If You Don’t Trust Doctors, You’ll Die From Ebola. Or Something Like That.

One of the best books I’ve read in the past few years is Undoctored by Dr. William Davis. As I explained in my review, I drove up to Wisconsin to interview Dr. Davis for the Fat Head Kids project while he was still working on Undoctored, and he told me about it over dinner.

So the new book (which was untitled at the time) would include two major sections: The first section would explain to readers why the “health-care” system is more interested in their dollars than their health. The second section would arm readers with the knowledge and tools to monitor and improve their own health, and thus avoid ending up in the belly of the health-care beast. With all the bad advice coming from the medical establishment, people need to do their own research and direct their own health instead of relying on doctors to do it for them.

As a reminder, here’s a quote from the introduction of Undoctored:

I propose that people can manage their own health safely and responsibly and attain results superior to those achieved through conventional healthcare – not less than, not on a par with, but superior.

Naturally, that doesn’t sit well with many doctors. In fact, a doctor named Dhruv Khullar recently wrote an op-ed in the New York Times titled Do You Trust The Medical Profession? And in case you have any doubts about where Khullar stand on the issue, the subtitle is A growing distrust could be dangerous to public health and safety. Let’s take a look:

Trust, in each other and in American institutions, is vital for our social and economic well-being: It allows us to work, buy, sell and vote with some reasonable expectation that our behavior will be met with fairness and good will.

But trust has been declining for decades, and the most tangible and immediate damage may be to public health and safety. Mistrust in the medical profession — particularly during emergencies like epidemics — can have deadly consequences.

In 1966, more than three-fourths of Americans had great confidence in medical leaders; today, only 34 percent do. Compared with people in other developed countries, Americans are considerably less likely to trust doctors, and only a quarter express confidence in the health system.

I’m going to step out on a limb here and say that if trust in the medical profession is less than half of what I was in 1966, there’s a good reason for that — reasons Dr. Davis spelled out in Undoctored. But let’s read on:

Trust is the cornerstone of the doctor-patient relationship, and patients who trust their doctors are more likely to follow treatment plans. One study found that nearly two-thirds of patients with high levels of trust always take their medications, but only 14 percent of those with low levels of trust do.

Well, yes, if you have blind faith in the medical profession, you’re more likely to take that statin your doctor prescribed. That’s why I don’t want you to have blind faith in the medical profession. Dr. Khullar is simply assuming that taking your prescribed medication is always the best decision.

Trust is also critical for patient satisfaction, and makes it more likely that patients keep seeing the same doctor.

Well, duh! Of course I’m more likely to keep seeing a doctor I trust. But that doesn’t mean I should just blindly trust any ol’ doctor.

Perhaps most concerning is evidence that low levels of trust can weaken the ability of governments and public health agencies to respond to epidemics.

Researchers surveyed people in Liberia about their knowledge of Ebola, about how much they trusted the government, and how likely they were to take recommended precautions against Ebola. These precautions included adopting safe burial practices; abiding by restrictions on travel, social gatherings and curfews; keeping a bucket of chlorinated water at home; and avoiding physical contact with those displaying symptoms.

People who didn’t trust the government were much less likely to take recommended precautions.

So to prove how dangerous it is not to trust doctors, governments and public health agencies, he had to reach across the ocean and find an example of people ignoring advice about Ebola — in Liberia. Sorry, but that doesn’t convince me I should trust the USDA’s dietary advice, or the CDC’s sodium advice, or my doctor’s advice on the need to lower my cholesterol.

To his credit, the doctor writes that trust needs to be earned:

But there are steps medical leaders and public health officials can take to show they deserve to be trusted. People’s trust depends fundamentally on three questions: Do you know what you’re doing? Will you tell me what you’re doing? Are you doing it to help me or help yourself?

I think the first question is where the rubber meets the road when it comes to trusting doctors. Does the doctor know what he or she is doing? I’d say that depends. If I’m diagnosed with an acute condition such as pneumonia, or appendicitis, or a torn bicep tendon, I’m going to trust the doctor. But if I’m diagnosed with “high” cholesterol, or “high” blood pressure, or type 2 diabetes, or any other chronic condition, I’m going to do some research before I just blindly follow the doctor’s advice.

To explain why, I’ll quote from a recent blog post by Chris Kresser:

Conventional medicine evolved during a time when acute, infectious diseases were the leading causes of death. Most other problems that brought people to the doctor were also acute, like appendicitis or gall bladder attack.

