Keith Runyan, MD, is a retired
physician, with type 1 diabetes, who graduated from Emory University
School of Medicine in 1986. A vast majority of physicians he has
encountered during his career have the patient’s best interest in
mind and want to improve their health.
So if you learn about the benefits of a
low carbohydrate lifestyle from books, articles published in medical
journals, or God forbid, the INTERNET, you might wonder why your
doctor is either not supportive or even cautions you against it.
His description of what doctors do not know is funny. He says the answer is simpler than you might think.
It is not that your doctor does not want you to experience the
benefits. It is most likely that your doctor was not educated about
the effect of diet on disease. To understand this, let me give you
some background about medical education.
In order to get into medical school in
the first place, you have to be an excellent student. In our current
education system, being an excellent student means being able to
learn and retain lots of information in a short period of time and
accurately recall that information on a test or later in medical
training with their patients. It does not require that they be
creative thinkers or innovators, or question what they are being
taught. Once a student enters medical school, the amount and pace of
learning is accelerated further. There is literally no time to
question the validity of the material.
Most medical students have heard from
their wise professors the phrase, “half of what you just learned
is wrong, but we don’t know which half. However, that is a
difficult concept to accept given the time and effort spent learning
all that material. In essence, the overwhelming feeling at the end
of medical school is, I know I don’t know everything, but at least
I know what matters the most.”
The next piece to this puzzle is to
know that nutrition is barely discussed in most (not all) medical
schools. At Emory, in 1982, we had about 2 weeks of education in
“nutrition.” But, what was covered was how the body metabolizes
protein, carbohydrate, and fat, nutritional deficiency diseases, and
the nutritional requirements to prevent those diseases. The fact
that many chronic diseases like cancer, heart disease, diabetes, and
digestive diseases were rare prior the adoption of the Western diet
was not covered. He states that, “I did not learn this until
2011 when I read Good Calories, Bad Calories by Gary Taubes.”
Some physicians will be familiar with
the low carbohydrate diet already and others may be willing to learn
about it and support you especially when they see your condition is
improving as a result. However, other physicians may immediately
recognize it is not part of their armamentarium, therefore it must be
either not effective, or possibly dangerous, especially if the word
“ketosis” or “ketones” is mentioned. Although doctors should
know the difference between “nutritional ketosis” and
“ketoacidosis,” the term “nutritional ketosis” is only
mentioned in the context of a low carbohydrate ketogenic diet and
therefore is not discussed in medical school. So the only context in
which most doctors know about “ketosis” is one of the following:
starvation ketosis, diabetic ketoacidosis, or alcoholic ketoacidosis,
none of which are good.
Dr. Runyan says, “For reasons
that are beyond the scope of this article, it is best to have your
physician on board with your low carbohydrate lifestyle. It will
affect the need for or lack thereof of many of your medications.
There can be side effects that are easily corrected with knowledge of
how the diet works.”
I would advise reading the complete
blog as this only covers part of it. Dr. Runyan covers a lot in his
blog.
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