July 6 2017 by , medical review by in For doctors, Health problems

patient is angry on doctor because of medical error

I have a few patients in my low-carb/keto clinic who have had diabetes for decades. They learned a long time ago to count their carbs to adjust their insulin units. Having diabetes is part of their lives and identities. After all, they have been told from day one that type 2 diabetes is a chronic and progressive disease.

One day, you get the diagnosis from your doctor. In Canada, the vast majority of doctors monitor fasting blood sugar levels, and/or HbA1c as part of the routine yearly checkups. When a result comes back abnormal, doctors can send patients for an oral glucose tolerance test where patients have to drink a glass a liquid sugar, and their blood is drawn at 0, 60 and 120 minutes.

If your fasting glucose value, your HbA1c or your oral glucose tolerance test values are abnormal, you either get a diagnosis of diabetes, or are warned that you have pre-diabetes, and that it’s only a matter of time.

We now know that by the time you have this discussion with your doctor, the process has been going on for many years. If your insulin level had been tested, you could have been told you were becoming insulin resistant many years ago. On the path towards diabetes, but not there yet.
In Canada, if we did a Kraft insulin test on our patients instead of just dosing their blood sugar levels, we would get a whole different story. The Kraft insulin test measures the insulin response to a load of sugar. It can diagnose diabetes months to years before the oral glucose tolerance test can.

But then again, had you been diagnosed with insulin resistance, most doctors would have told you: eat less, exercise more, follow the food guide. That’s it.

Eat less, exercise more

As you’ve likely already read on DietDoctor, eating less and exercising more is not a strategy that works long term for most people. Counting calories is annoying and can rapidly make anyone become obsessive. Exercising for hours every day while trying to ignore your hunger can only last so long before you give up this masochistic and time-consuming approach. It’s useless suffering. Exercising is good for all kinds of reasons. But it’s not great for losing weight.

It’s a fallacy anyway. A simplistic, close-minded and ancient way of thinking. Because a calorie isn’t just a calorie. You can’t just create a negative caloric balance, and lose weight a little more every day until you reach a healthy weight. If it was that simple, we would all do it. There wouldn’t be an obesity epidemic worldwide. Not many people enjoy being overweight. Not many people are overweight on purpose.

As a matter of fact, the vast majority of my overweight patients have been dieting and cutting calories all their lives. Many have a gastric band, and eat less than 1000 calories a day. Yet, they are still overweight. And chronically tired. Most also have some form of chronic pain.

For doctors, though, it’s convenient. We put the blame on you. Instead of putting the blame on us for giving you the wrong advice for the past 4 or 5 decades, and for refusing to change our current views on the matter.

Follow the Food Guide

I believe following the Canadian Food Guide or most Western world food guides that promote carbs and demonize fats will end up in diabesity. For instance, the Canadian guide recommends young adults to eat between 6 and 8 servings of grains per day. That can easily amount to 176 g of carbs or more, which is the equivalent to 42 teaspoons of white sugar. And that’s just the grains. There are the fruit and the low-fat dairy products, which all add to the total amount of sugar ingested daily.

According to the Canadian Food Guide website, having the amount and type of food recommended will help reduce your risk of obesity, type 2 diabetes, heart disease, certain types of cancer and osteoporosis, as well as contribute to your overall health and vitality

But we know that the rates of obesity, type 2 diabetes, and heart disease have increased exponentially in the last decades. Is the proposed diet not working, or can people not comply with it? Either way, the end result is the same.

What does that tell you?

Is being sick the new normal?

Most of the patients who enroll in our low-carb program want to stop being sick. They are overweight, have diabetes, or chronically tired, they suffer from chronic pain, and they have none of the vitality the Food Guide said they should have. Most also feel they are not helped very much by their numerous medications.

However, Nurse Sylvie and I sometimes encounter patients who want to stop being sick, but who have a hard time adjusting to not being sick. They have had diabetes for most of their adult lives. They sometimes have diabetes jewelry, even type 2 diabetes tattoos! It’s part of who they are. They were told their disease was chronic and progressive, and that there was nothing they could do about it, except, of course, take their pills, and eventually their insulin.

We’ve had patients tell us not to lower their insulin, even when it’s clearly needed. Every small decrease was a battle, and was met with fear, tears and anxiety. We’ve also had people who dropped out of our program after a few weeks, despite the fact that they were doing great, losing weight and medications.

At first, I was totally confused by patients resisting me lowering their medication, and by successful patients dropping out halfway through.

I’m wondering if being sick hasn’t just become the new normal. Because it’s just so common. It’s normal to have type 2 diabetes. It’s normal to take multiple drugs. It’s normal to visit your doctor numerous times per year, and to be told that there is nothing you can do about your chronic diseases. It’s normal that your doctor’s only approach to your chronic diseases is to tell you to follow the food guide, and/or to prescribe you pills. It’s so frequent, it’s normal.

And many people don’t want to be outside of the norm. Even if that means not being sick anymore.

But being sick from diseases caused by lifestyle habits is NOT the new normal.

As a patient, do not accept such a fate. Do not get used to being sick. It is not part of your identity. It doesn’t have to be part of your life. Get healthy eating low carb, and spread the word around you.

As a doctor, do not accept that the chronic diseases of your patients caused by lifestyle habits are a fatality, and that there is nothing you can do about it. Patients are sick and will be sick? Glucose levels are rising and waist circumferences are increasing constantly? This is not normal. You can help change that. Coach them to go low-carb. Seeing them get healthier, now that’s the new normal.

—
Dr. Èvelyne Bourdua-Roy

Low Carb for Beginners

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Eat less, exercise more

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