Treatment in these cases was relatively simple: the patient developed pneumonia, went to see the doctor, received an antibiotic (once they were invented), and either got well or died. One problem, one doctor, one treatment.

Today things aren’t quite so simple. The average patient sees the doctor not for an acute problem, but for a chronic one (or in many cases, more than one chronic issue). Chronic diseases are difficult to manage, expensive to treat, require more than one doctor, and typically last a lifetime. They don’t lend themselves to the “one problem, one doctor, one treatment” approach of the past.

Unfortunately, the application of the conventional medical paradigm to the modern problem of chronic disease has led to a system that emphasizes suppressing symptoms with drugs (and sometimes surgery), rather than addressing the underlying cause of the problem.

Just today, I heard about another case of doctors not addressing the underlying cause of a problem. A co-worker told me his daughter suffered from irritable bowel syndrome for years. Doctors treated her with drugs, of course, which sometimes worked and sometimes didn’t. It was a family friend who finally suggested the daughter try a diet devoid of grains. You can guess the happy ending: no more irritable bowel syndrome. How many times have we all heard similar stories?

And of course, modern medical doctors sometimes want to treat a “problem” that isn’t a problem in the first place. Here’s an example I’ve mentioned before: Some years ago, I had a checkup that included (of course) a lipid panel. After viewing the results, the doctor told me I needed to go on a low-fat diet and consider taking a statin. I asked why.

“Your cholesterol is elevated.”

“Put a number on that, please.”

“It’s 203.”

“Uh-huh. And what’s my HDL?”

“Let me see … it’s 64.”

“What about the triglycerides?”

“Hang on … 71.”

“So what you’ve just told me is that for a guy my age, my cholesterol profile is excellent. I’m not going on a low-fat diet, and no, I’m not taking a statin.”

This doctor knew less about how to interpret a cholesterol panel than I did. He saw one number — 203 — and decided my heart was at risk. Strike one. He thought the solution would be a low-fat diet. Strike two. Or a statin. Strike three.

Not trusting that doctor was the right decision. Same goes for my mom’s doctor, who recently put her on statins — again. My mom called and asked why she might be taking something spelled A-V-O-R-A—

“Statin,” I finished. “Avorastatin. It’s a statin. It’s to lower your cholesterol, and no, you don’t need it. There’s never been a single study proving that giving statins to women in your age group prevents any deaths.”

And yet there she was, taking a worthless drug that can screw up a person’s memory, despite the fact that she’s been having memory issues for the past couple of years. Doctor’s orders.

So let’s put two and two (plus one more) together: Dr. Khullar complains that trust in the medical profession is less than half what it was 40-some years ago. Chris Kresser notes that most people these days see doctors for chronic conditions. I’m pretty sure those are related. Too many doctors suck at treating chronic conditions. They mean well, but the advice still sucks.

Dr. Malcolm Kendrick put it nicely in his terrific book Doctoring Data:

The sad truth is that most of the advice we are now bombarded with varies from neutral to damaging. In some cases it can be potentially very damaging indeed. Advising people with diabetes to eat a low fat, high carbohydrate diet, for example. As a piece of harmful idiocy, this really could hardly be bettered.

No wonder patients aren’t happy and full of trust.

Then there’s this additional problem, as described by Dr. Davis in Undoctored:

There is a continual push to medicalize human life. Shyness is now “social anxiety disorder” to justify “treatment” with antidepressant medication; binging in the middle of the night is now “sleep-related eating disorder” to justify treatment with seizure medication and antidepressants; obesity, declared a disease by the FDA, justifies insurance payments for gastric bypass and lap-band. Don’t be surprised if sometime soon, bad dreams, between-meal hunger and excessive love of your cat are labeled diseases warranting treatment.

I read recently that 20% of American boys are diagnosed with ADHD by the time they reach high school and two-thirds of them end up being prescribed drugs — apparently for being energetic males who annoy teachers. Talk about medicalizing what used to be considered a normal part of life.

Here’s another quote from Dr. Kendrick:

As for the elderly, it has become virtually impossible to find anyone taking fewer than four or five separate medications. One of my jobs is working in Intermediate Care where I help to look after elderly people, many of whom have suffered an injury or fracture of some sort. When patients enter this unit, the average number of medications taken is ten. That is ten different drugs, to be taken each and every day, some of them three or four times each day. I suppose it saves on buying food.

