Your Opinion on Diet and Nutrition

[blacktowel]

It's quite alarming that in this metabolic syndrome epidemic, there is a divergence of opinion from health professionals regarding an appropriate diet.

There is a growing proponent of supporters for a low carb high-fat (LCHF) diet as described in dietdoctor.com, and supported by physicians like Canadian nephrologist and LCHF evangelist Dr. Jason Fung. These proponents argue that the low-fat craze was initiated from poor studies and continued via sugar lobbyists and good ol' medical inertia. An example of a poor landmark study was via physiologist Dr. Ancel Keys who linked heart disease with the consumption of fats by comparing the diets of americans and the brits to the japanese (while ignoring heart-healthy butter loving nations like france, and norway). He inevitably endorsed (and was covered on TIME magazine in 1964), a daily caloric profile of 70% carbs 15% fat: http://nypost.com/2016/12/20/how-butter-became-a-villain-and-why-its-actually-really-good-for-you/

These LCHF folks then argue that there is mounting evidence of the alternative (This source links 19 RCTs favouring LCHF for weight control and chronic disease: The Science of Low Carb - Diet Doctor).

On the otherhand, my senior attending staff (ie. conventional medical wisdom) and uptodate and other prolific medical resources would claim that there are huge merits to a low fat diet instead. On the uptodate article "Obesity in adults: Dietary therapy", it notes the merits of a LCHF diet; however, it ultimately argues that a low fat diet is atleast non-inferior to LCHF and cites studies that support that claim (studies that I don't personally find very compelling).

I'm a Canadian medical resident, and it required a substantial amount of digging and an understanding of medical literature for me to currently be in favour of LCHF. Imagine how challenging it is for our patients to be confident enough in their idea of an ideal diet in order to stick to it and develop meaningfully positive long-term outcomes.

What do you all think? LCHF FTW? Low-fat FTW?

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[JustPlainBill]

It's quite alarming that in this metabolic syndrome epidemic, there is a divergence of opinion from health professionals regarding an appropriate diet.

There is a growing proponent of supporters for a low carb high-fat (LCHF) diet as described in dietdoctor.com, and supported by physicians like Canadian nephrologist and LCHF evangelist Dr. Jason Fung. These proponents argue that the low-fat craze was initiated from poor studies and continued via sugar lobbyists and good ol' medical inertia. An example of a poor landmark study was via physiologist Dr. Ancel Keys who linked heart disease with the consumption of fats by comparing the diets of americans and the brits to the japanese (while ignoring heart-healthy butter loving nations like france, and norway). He inevitably endorsed (and was covered on TIME magazine in 1964), a daily caloric profile of 70% carbs 15% fat: http://nypost.com/2016/12/20/how-butter-became-a-villain-and-why-its-actually-really-good-for-you/

These LCHF folks then argue that there is mounting evidence of the alternative (This source links 19 RCTs favouring LCHF for weight control and chronic disease: The Science of Low Carb - Diet Doctor).

On the otherhand, my senior attending staff (ie. conventional medical wisdom) and uptodate and other prolific medical resources would claim that there are huge merits to a low fat diet instead. On the uptodate article "Obesity in adults: Dietary therapy", it notes the merits of a LCHF diet; however, it ultimately argues that a low fat diet is atleast non-inferior to LCHF and cites studies that support that claim (studies that I don't personally find very compelling).

I'm a Canadian medical resident, and it required a substantial amount of digging and an understanding of medical literature for me to currently be in favour of LCHF. Imagine how challenging it is for our patients to be confident enough in their idea of an ideal diet in order to stick to it and develop meaningfully positive long-term outcomes.

What do you all think? LCHF FTW? Low-fat FTW?

You forgot William Davis, MD -- cardiologist and author of "Wheat Belly Total Health" and "Wheat Belly Detox"; You also forgot that LCHF is a major part of the anti-aging movement with OTC DHEA/Pregnenolone/Armour-Nature Thyroid use/DIM/Testosterone "therapy".....

