I got an interesting email over the weekend from a 56-year-old type 2 diabetic. He was diagnosed at age 42. He initially managed this as he was advised: with a high carbohydrate, low fat diet. He moved to ‘healthy’ grains that were ‘less refined’ and ate sourdough bread. In his own words: “And despite all of this, I saw no improvement, in fact I gained weight to around 90 kg before changing my diet at the start of the year.” The man in question ended up reading the book Primal Body, Primal Mind by Nora T Gedaudas after hearing her featured on a podcast.

After reading Nora’s book, he followed most of her advice and then slowly extricated himself from the wheat and grain-dominated foods that he “was supposed to eat to obtain energy and remain healthy.” He started eating animal fats for the first time in years and gave up alcohol. Here’s his email to me:

I had my 6 monthly diabetes check-up last Wednesday. The diabetes consultant was really happy with all of my figures on cholesterol, triglycerides, blood pressure, weight (I’ve lost another 4 kg since February without really trying), kidney and liver function are excellent – in fact he was really impressed and asked me what I was doing to get these improvements. Simple, I said, I’ve stopped eating wheat in all its forms and grains in general, I avoid rice and all potato products. I eat animal fat and the only oil that I use is extra virgin olive oil. Breakfast is typically a one-egg omelette and with a small amount of bacon, smoked salmon or Parma ham. I have spinach or other leafy greens and tomatoes. Lunch is often not taken as I do not feel hungry until 6.00 pm when I have my evening meal. Another small portion of meat and plenty of veggies. The only fruit that I have are a few blueberries, wild strawberries (when they are available) and raspberries – and I mean a few. I sleep better than ever, don’t feel tired and have lost weight. I really ought to exercise though, that is the only flaw in my regime. “No, you MUST eat some carbohydrates” he said. “I do, I told you, I eat plenty of vegetables.” I said. “No, no, starchy carbohydrates, you NEED them” “Why do I NEED them?” “For energy, your body needs carbohydrates for energy” came his concerned reply. “How do you think that I’ve managed to survive since you last saw me then? And, you told me how pleased you were with all of my readings – doesn’t that suggest that I’m doing fine without refined, starchy carbohydrates?” He had no reply other than to repeat to me that I MUST eat carbohydrates for energy. I urged him to read Primal Body, Primal Mind by Nora T Gedgaudas and made him write it down. I could see that he wasn’t convinced. So, I told him that the bullshit that he’d been taught by the food industry-research funded nonsense that the Government taught him is causing all of the major health problems that he has to deal with every day. I also said that I throw a fat-fuelled log onto the fire in the morning rather than the carbohydrate kindling throughout the day to keep me provided with energy and avoid the feeling of hunger. Again, nothing seemed to penetrate that simple head of his; it was full of the guff that he’d been taught not to question.

I decided to post this story because it represents to me many facets of a growing theme in the interactions patients have with their health and healthcare professionals. This is the sort of scenario I’m talking about (I’m using diabetes as an example, but the themes can apply to lots of conditions):

1. someone gets diagnosed with diabetes and takes conventional advice to eat a high-carbohydrate, low fat diet.

2. the diabetic finds it difficult to control blood sugar levels effectively, even with sometimes multiple medications.

3. the diabetic starts reading information on the internet and in books which explains why a high-carbohydrate diet is (generally) a disaster for diabetics and what works better (a diet richer in fat and adequate protein).

4. the diabetic decides to take matters into their own hands, changes their diet, and their blood sugar control and general health improve through the roof.

5. when their doctor finds out that their patient is eating a ‘fad’, ‘low-carb’ or ‘Atkins’ diet, they either elect not to engage with this, or positively dissuade the diabetic from taking this approach.

In this particular case, the doctor shows a mind-numbing ignorance about basic physiology (assuming he’s been quoted correctly): No-one needs to eat starchy carbohydrate (or any carbohydrate) for energy. For a start, fat is a suitable fuel for the body. Plus, sugar can be made from other dietary elements (e.g. protein) in the liver.

I fear that we doctors are going to have to ‘get with the programme’ by ensuring we are better educated about the impact of nutrition on health. And another thing we could do better, I think, is not to dismiss our patients who have been motivated enough to educate and help themselves, and in so doing have experienced significant improvements in their health and wellbeing. Isn’t it by listening to patients that we doctors get to know what works and what doesn’t? And won’t this information and experience be invaluable to us when we come to advise other patients?

The age of the internet means patients can quite easily know much more about their health and health management than their doctors. Rather than dismiss what they have discovered, I suggest we doctors embrace these experiences and learn from them. That is, of course, if we care about our patients getting the best advice and support possible.