Yes, it’s true: people don’t trust doctors like they once did. But it’s not because people are stupid. It’s because they’re smart. It’s because they can do their own research and share experiences with others online. It’s because they’ve learned the hard way that far too often, simply following the doctor’s orders doesn’t heal what ails them.

Personally, I think it would be great if surveys 30 years from now show a renewed faith in the health-care profession. But for that to happens, it’s the profession that needs to change, not the rest of us.


75 thoughts on “If You Don’t Trust Doctors, You’ll Die From Ebola. Or Something Like That.

  1. Barbara

    I take warfarin, I’ve had several blood clots. My insurance will allow me to do self monitoring at home with my doctor’s approval. When I asked if he would approve, he reacted like I was asking to do my own surgery. He denied it and said that he would do the blood stick in the office. I told him that every office visit is a $40 co-pay plus any interpretive charges they’d like to add on. He poo-poo’d that saying that he knows another patient that only pays $5 per office visit. I explained that I am self employed and do not work for a large corporation that gets platinum health care…I’m lucky that I can afford the silver plan. I also explained that at the age of 63 I was more than capable to poke my finger, get a drop of blood on a test strip and call in the results. He completely ignored me. Told me to sign a release so he could get my medical files from the doctor that retired who had been monitoring my INR. I took the form, walked out and will never go back. Dr. Khullar is correct, trust has to be earned…but I keep seeing a money grab. Looking for a new doctor, preferably one that is a functional doctor.

  2. Wayne Gage

    My doctor may be considering dropping me. I have refused to follow his advice of prescribed statins.
    My cholesterol readings of last month Total cholesterol 294, HDL 100, triglycerides 73 and Calculated..note, calculated not measured VLDL 15, and LDL of 179.
    Last year my doctor sat me down and spent 15 minutes explaining why I needed statins, I still refused the prescription. Not all doctors follow the cholesterol recommendations. Maybe I should change doctors but other than his insistence on statins, he is a very good doctor. He is not happy with my “self diagnosis.”

    1. Tom Naughton Post author

      You can always do what a doctor on Jimmy Moore’s show suggested: if you otherwise like your doctor, don’t argue about statins. Just don’t fill the prescription.

  3. Michael Cohen

    I am 69 years old. After a routine stress test which proved negative. The cardiologist administering the test looked at my last lipid panel and repeated my TC number. Your cholesterol is 200, that’s not too bad, but at your age, given the fact that your risk factors for having a coronary event are greater than 7.5% in the next ten years, I think that you should be on a statin. I reminded him that my chances of dying of anything in the next ten years were greater than 7.5%. He had no sense of irony or dissonance. These were the new guidelines and “standard of care” so they had to be followed. I said “That means almost everyone should be on a statin” Of course I refused. I showed him (among other things) the Lipitor ad showing an absolute risk reduction in small letters of 1%, opposed th the advertised relative risk reduction of 34%. He said “I dont contest those numbers, but do you want to be in that 1% ?” I said given the side effects and the fact that they dont work, of course I do.

    1. Tom Naughton Post author

      The AHA’s new guidelines are working as intended, creating millions of new customers for statins.

  4. Joshua

    Doctors lose my trust when they lose their humility. There’s a LOT they don’t know, and not all of them are comfortable admitting that – maybe even to themselves. I feel so much more comfortable with a doctor who says “Hmmm. I don’t know what’s going on here, but here’s my theory, and here’s why I think we should do this and see if it works.” than with a doctor who says “Yep, got a case of heeby-jeebies here. Do this, that, and the other and you’ll be fine in a week.” All too often it turns out to be the yibby dibbies instead of the heeby-jeebies, and I’m not inclined to go back to somebody who was so confidently wrong.

    1. Tom Naughton Post author

      In Undoctored, Dr. Davis explains that generations of doctors were trained to never express doubts, the theory being that patients needed to have complete confidence in the doctor. Like you, I have more confidence in people who can admit they don’t always know the answer.