My diet advice usually consists of: 1) Don't eat anything bigger than you are (stick to chicken/fish/turkey) 2) If it can sit on your shelf without spoiling for more than 5 days, you probably shouldn't eat it 3) if you can't see through it, you probably shouldn't drink it 4) Be sure to take at least 30 minutes to eat your meal (i.e. eat slowly)
5) Take a 30 minute walk 5 times a week 6) Dinner time is from 5:30 to 7pm -- it does not consist of eating repeatedly until bedtime.

 

[deleted87716]

 

[Mad Jack]

Low carb, low fat, high protein ftw.

 

[mabinante]

Isnt the LCHF diet the Atkin diet?

I don't really know. I feel like the pendulum swings every few years.

I tell my patients to eat in moderation and a balanced diet including fruits, veggies, fat, sugars, carbs, protein, etc.

I don't necessarily back it up with EBM but I feel like whatever I recommend that is currently EBM, it will be disproven or fall out of favor in a few years.

 

[JustPlainBill]

Isnt the LCHF diet the Atkin diet?

I don't really know. I feel like the pendulum swings every few years.

I tell my patients to eat in moderation and a balanced diet including fruits, veggies, fat, sugars, carbs, protein, etc.

I don't necessarily back it up with EBM but I feel like whatever I recommend that is currently EBM, it will be disproven or fall out of favor in a few years.

I hear you there --- I find it most interesting when patients come in swearing by a particular diet. It's so hard to teach that food should be used for it's original use -- fueling the body -- not to make up for being bored or other emotional reasons --- eat when you are truly hungry and then don't overeat but learn to listen to the cues your body gives you when your are satiated.....oh, well....

 

[FrustratedFamDoc]

I have several patients doing well on the LCHF lifestyle and find that it's far more sustainable than any of the others.

Sustained weight loss is such a challenge to most because it requires thought and discipline (mean but true), and it requires most people to totally change the way they've done things their whole life, and it requires them to totally change the way they've viewed food as well. The majority of people think and live day to day. Dave Ramsey's data says that 70% of Americans live paycheck to paycheck. We also live meal (or snack) to meal. There is no thought that goes in to goals. We think about Wednesday's dinner at 6:45 pm when we come home from work and are tired. Come early spring, we go to our fam doc and ask for adipex "cuz bathing suit season's coming."

I preach meal planning for the week on your day off and avoiding the center of the grocery store. You can have a chicken tender, rice and veggie meal rocked out in 20 minutes.

Barriers:

1. Actually recognizing that a problem exists and the habits that has brought this on. Most people don't see obesity for the problem that it truly is since everyone else is like this (lemming mentality).
2. Requires foresight, creativity and thought
3. Requires planning
4. Requires more effort
5. May be more expensive
6. Positive attracts negative. The knockers come from all angles when you try to do good things in your life
7. Grilled chicken with asparagus and rice isn't yet classified as comfort food.
8. "I hate the way water tastes" translates in to "All I've ever known is soda and sweet tea that my parents gave me as soon as I was old enough to breathe."

There's about 50 more, but these are the ones I usually try to address on a weight loss visit. I think my > 1 year success rate is about 10-15%.

 

[Carouselambra]

It's quite alarming that in this metabolic syndrome epidemic, there is a divergence of opinion from health professionals regarding an appropriate diet.

There is a growing proponent of supporters for a low carb high-fat (LCHF) diet as described in dietdoctor.com, and supported by physicians like Canadian nephrologist and LCHF evangelist Dr. Jason Fung. These proponents argue that the low-fat craze was initiated from poor studies and continued via sugar lobbyists and good ol' medical inertia. An example of a poor landmark study was via physiologist Dr. Ancel Keys who linked heart disease with the consumption of fats by comparing the diets of americans and the brits to the japanese (while ignoring heart-healthy butter loving nations like france, and norway). He inevitably endorsed (and was covered on TIME magazine in 1964), a daily caloric profile of 70% carbs 15% fat: http://nypost.com/2016/12/20/how-butter-became-a-villain-and-why-its-actually-really-good-for-you/

These LCHF folks then argue that there is mounting evidence of the alternative (This source links 19 RCTs favouring LCHF for weight control and chronic disease: The Science of Low Carb - Diet Doctor).

