ies against it. Those anti­bod­ies can then attack your own tis­sue. Diets that are high in fat and cho­les­terol make this prob­lem worse by dam­ag­ing the lin­ing of the intes­tine. (Some of the med­ica­tions used to treat arthri­tis pain also dam­age the intes­tine.) If your intes­tine leaks, then more bits of undi­gest­ed pro­tein will get into your blood­stream.

Why plant-based diets are better for your health


An Elimination Diet

A low-fat veg­an diet can restore many patients’ health. Patients who remain sick can try a gluten-free veg­an diet. Gluten is a pro­tein found only in wheat, rye, and bar­ley. In a small per­cent­age of the pop­u­la­tion, it caus­es a dis­ease of the intes­tine, called celi­ac dis­ease. If the gluten-free veg­an diet does not pro­vide enough relief, the patient can try a for­mal elim­i­na­tion diet. Dr. McDougall’s Diet for the Des­per­ate is an exam­ple. It excludes the oth­er plant-source foods that some­times cause prob­lems in some patients (e.g., corn, soy, straw­ber­ries, cit­rus fruits). After the patient feels bet­ter, these plant-source foods can be care­ful­ly rein­tro­duced, one at a time. The goal is to iden­ti­fy which foods were caus­ing prob­lems.

Therapeutic Fasting

In severe cas­es, the doc­tor may want to start at the top step. For a patient with a flare of rheuma­toid arthri­tis, that means a ther­a­peu­tic fast. Dur­ing a ther­a­peu­tic fast, the patient takes noth­ing but water by mouth for days to weeks, in a set­ting of com­plete rest.

A water-only fast is the ulti­mate elim­i­na­tion diet. By eat­ing noth­ing at all, you avoid all pos­si­ble dietary trig­gers of dis­ease. A ther­a­peu­tic fast also sup­press­es inflam­ma­tion. Of course, if you con­tin­ued fast­ing, you would starve to death. So you have to break your fast even­tu­al­ly. After the fast, foods should be rein­tro­duced care­ful­ly, one at a time.

Ther­a­peu­tic fast­ing should be done only under med­ical super­vi­sion. Fast­ing is pow­er­ful med­i­cine against the dis­eases of over­nu­tri­tion. It can cure type 2 dia­betes and high blood pres­sure. (See chap­ter 9 of my book Thin Dia­betes, Fat Dia­betes: Pre­vent Type 1, Cure Type 2).

Water-only fasting is powerful medicine

Accountants Should Not Practice Medicine

Insur­ance com­pa­nies are for-prof­it busi­ness­es. They are not pub­lic health agen­cies. As a result, they devel­op poli­cies to boost their own prof­its, not to pro­tect your health.

To improve pub­lic health while con­trol­ling health­care spend­ing, teach doc­tors about nutri­tion. Teach doc­tors how to use diet rather than drugs to solve diet-relat­ed prob­lems. Then, let the doc­tors decide what oth­er kinds of treat­ment their patients need, even if that treat­ment is expen­sive. Let the doc­tors, not the accoun­tants, prac­tice med­i­cine.

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