      1. KidPsych

        In fairness, some clients do make that demand of me. I tend to be very open about what I don’t know and always try to match recommendations with the realities of people’s lives. There are some who absolutely come to me to hear something definitive. I can recall one father (whose son was depressed, likely triggered by excessive smoking during pregnancy – a sad case) who nearly leapt out of his chair when I asked the simple question, “What do you need?” He was a big feller, and for a brief instant I remember thinking, he’s going to deck me. People in crisis often need that feeling of someone being in charge – who can remove the pain for a moment by laying out a definitive plan. Not disagreeing with anything written here, just noting that there is some nuance that might be added to the discussion.

  5. Firebird7478

    “Binging in the middle of the night is now “sleep-related eating disorder” to justify treatment with seizure medication and antidepressants.”

    I think I have mentioned this before but there is documentation that, before the electronic age, humans had what was known as “two sleeps”. People would go to bed at say, 9 PM. They’d sleep for 4 hours, wake up then spend an hour or so reading, praying, eating, have sex, visit neighbors, then go back to bed and sleep for another 4 hours.

    This is mentioned in literature and they have uncovered medical documentation, including a note from a French doctor in the 1500s. His patient came to him with complaints that she could not conceive. The doctor recommended that instead of having sex before going to bed, she and her husband should first relax and go to sleep, then try when they wake up in between the first and second sleep of the evening. The records indicated that the advice worked.

    Fast forward to the present. The doctor would put this woman on anxiety medication, something for sleep and Rx fertility drugs.

  6. Walter

    If the doctors want to be trusted they *need* to be trustworthy. One of my friends asked the doctor what he would do in her position after he gave his advice. He didn’t answer.

    I know that giving honest advice could cost him his license, a big law suit , being dropped by the insurance company inclusive or his employer, but you shouldn’t trust anyone who won’t give his (or her) honest opinion.

    1. Tom Naughton Post author

      Yes, to be fair to doctors, they’re often operating under protocol restrictions. But that’s just another reason for us not to blindly follow the advice.

  7. Bonnie

    After having been misdiagnosed several times – by different doctors – why in the world would I want to blindly trust any doctor? I like & trust my doctor, but I don’t ask her for advice about my t2 diabetes – she doesn’t know anything more than what the ADA recommends. I also turned down the statin prescription – she just said, “OK.” And that was that!

    After reading about the possible side affects, husband stopped taking his statin – with his doctor’s full approval. (He said the doctor was muttering about the insanity of having elderly people take a statin.) But Medicare Part D wasn’t happy – they sent multiple notices saying husband should be taking a statin. They finally stopped bugging him when we put a stop to the insurance. I hadn’t known then that Part D is private insurance, but under the Medicare umbrella.

    1. Tom Naughton Post author

      At least your husband’s doctor recognizes the insanity of giving statins to old folks. My mom’s doctor put an 82-year-old woman with memory issues on the @#$%ing things.

  8. chris c

    “My” doctor is actually pretty good, and she has obviously learned from experience over the years. The problem is she is usually so busy I can’t get an appointment within three or four weeks, and if her list goes over four weeks “the computer” refuses to book appointments altogether.

    One of the others came highly recommended by some patients and the now retired head of the practice. Well he may be an excellent diagnostician and probably good with acute illnesses but with chronic conditions, not so much. He regards himself as “evidence based” without understanding that half the evidence is missing. Yet he is insistent on being obeyed when he is completely wrong. Hmmm, he reminds me of someone, I can’t quite put a name to him.

      1. Walter

        “The task of filling out the blanks I’d rather leave to you, for they’d none of them be missed, they’d none of them be missed.” “The Mikado” by Gilbert and Sullivan

        Most people don’t know how weak the evidence is in most research especially in nutrition. Most doctors today are on a treadmill and have no time to critically read research papers.

        1. Tom Naughton Post author

          Dr. Eades told me that years ago. When the average doctor comes home from a day of being swamped, he isn’t going to sit down and read studies.

            1. Walter

              You read more papers than nearly all doctors. There may be exceptions in doctors that don’t take insurance, but few can afford them, and they are still subject to sanction from the Anointed.

            2. chris c

              “My explanation for doctors not reading medical journals is that they actually believe they receive all the information relevant to clinical practice through the guidelines developed by the experts in the field.”

              This, in the comments.

            3. Walter

              Doctors may not have the background to read research papers. Consider that the researchers may not understand statistics themselves and consider statistician as research antagonistic, because the researcher is primarily concerned in getting her paper published.

            4. Walter

              Actually they receive their training from detail people from big Pharma and Big Pharma provided shindigs.