On the otherhand, my senior attending staff (ie. conventional medical wisdom) and uptodate and other prolific medical resources would claim that there are huge merits to a low fat diet instead. On the uptodate article "Obesity in adults: Dietary therapy", it notes the merits of a LCHF diet; however, it ultimately argues that a low fat diet is atleast non-inferior to LCHF and cites studies that support that claim (studies that I don't personally find very compelling).

I'm a Canadian medical resident, and it required a substantial amount of digging and an understanding of medical literature for me to currently be in favour of LCHF. Imagine how challenging it is for our patients to be confident enough in their idea of an ideal diet in order to stick to it and develop meaningfully positive long-term outcomes.

What do you all think? LCHF FTW? Low-fat FTW?

If you haven't already come across this here's another MD proponent of low carb / ketosis with a really good breakdown of the biochemistry, diet, and lab testing.

The straight dope on cholesterol – Part I -

You could also check out the reddit keto science page for some interesting posts/discussion. Or more anecdotally, the reddit keto page if you want to see posts by a lot of people losing a ton of weight and improving their bp and cholesterol eating high fat low carb.

 

[septoplasty]

Isn't the most common answer to all of these "Diets": They all work, if you can stick to them?

Regardless, not sure where you guys are practicing primary care.. but over where I was/am, not having 50% of your plate covered in meat is like the apocalypse. I'm surprised theres people out there that "research" these diets and stick to them..

 

[deleted87716]

Regardless, not sure where you guys are practicing primary care.. but over where I was/am, not having 50% of your plate covered in meat is like the apocalypse. I'm surprised theres people out there that "research" these diets and stick to them..

I'm in the South (in a yellow state on this map), but we're surrounded by orange, and it's getting worse. On the bright side, I know a lot about managing diabetes...

New Adult Obesity Maps

 

[deleted87716]

FWIW, I take my own advice, too. I (usually) eat pretty healthy and exercise (treadmill) several times/week. My BMI is 25, and I'm determined to keep it there.

 

[Ericslv]

In the recent years there have been many studies to support nutritional ketosis. Many of these studies are done and currently being done on Olympic and world class level endurance athletes. They have shown significantly positive outcomes in these studies.

For the purpose of weight loss it is one of the most effective ways to lose weight safely (meaning you won't lose bone mass or muscle mass but will lose fat). IT HAS TO BE DONE CORRECTLY AND MONITORED.

For long term lifestyle use it is a little tricky because few people (especially in our society of sugar everywhere) can maintain this type of eating for long periods of time.

It take about 3 weeks to go into nutritional ketosis and a couple of those 3 weeks can be horrible because you can feel feverish and tired due to the depletion of sugar reserves in the body.

Once a person has lost the weight they want they can slowly transition into a balanced diet where they take in some high quality sugars such as fruits, some grains like oats and perhaps occasional low quality sugars.

If they exercise to their cardio-metabolic potential those low quality sugars will burn off. It's important to remember that exercise does not cause weight loss. What you eat and don't eat does.

It's also important to remember that nutritional ketosis does not mean high protein. In fact that will destroy your ketotic state because protein can be converted to sugar by you body.

 

[septoplasty]

I
If they exercise to their cardio-metabolic potential those low quality sugars will burn off. It's important to remember that exercise does not cause weight loss. What you eat and don't eat does.

Uh..

 

[TorMed]

It's important to remember that exercise does not cause weight loss. What you eat and don't eat does.
.

I run 4 miles 4 times a week and have a long run of 10 to 12 miles on the weekend. I think I can tell you from personal experience that exercise can take a lot of weight off. I'm 5'10" and I struggle to stay above 150 lbs.


Sent from my iPhone using SDN mobile

 

[JustPlainBill]

I run 4 miles 4 times a week and have a long run of 10 to 12 miles on the weekend. I think I can tell you from personal experience that exercise can take a lot of weight off. I'm 5'10" and I struggle to stay above 150 lbs.


Sent from my iPhone using SDN mobile

And I ran 3 miles over lunch and trained in Tae Kwon Do and Jujutsu 2 hours a night for 4 days a week. On weekends I had a 4 hour long sparring session with my instructor and then ran 6 miles in the late afternoon. I'm 5'11" and I struggled to stay below 205 with clean eating. I was at 13% bodyfat at the time, had a resting heart rate in 50s and my labs were excellent. You can't outtrain a poor diet.

 

[deleted87716]

Both of the above posts are true. However, if you're only going to do one (diet or exercise), improving your diet is the way to go.

 

[Ericslv]

I run 4 miles 4 times a week and have a long run of 10 to 12 miles on the weekend. I think I can tell you from personal experience that exercise can take a lot of weight off. I'm 5'10" and I struggle to stay above 150 lbs.


Sent from my iPhone using SDN mobile

I see what your saying. Studies show that exercise does not help much in losing weight. It does help in keeping it off once you've lost it or prevent you from gaining it. Metabolism is increased, muscle mass is increased (depending on the exercise) and you burn fuel more efficiently.

In order to burn 1000 calories you will have to exercise vigorously for about 2 to 3 hours. The first hour is usually burning through your sugar reserves. Even if you run at 10 miles per hour for one hour you will burn about 600 -800 calories or so. Not many can run at 10 miles per hours and even then the burn is dependent partly on weight and partly on what % of your VO2 max you are exercising at. Efficiency.

But, it will keep the weight off. It's also anti-inflammatory in nature and helps reduce visceral fat. The fat that is most responsible to heart disease and other inflammatory condition.

 

[Ericslv]

And I ran 3 miles over lunch and trained in Tae Kwon Do and Jujutsu 2 hours a night for 4 days a week. On weekends I had a 4 hour long sparring session with my instructor and then ran 6 miles in the late afternoon. I'm 5'11" and I struggled to stay below 205 with clean eating. I was at 13% bodyfat at the time, had a resting heart rate in 50s and my labs were excellent. You can't outtrain a poor diet.

But you can over train and not lose weight. The body has a way of resetting. Also, 13% body is very good. If you go too much lower you start to lose muscle and bone mass. Then, the next time you eat a little poor, you gain weight faster. Your body feels like it's starving and adjusts accordingly.

In fact you can meet all your metabolic needs for cardio in about 15 to 20 minutes of exercising to your ideal vo2 max.

 

[cabinbuilder]

1.The general public has forgotten how to cook their own food.
2. The variety of disgusting prepackaged food you can buy is unreal
3. Nobody knows how to grow their own food.
4. Most eat out anymore where you have no control of how things are cooked
5. Buffets, i.e. Golden Corral and general fast food has created this overweight society. When Tom Hanks was told to gain 40 lbs for "a league of their own" he ate a big mac every day.

 

[JustPlainBill]

1.The general public has forgotten how to cook their own food.
2. The variety of disgusting prepackaged food you can buy is unreal
3. Nobody knows how to grow their own food.
4. Most eat out anymore where you have no control of how things are cooked
5. Buffets, i.e. Golden Corral and general fast food has created this overweight society. When Tom Hanks was told to gain 40 lbs for "a league of their own" he ate a big mac every day.

I thought you were going to talk about Morgan Spurlock's "Supersize Me"... I've actually had diabetic patients sit there and tell me their diet was good as they were slurping on a coke from Sonic -- when I called them on it I was told ," But it's Diet Coke"....