          1. chris c

            Yes that’s a lot of it. I have actually heard of GPs in the UK complaining that their computers are locked down and they can only access “approved” sites like WebMD, NICE and NHS Evidence. At least mine has read papers I have printed out for her, and looked up the likes of David Unwin. Many doctors will not consider anything patients bring them, or tell them, only what they are fed from Official Sources. Not entirely their fault, and of course not following Convention Wisdom can get them into legal trouble with The Management, or worse like Noakes, Fettke et al. I haven’t heard of any doctors losing their jobs (yet) for using low carb diets for their diabetics but I have heard of several who were threatened. I HAVE heard of a few who were deregistered for prescribing T3 or Armour for thyroid though. Then they are paid “incentives” to prescribe statins and BP meds, and to run tests for things their patients probably don’t have. They are currently under a HUGE amount of pressure, a lot of which comes from the burden of treating obesity, diabetes and other metabolic diseases as if they were drug deficiencies. Or surgery deficiencies.

  9. Emily

    Not to mention the opiate crisis. Some doctors were and are blatantly criminal there — and that “some” sent millions of pills out into the wild. The majority of doctors who prescribed pain pills were well-meaning, but they believed what the pharmaceutical companies told them, which means they were not thinking critically and knew nothing of the history of medicine. Doctors figured out opiates were terrible for chronic pain in the 19th century, if not before. It is now being found (again) that opiates increase long-term chronic pain, something that a whole lot of us pain patients have been telling doctors for years.

    So now we have a lot of people who don’t trust doctors on anything whatsoever, which is a pretty serious problem. You don’t want a population that resorts to magic crystals for healing because they don’t trust scientifically proven treatments. But whose fault is that? Not the people who’ve seen their communities and families ravaged by prescription painkillers, found their anxiety disappear on high-fat diets, and had doctors refuse to treat them for sinus infections because the doctor is disgusted by their body shape.

    1. Walter

      Magic crystals at least do no harm and allow for homeostasis to kick in. Maybe they help people relax, which is usually helpful.

  10. Beatrix Willius

    The Favourite Sister (my only one) had cholesterol of 204 and a HB1AC of 5,8. The doctor said she should take a statin. I asked if the statin didn’t make diabetes in woman. He said: no, statins don’t make diabetes. The sister got a present of the book from Jason Fung and the doctor won’t get a repeat visit.

    And don’t get me started on doctors in hospitals.

    1. Tom Naughton Post author

      A doctor wanted to put my diabetic father-in-law on a statin as well. Apparently a lot of doctors aren’t aware that even the FDA officially recognizes that statins may produce diabetes.

      1. Dianne

        Statins may produce diabetes? Yikes — I wonder if my doctor knows that. She’s always urging me to lower my blood sugars and A1c, which are edging into the pre-diabetic range, and at the same time keeps trying to put me on statins. (My chiropractor, who is very much into nutrition and natural health, says my cholesterol levels are fine.)

          1. Firebird7478

            My osteopath is, and she enjoyed reading “Fat Head Kids” but she felt her 11 year old son wasn’t ready for it.

  11. Stefan

    Went to see a urologists a few years back. Minor issue but persistent. Doc says “I’ll put you on a short course of antibiotics, that should clear it”, and writes a prescription for a fluoroquinone (a certain category of antibiotics). I looked at him and said that I won’t be taking any fluoroquinone because I already had trouble with achilles tendonitis. His facial expression was somewhat between amused and annoyed. When I asked him to read the patient leaflet (which states that quinolones are at least associated with increased cases of tendinopathy) he looked more like I told him that his wife had an affair. To his credit he did grab what looked like a worn out copy of a medical text book and sure enough it advises caution in patients with prior tendonitis. We then quickly agreed that a different class of antibiotics would be ok, too.
    Which begs the question: who should be charging whom for what service?

    1. Tom Naughton Post author

      In some cases, you’re paying the doctor for his or her role as the gatekeeper of prescription drugs.

      1. Kathy in OK

        That’s exactly why I see my doc once a year. I take one “maintenance” drug. Will I die without it? No. Will I be miserable without it? Yes, so quality of life comes into play. I have yet to find something non-Rx that works, but I keep looking. Other than that, at 70 I’m in pretty good shape.

        Off topic………

        We moved from the DFW area of Texas to Tulsa OK about 18 months ago. Couple of things I’ve found out lately from the news:

        1 in 7 Tulsans suffers from mental illness. (Is this high, or am I just clueless?)
        The #1 prescribed drug in Oklahoma is hydrocodone/acetaminophen.
        And I won’t even go into the state economy and the public school issues.

        My Tulsan sister-in-law asked me if I thought I’d miss Texas when we announced we were moving up here. I said no. Maybe I was wrong.

    2. Cameron

      Every time I take my daughter for her checkups I end up bringing medical literature along. “Here is why I said your advice about not feeding peanuts is no longer considered accurate.” “Here is the research showing why continuing to serve whole fat milk past the age of 1 year is beneficial.” “etc”.

      The doctor always thanks me and says she will read it. No idea if she actually does, but I’m glad that on the surface she atleast pretends to take my concerns seriously.

      1. Tom Naughton Post author

        I guess pretending is better than giving you a “I’m the doctor and you’re not” speech.

  12. Lori Miller

    This excerpt from an article in the Washington Post called “Liberia Already Had Only a Few Dozen of its Own Doctors. Then Came Ebola” might help explain why Liberians don’t have much trust in doctors:

    “There is no incinerator, so a 10-foot pile of Ebola-laced garbage and excrement sits in the back yard [of JFK Hospital]. There is no morgue, so bodies sometimes decay outside, next to where patients sit in white lawn chairs. There are no protective hoods for the full-body medical suits, so the health workers cut theirs out of extra Tyvek material. Moses, the top doctor here, received only one day of Ebola training.”

    Tragic, but what in the world does this have to do with diabetes, opioids, pharmaceutical company shenanigans, or rigged research in the US?

    1. Tom Naughton Post author

      Yeah, I kind of figured we’re talking about two wildly different systems. Trust in one has no bearing on trust in the other.

  13. Karen

    I developed appendicitis over a weekend and was seen in ER and had surgery the same day. First, I’m a person with no health issues, takes herbs and vitamins, follows Dr Williams Wheat Belly program and feels my health depends on me staying as far away from doctors as I can.
    I told every medical person I saw from ER to surgery that there was on class of drugs I would not take and that was flouroquins. Being discharged the next day the surgeon said he was sending me home on Cipro. I said no, he said why? I told him what U’d read about them and my past history of tendinitis several times, he said you only have a problem with this drug if you are in them a long time. He made me feel really stupid- he had a young resident with him he had to impress. We got the Rx filled, read all the papers and called the office and said Iveill not take these drugs. He was not pleased. At the 2 wk follow up I took the papers with me with info highlighted and told him what he told me was absolutely not true and he needed to educate himself before giving bad info to anyone else.

    1. Tom Naughton Post author

      If there’s a “difficult patient” list that follows you around (as in an episode of Seinfeld), you’re probably on it now.

    2. Bob Niland

      Karen wrote: «I developed appendicitis over a weekend and was seen in ER and had surgery the same day.»

      Was appendectomy the only treatment option offered?

      re: «…takes herbs and vitamins, follows Dr Williams Wheat Belly program…»

      What vintage of the Wheat Belly program? Prior to 2014 (circa Wheat Belly Total Health), the program didn’t include any specific advice on microbiome.

      The human appendix was long thought to be a “vestigial” organ. It used to be routinely removed. In the 1950s, a kid that still had one might feel left out. It’s now conjectured to be a reservoir of gut flora, perhaps ancestrally used to repopulate the gut after an ill-considered meal of rotten mastodon resulted in violent bidirectional gut evacuation.

      I’m a contributor on the Wheat Belly and Undoctored programs, and I don’t recall seeing any reports of appendix problems in people subsequent to following the 2014+ program, which is interesting. It may be that people deliberately cultivating gut flora don’t get appendicitis, but there’s likely not enough data yet to say one way or the other. Unsurprisingly, the program has no treatment suggestions for appendicitis that might be less invasive and irrevocable vs. appendectomy.

      Separately, there’s also not yet any specific program advice for people who have already undergone appendectomy. It may be that they need to be more attentive to probiotic support (live-culture fermented foods, more frequent courses of deliberate probiotics). Chances are any hints on that are hard to detect, due to the noise of what appears to be pervasive SIBO in the population at large. SIBO may also play a role in appendicitis, for those on standard diets — as might excess use of antibiotics.