 

[septoplasty]

I thought you were going to talk about Morgan Spurlock's "Supersize Me"... I've actually had diabetic patients sit there and tell me their diet was good as they were slurping on a coke from Sonic -- when I called them on it I was told ," But it's Diet Coke"....

I've had diabetics who drank "sugar free" sodas with horrible weight/A1c issues tell me "oh I thought its okay cause there's no sugar in there"... uh :/

Marketing is probably the biggest threat to the American well being.

 

[JustPlainBill]

I've had diabetics who drank "sugar free" sodas with horrible weight/A1c issues tell me "oh I thought its okay cause there's no sugar in there"... uh :/

Marketing is probably the biggest threat to the American well being.

Just finished reviewing DeFronzo's Ominous Octet paper --- rather interesting to say the least.

 

[Goro]

1.The general public has forgotten how to cook their own food.
2. The variety of disgusting prepackaged food you can buy is unreal
3. Nobody knows how to grow their own food.
4. Most eat out anymore where you have no control of how things are cooked
5. Buffets, i.e. Golden Corral and general fast food has created this overweight society. When Tom Hanks was told to gain 40 lbs for "a league of their own" he ate a big mac every day.

To these sage observations, add:

6. High fructose corn syrup is even worse than sugar, and is a very common sweetener (while people noticed a link between obesity and white sugar consumption as far back as the 1920s, I don't think that it's a coincidence that the diabetes epidemic started in the mid-1980s, right about the time New Coke was introduced, with HFCS replacing sugar)
7: Restaurant portion sizes are bigger

 

[JustPlainBill]

To these sage observations, add:

6. High fructose corn syrup is even worse than sugar, and is a very common sweetener (while people noticed a link between obesity and white sugar consumption as far back as the 1920s, I don't think that it's a coincidence that the diabetes epidemic started in the mid-1980s, right about the time New Coke was introduced, with HFCS replacing sugar)
7: Restaurant portion sizes are bigger

Yes, they are --- when was the last time you saw an actual chicken, real live, run around the yard and beat it's face to feed chicken with a breast portion that looked like some of the one's you see on your plate at a restaurant? Hormones and forcefeeding.

I am old enough to remember that an adult sized large fry from McDonald's in 1974 was the same size as the children's size portion now. An adult sized large drink was the same size as a medium is now.

We didn't eat out much when I was a kid -- it just wasn't available and we didn't have the money. Pizza? yeah, that was Chef Boy Ardee make your own pizza kit -- Now, I've got people delivering wagon wheels loaded with everything on it, cheese in the crust, plus wings and 2liters of coke to the door.

 

[clausewitz2]

I've had diabetics who drank "sugar free" sodas with horrible weight/A1c issues tell me "oh I thought its okay cause there's no sugar in there"... uh :/

Marketing is probably the biggest threat to the American well being.

So there is actual solid nutritional science backing up the idea that if used strictly in substitution for full-sugar sodas, sugar-free sodas are indeed associated with weight loss. Aspartame or sucralose are not actually compounds capable of dark sorceries that cause you to magically gain weight.

Of more concern is the fact that for many people artificial, non-digestible sugars may ramp up appetite significantly. There is increasing evidence that there is a complex lipostat system operating in your central nervous system that regulates a lot of eating behavior, and anything that pushes up your set point is going to make you have a bad time if you are trying to keep weight off. Still, if someone is able to a)hold their other intake constant and b) drinks a lot of sugary drinks, if they replace all those Cokes with Diet Cokes, you can expect pretty strong positive effects from a weight perspective.

 

[deleted87716]

I am old enough to remember that an adult sized large fry from McDonald's in 1974 was the same size as the children's size portion now. An adult sized large drink was the same size as a medium is now.

Look at the size of Grandma's dinner plates and coffee cups to get an idea of what portion sizes looked like back in the day, as well.

I was at Hardee's once (I was hungry and in a hurry, and it was there), and ordered a "Little Thickburger" (a 1/4-lb. hamburger, the smallest one they have) with a small order of fries and unsweetened iced tea. The cashier looked up and said "Is that all?" I paused, looked over my shoulder on both sides, and said, "Yep, it's just me."