  14. Jeffrey T Ranney

    This article explains it ALL. I do not like the feeling of distrust in my medical care. It is such a shame, as they say, to be in the same room with a person with a white coat and stethescope, and YOU be the smartest one in the room.
    Doctors get no nutrition training in 8 years of schooling, and once out and in practice, are hammered by the drug reps to prescribe their drugs and win the trip to Las Vegas in December.
    So, we do it on our own and put our questions out to the Wisdom of Crowds. Doing so, we more than often always get the correct answer!
    Keep it up, Tom!

    1. Tom Naughton Post author

      The goods news is that I saw an article recently describing how younger doctors are complaining that medical school doesn’t include enough good courses on nutrition. Maybe things will change.

        1. Tom Naughton Post author

          Kudos to the doctor, though, for saying obesity is complicated and we shouldn’t infer that it’s just a matter of willpower.

    1. BobM

      In about the middle of my low carb experience, I went high(er) fat. While that helps create (blow or pinprick) nice ketone numbers, I’m not sure it’s beneficial. I’ve since gone to low(er) fat, high(er) protein, and I do find protein filling. I think it allows a longer time period between eating. I also used a continuous glucose monitor, looking for delayed gluconeogenesis, but could not find any. 1 pound ground beef causes zero blood sugar rise (whereas even small amounts of potatoes skyrocket my blood sugar). I’d love to have an insulin meter, to see what happens there too (and glucagon while we’re at it).

      Currently, I eat a lot of meat, very low amount of vegetables, that’s basically it. I tried probiotics/prebiotics (eg, potato starch, plantain flour, even heated/cooled rice or potatoes at times), and that seemed to cause IBS and the like. I still eat fermented foods such as pickles, though I have trouble with some such as sauerkraut. While I will eat potatoes and other tubers at times, they wreak havoc with my blood sugar, so I limit them. I still perform intermittent fasting (36+ hours at times, rarely eat breakfast, sometimes eat bfast but no lunch, etc.) I find intermittent fasting to be highly beneficial.

      I’ll be getting a follow up DEXA (dual energy X-ray absorptometry) scan to see what my real muscle mass gain/weight loss is.

      Anyway, I think there are many ways to skin a cat, and his weight loss is astounding.

      Tom, you might consider a blog entry as to what to do when someone you primary agree with says something you don’t agree with. I like the Wheat Belly doctor, but he had a blog entry about keto being bad. I posted there and think I got kicked off. Anyway, one of the reasons he gave about not being in keto all the time concerned a study that used corn oil. Corn oil is so bad on so many levels that to use that as evidence that keto is bad is just wrong. Also, as someone who has been at keto or near it for many years (4+ now), it’s quite difficult to remain in keto, especially while eating higher protein, which lowers ketosis. (The only way for me to get above 1.0 BOHB levels is to eat fat or fast multiple days.) I find if I have a stew, I can eat the meat, but if I have ANY of the sauce, I’m out of ketosis (defined as BOHB < 0.5). If I eat high protein, then more vegetables than I normally do, I'm out of ketosis. So, when it comes to ketosis, I think the Wheat Belly doctor really does not know what he's talking about. I have a hard time going back to visit his site when I believe he's wrong or at least clueless on this issue.

      1. Tom Naughton Post author

        I don’t try to stay in ketosis all the time because I don’t think it’s necessary for most of us. Beneficial for some, but actually necessary for very few.

        Higher protein works better for me, even though it kicks me out of ketosis, at least as measured on a meter.

        1. chris c

          I suspect but can’t prove that what happens is you only produce ketones at about the same rate you metabolise them, so after a while you don’t get enough hanging around in your blood to register.

          I go by the Mk 1 Nose, if my early morning pee smells of ketones but not so much during the rest of the day then I’m probably on track. The second and most obvious indicator is that I go for hours without getting hungry so I am living off stored energy from the previous day’s meal(s).


          1. Tom Naughton Post author

            I’m pretty sure I drift in and out of ketosis over the course of a week. I don’t measure anymore because there’s no point to it. It’s not as if I’m going to change my diet based on the measurements.

  15. Walter

    Lest it escape anyone’s attention many people trusted their doctor and ended up hung up on opioids.

  16. Dianne

    Tom, your new header graphic disappeared a couple of days ago. All I get in that space is a lot of white and one tiny box with an X in it, which does nothing when I click on it. Is it your site or my computer?