In fairness, I noted that the guy standing in line next to me had ordered TWO double-cheeseburgers, large fries, and a large Coke - for himself. I guess that's what they're used to.

 

[septoplasty]

So there is actual solid nutritional science backing up the idea that wif used strictly in substitution for full-sugar sodas, sugar-free sodas are indeed associated with weight loss. Aspartame or sucralose are not actually compounds capable of dark sorceries that cause you to magically gain weight.

Of more concern is the fact that for many people artificial, non-digestible sugars may ramp up appetite significantly. There is increasing evidence that there is a complex lipostat system operating in your central nervous system that regulates a lot of eating behavior, and anything that pushes up your set point is going to make you have a bad time if you are trying to keep weight off. Still, if someone is able to a)hold their other intake constant and b) drinks a lot of sugary drinks, if they replace all those Cokes with Diet Cokes, you can expect pretty strong positive effects from a weight perspective.

Good points.. what I think you are mentioning in your second paragraph is NSS's ability to alter the reward pathway to consistently have more sugary stuff.

Wasn't there a study not too long ago that said NSS led to glucose intolerance by either changing gene replication or altering sugar absorption? Can't think of it right now..

 

[Ericslv]

So there is actual solid nutritional science backing up the idea that if used strictly in substitution for full-sugar sodas, sugar-free sodas are indeed associated with weight loss. Aspartame or sucralose are not actually compounds capable of dark sorceries that cause you to magically gain weight.

Of more concern is the fact that for many people artificial, non-digestible sugars may ramp up appetite significantly. There is increasing evidence that there is a complex lipostat system operating in your central nervous system that regulates a lot of eating behavior, and anything that pushes up your set point is going to make you have a bad time if you are trying to keep weight off. Still, if someone is able to a)hold their other intake constant and b) drinks a lot of sugary drinks, if they replace all those Cokes with Diet Cokes, you can expect pretty strong positive effects from a weight perspective.

Actually, studies have shown that diet drinks elicit an insulin response similar to sugar. Insulin is a pro growth hormone and therefore as long as your insulin levels run high you will have a heck of a time losing weight.

 

[VA Hopeful Dr]

Actually, studies have shown that diet drinks elicit an insulin response similar to sugar. Insulin is a pro growth hormone and therefore as long as your insulin levels run high you will have a heck of a time losing weight.

And seem to stimulate appetite, lots of nursing homes now give diet Coke to residents to keep them eating

 

[Ericslv]

And seem to stimulate appetite, lots of nursing homes now give diet Coke to residents to keep them eating

If they are eating they are happy. But then at that age I would want to do whatever I want.

 

[deleted87716]

If they are eating they are happy. But then at that age I would want to do whatever I want.

Never heard of the Diet Coke thing in nursing homes, but agree with the "let them eat cake" approach with most elderly.

 

[VA Hopeful Dr]

Never heard of the Diet Coke thing in nursing homes, but agree with the "let them eat cake" approach with most elderly.

It sounds crazy but absolutely works. Give it a shot next time you've got an elderly patient whose not eating much.

 

[Ericslv]

It sounds crazy but absolutely works. Give it a shot next time you've got an elderly patient whose not eating much.

If I make it that far I will eat whatever I want, when I want. What do I have to lose.

 

[surrender903]

It sounds crazy but absolutely works. Give it a shot next time you've got an elderly patient whose not eating much.

i tell my patients that aren't eating that much to travel to colorado with the rest of their family and explore the greenery.

 

[VA Hopeful Dr]

If I make it that far I will eat whatever I want, when I want. What do I have to lose.

Yeah when you're demented and your family is harassing the nursing home doctor daily about you not eating...

 

[JustPlainBill]

Yeah when you're demented and your family is harassing the nursing home doctor daily about you not eating...

And you're biting the PT and have to be given chewing gum to keep you occupied.....