    1. Tom Naughton Post author

      Yeah, we’re having a WordPress issue. Chareva’s working on trying to upload a new one. From what we’re read online, it’s a common issue with WordPress.

      1. Dianne

        It’s back now, and this one’s better than ever. Clever of you to marry such a smart, artistic gal!

        1. Tom Naughton Post author

          Clever, or perhaps just dumb luck. She hadn’t studied art yet when we got married, and I had no idea she’d end up being my graphic artist. I love her drawings.

  17. Kathy in OK

    I keep forgetting to mention how much I like the newer header over the last one. Will we one day be able to click on a detail on the header – say the farm pics – and be taken to posts regarding that topic?

    1. Tom Naughton Post author

      Hadn’t thought of that. Not sure WordPress has that capability. I had to manually edit one of the .php files just to get the derned graphic to show up.

  18. Kathy in OK

    Life is so much simpler (mine) when you don’t know what makes everything work. I tried to learn to code several years ago, but my attention span is too short. I like to learn stuff, but once I grasp the concepts, I want to move on to something else. So I cook, sew, paint, work leather, work in stained/leaded glass, engrave/etch glass, metal, wood,etc. I’m not good enough to make a living at any of it, but I own a lot of expensive tools. My point, I guess, is that I appreciate your dedication. Thanks.

    1. Tom Naughton Post author

      I’m a big believer in learning what I need to know when I need to know it. I didn’t know how to animate when we made Fat Head, so I paid an animator. This time I wanted to do the animation myself, so I pounded through several Lynda.com courses and learned just enough to do the animations we need for this film. If I don’t have a task to accomplish, I’m far less curious.

  19. Irma

    Great post!

    People forget that not all of the doctors out there graduate at the top of the class. There are plenty who got their credentials by just scraping by. Just like incompetent plumbers and electricians and dare I say, nurses. People go into these careers for the money, not to help people.

    My previous doctor laughed at me when I saw him to report that I was having chest and breathing problems after a chemical spill at work. He told me that I did not have the right symptoms for respiratory damage. I told him “I was there. The whole department was there. We left work half way through the day because you could not breathe”.

    He also recommended statins for me. And he thought I should get a hysterectomy; 3 times he mentioned it in 5 minutes. I went online and discovered that hysterectomy is the most prescribed treatment for women above the other 9 or 10 potential treatments because the doctor got $500 for it and the other non-body part removal treatments only paid out $200.

    I said I want to know why I have the problem. I do not want to remove body parts just to get rid of symptoms.

    Unfortunately we have a real shortage of doctors here and I had to keep seeing this quack. Now I drive 40 minutes to another community to see an actual doctor.

    1. Tom Naughton Post author

      I’m a little less cynical about doctors. I’m sure some go into the profession for the money, but I’ve also met doctors who seem to genuinely care about people and want to help them. I’ve gotten nothing but good vibes from the surgeon who fixed my knee five years ago and my shoulder and bicep recently, to name one example. He no doubt enjoys the surgeon’s income, but if he doesn’t care about his patients, he’s a helluva good actor.

  20. Jane

    I love your website and I’ve made everyone in my family watch your movie. In fact, my son wrote one of his college essays on the Ancel Keys debacle. (PS he was accepted to the University that he submitted it to.)

    Anyway, I’m currently having an ongoing debate with my primary care doctor. I had less than optimal results on a recent CIMT and she wants to put me on a Statin. I’m very hesitant to do so because I have been on them before and had adverse effects. She says that statins have been proven to stabilize arterial plaque and to decrease inflammation. Can anyone point me in the direction of any scholarly studies or papers that contradict or question the current thinking that statins stabilize arterial plaques? I’m not looking for medical advice, I just want to read some of these studies myself.

    Thanks so much, Jane

  21. Stuart

    I can top that. My 92yo mother’s cardiologist keeps trying to put her on a statin despite:
    – evidence that statins do not reduce heart attacks in women
    – evidence that statins do not reduce heart attacks in either gender after 65yo
    – elderly people with higher cholesterol live longer
    Luckily my mother has refused them. The irony is that not only does this female cardiologist appear to be ignorant of the most basic facts about statins, she is probably ruining her own health by taking the damn stuff herself.

    1. Stuart

      My comment above was a response to Tom’s comment of March 31 beginning “A doctor wanted to put my diabetic father-in-law on a statin as well”. I’m not sure why the comment posted out of order.


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