 

[absolutdokta]

it can be such a sea of confusion for patients. i rarely refer to nutrition anymore mostly because at my current location (not sure if it's the nutrition office or the patients themselves) because 90% of the time they come back with an A1c or weight higher or the same and say "nutrition??? oh yeah, i went. don't remember much of what they said but i went."

i have a particular passion for diet and exercise (9 years ago dropped 40 pounds and have kept it off through my lifestyle changes and exercise habits. i've waded through the muddy waters of the internet reading a TON about diet/exercise over the last decade so i feel fairly confident in counseling patients and imparting advice on things that could work well for them. that and i've tried to improve my motivational interviewing because a lot of the time they just can't cut the crap out of their daily food intake because of sheer lack of motivation

 

[Ericslv]

I have a question?

Should we care what they eat or don't? I mean after we have counseled them on proper eating and exercise, if they don't follow our advice why should we care?

Here are your meds mr. x have a nice day and if you die you die because if you don't care why should I?

 

[scharnhorst]

we need less variety of food too
and food that does not taste so good

people will automatically eat less and focus more on other healthier activities in life

spend a day with one of our average metabolic synd patient their whole life revolves around thinking about food

 

[FrustratedFamDoc]

I have a question?

Should we care what they eat or don't? I mean after we have counseled them on proper eating and exercise, if they don't follow our advice why should we care?

Here are your meds mr. x have a nice day and if you die you die because if you don't care why should I?

I'd love to say that after doing this for several years I'd know better, but it's so hard to not get frustrated. I see their poor treatment of themselves as directly undermining what I'm trying to accomplish. Our goals are exactly 180 degrees out of phase. Moreover, the smoking, obese, A1c >10 patient NEVER EVER feels good. NEVER. You walk in the room and say "hello ms/mr X, great to see you! How ya been?!" And you know what's coming next.... the long, draining, sigh. The sigh of despair and hopelessness. These patients will never tell you about the awesomeness going on in their lives right now. It's really more of an uncontrolled life situation than anything else but there's no good generic medications to help that one out just yet.

Secretly, you'd love nothing more than to just stop seeing that patient on your schedule but how do you let a patient go that is otherwise polite, on time, and pays their bills? What do you tell their 5 or so other family members that you also see after you send maw maw or paw paw packing? Alas, we all have to take the good with the not so good and hope you front office likes you enough to not put them all on the schedule for the same day.

There is a way to a better life but many (most) don't really care to try anything different that what they already know.

 

[deleted87716]

Moreover, the smoking, obese, A1c >10 patient NEVER EVER feels good. NEVER. You walk in the room and say "hello ms/mr X, great to see you! How ya been?!" And you know what's coming next.... the long, draining, sigh. The sigh of despair and hopelessness. These patients will never tell you about the awesomeness going on in their lives right now. It's really more of an uncontrolled life situation than anything else but there's no good generic medications to help that one out just yet.

 

[Ericslv]

I'd love to say that after doing this for several years I'd know better, but it's so hard to not get frustrated. I see their poor treatment of themselves as directly undermining what I'm trying to accomplish. Our goals are exactly 180 degrees out of phase. Moreover, the smoking, obese, A1c >10 patient NEVER EVER feels good. NEVER. You walk in the room and say "hello ms/mr X, great to see you! How ya been?!" And you know what's coming next.... the long, draining, sigh. The sigh of despair and hopelessness. These patients will never tell you about the awesomeness going on in their lives right now. It's really more of an uncontrolled life situation than anything else but there's no good generic medications to help that one out just yet.

Secretly, you'd love nothing more than to just stop seeing that patient on your schedule but how do you let a patient go that is otherwise polite, on time, and pays their bills? What do you tell their 5 or so other family members that you also see after you send maw maw or paw paw packing? Alas, we all have to take the good with the not so good and hope you front office likes you enough to not put them all on the schedule for the same day.

There is a way to a better life but many (most) don't really care to try anything different that what they already know.

Perhaps it's time to be more direct with them. It will get you several bad yelp reviews. I mean if we can't be the ones who are direct with them, then who can?

 

[FrustratedFamDoc]

Perhaps it's time to be more direct with them. It will get you several bad yelp reviews. I mean if we can't be the ones who are direct with them, then who can?

Oh, I'm plenty direct with them. I've even been known to tell some of them to check out some of the area nursing homes while they are still of able body and mind, so they know which one is just the right fit for them, after the massive infarction takes em right to the edge but doesn't quite finish them off and they now have ugly people changing their diapers.

As a family doc, we have several motivational techniques at our disposal because trying to impart change of behavior is at the core of what we do. Pep talk and reason is my initial approach. Sometimes I sic their spouse on em. When all that breaks down, all that we really have left is fear and guilt. When all that fails, unfortunately, we have reached an impasse.

I'm not so worried about the bad reviews. Regardless of what walks in the door, I'm fair, honest, and straight forward and so far, it's worked out pretty well.

 

[deleted87716]

I told one guy flat-out that unless he lost a lot of weight, he would never live to be an old man. He had young kids. He's still my patient, and has since lost 100+ lbs. (gastric sleeve). Being direct probably helped save his life.

 

[Ericslv]

Oh, I'm plenty direct with them. I've even been known to tell some of them to check out some of the area nursing homes while they are still of able body and mind, so they know which one is just the right fit for them, after the massive infarction takes em right to the edge but doesn't quite finish them off and they now have ugly people changing their diapers.

As a family doc, we have several motivational techniques at our disposal because trying to impart change of behavior is at the core of what we do. Pep talk and reason is my initial approach. Sometimes I sic their spouse on em. When all that breaks down, all that we really have left is fear and guilt. When all that fails, unfortunately, we have reached an impasse.

I'm not so worried about the bad reviews. Regardless of what walks in the door, I'm fair, honest, and straight forward and so far, it's worked out pretty well.

My approach. Tell them the facts leave it at that. Document that I told them the facts, options and offered treatment and alternatives. DONE.

 

[Ericslv]

I told one guy flat-out that unless he lost a lot of weight, he would never live to be an old man. He had young kids. He's still my patient, and has since lost 100+ lbs. (gastric sleeve). Being direct probably helped save his life.

I had a patient who was in the office and told him nearly the same thing. He came back with his wife who was almost as big as him. I told both of them the same thing but keeping the conversation about him because he was the patient. I never saw them again. I just stick to the facts and educate. If the patient shows interest and wants to take an active role then I try to do as much as I can.

 

[deleted87716]

I had a patient who was in the office and told him nearly the same thing. He came back with his wife who was almost as big as him. I told both of them the same thing but keeping the conversation about him because he was the patient. I never saw them again. I just stick to the facts and educate. If the patient shows interest and wants to take an active role then I try to do as much as I can.

To quote St. Bernadette, "My job is to inform, not to convince."

 

[Ericslv]

I told one guy flat-out that unless he lost a lot of weight, he would never live to be an old man. He had young kids. He's still my patient, and has since lost 100+ lbs. (gastric sleeve). Being direct probably helped save his life.

I've been accused of having to much candor. The older I get the more I have. I kinda like it that way.

 

[angeltalbot]

Isnt the LCHF diet the Atkin diet?

I don't really know. I feel like the pendulum swings every few years.

I tell my patients to eat in moderation and a balanced diet including fruits, veggies, fat, sugars, carbs, protein, etc.

I don't necessarily back it up with EBM but I feel like whatever I recommend that is currently EBM, it will be disproven or fall out of favor in a few years.

To set yourself up for success, think about planning a healthy diet as a number of small, manageable steps rather than one big drastic change. If you approach the changes gradually and with commitment, you will have a healthy diet sooner than you think.

 

[master-dissertations]

Home made food is the best solution for any diet and just eat good breakfast and lunch, light dinner. No junk food.