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8: What Questions Should I Ask My (Non-Low-Carb Friendly) Doc? | Dr. Mary Vernon

8: What Questions Should I Ask My (Non-Low-Carb Friendly) Doc? | Dr. Mary Vernon

AIR DATE: March 1, 2012 at 7PM ET
FEATURED EXPERT: Dr. Mary Vernon
FEATURED TOPIC: “What Questions Should I Ask My (Non-Low-Carb Friendly) Doc?”

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Famed low-carb clinician Dr. Mary Vernon, MD is the co-author of Atkins Diabetes Revolution with Jackie Eberstein, RN (who was our very first guest in Episode 1 of ATLCX). She is a Past President of the American Society of Bariatric Physicians. Dr. Vernon is well-known amongst her medical professional peers as an expert on the therapeutic use of low-carb ketogenic diets on patients to treat a variety of health issues, including diabetes and metabolic syndrome. She is the CEO of Innovative Metabolic Solutions which seeks to educate her fellow physicians and medical professionals on how to use science-based modalities with patients. Dr. Vernon has a heart for arming doctors with practical ways to implement low-carb diets where they are necessary for improving key health markers. What better expert could we have to address what questions you should be asking your (non-low-carb friendly) doctor than her!

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Here are some of the questions we addressed in this podcast:

KELLY ASKS:
My frustration with doctors is they spout the conventional “wisdom” of the food pyramid or MyPlate or whatever it is now, but yet when it doesn’t work for me they say I’m just not trying hard enough – which is without a doubt not true. So I guess my question would be – If something isn’t working, wouldn’t it be smart to try something else? And really – where are the medical studies that back up that a low fat diet is better for my health? Where are the studies that correlate fat = heart disease? If I lose weight (even if it’s a small amount) and feel better and have lower blood sugar on a low-carb diet, then shouldn’t I stick to something that’s working? And is it so wrong that I want to be personally involved in my health enough that I HAVE done research and have looked up the studies and that I might actually have a working knowledge of what is best for my body?

CONRAD ASKS:
I am currently in the process of looking for a new Doctor (already checked http://lowcarbdoctors.blogspot.com/) What questions can I ask before visiting to find out if they might support a low carb lifestyle, other than the obvious “Do you support low-carb, high-fat diets?” I have read that I should make sure they perform and understand a VAP instead of standard cholesterol test. Are there any other tests or procedures I should be aware of and ask for?

KATHY ASKS:
I just got my lab work back from my doctor and my total cholesterol was 249 with LDL at 171 and my sugar at 103. That’s basically all he said and then of course, “I’d like to start you on a low dose statin, keep eating a low carb, low cholesterol diet”. The cholesterol is up a little and so is the LDL from 6 months ago. I am not a diabetic and have never had problem with that. I wanted him to run an NMR. My doctor called me and had absolutely no idea what the NMR Lipoprofile test was even after I gave him the CPT code. Then he went on to say “size doesn’t really matter and thats for HDL, not LDL. And if I went to any hospital they wouldn’t know what an NMR test was.” So, he is having me do a VAP profile test. He said, “elevated LDL is bad no matter what the size.” Mine isn’t horrible for a women without a risk factor, but it keeps going up. Any suggestions?

MIKE ASKS:
How do you have a conversation with your doctor about putting you on a statin drug with and HDL of 75 and triglycerides of 80 when your LDL is 225? I got these numbers in a blood test at my doctor’s office after consuming a low-carb diet.

KATHY ASKS:
How should patients deal with doctors who want to follow the guidelines put out by a group like the American Heart Association or American Diabetes Association if that association’s guidelines aren’t in keeping with our own opinions of current best evidence or even n=1 experiments we’ve done on ourselves? Sometimes doctors seem to think they have to follow those association-based guidelines to protect themselves against malpractice, do they have a point? How do we get around that if we believe those organizations aren’t up to date with their evidence or if we think the guidelines are politically motivated or otherwise flawed?

JOHN ASKS:
I’m a Type 1 diabetic and I believe I suffer from insulin resistance. I use 18.3 units for basal and my TDD on 10% carbs and 25% protein runs in the high 30’s. Whenever I fast, even for a single meal, I get a major liver dump at the next meal followed by some major cravings which seem to counter any benefits I might have seen from fasting. I’m stuck in my weight loss, and I think Metformin or a GLP-1 would help. Symlin is not an option where I live in Canada. My endocrinologist says my TDD insulin is already much lower than “normal” and refuses to consider giving me a prescription. He’s the local head of internal medicine and is known for not listening to colleagues. Any suggestions on how to proceed would be helpful.

SPARKY ASKS:
I would love to go to a doctor and find out what all my lipid numbers and thyroid numbers are. But I dread talking about my diet — I can’t defend it in terms of weight loss, because I weigh only about five pounds less than when I first started low-carbing 10 years ago. (Although a lot of women gain weight during their 40s, so maybe I’m better off than I think!)

There are no low-carb friendly doctors where I am (at least none listed on Jimmy’s List of Low-Carb Doctors blog).

I’m afraid of getting caught in the gears of the medical machinery. For example, what if my cholesterol is “high” and they want me to take statins?

Can you just go to your family practice doctor and say, “I want these tests, please have them done for me”? What exact tests should I ask for? I don’t want just a couple of numbers that don’t REALLY tell anyone anything, which seems to be what most people wind up with.

I suspect thyroid issues (20 extra pounds of fat won’t go away, cold hands and feet, dry skin). Also, one hand or the other occasionally gets a pins-and-needles feeling — I have no idea what that could mean.

I just turned 50 and am in excellent health overall. I have regular periods, no change in that regard. I haven’t had a checkup for nearly 8 years, since my last postpartum checkup. I’ve never had cholesterol tested or a glucose tolerance test. Blood pressure has always been around 90/70.

I’ve eaten mostly real, whole foods since I was a teenager (including 17 years of vegetarianism), and mostly low-carb/Paleo/Weston A. Price for the past several years. I keep the carbs to around 25-75g and rarely eat wheat or other grains.

PENNY ASKS:
While my mother’s doctor always congratulates her on her steady weight loss (and better blood sugar level control) he never fails to tell her that cutting back on her carbs is going to cause more problems in the long run. He points out that her cholesterol levels are elevated above normal, caused by eating too much saturated fat of course, and her refusing to take statins, which caused her muscle pain in the past, is leading her to a massive heart attack. She never knows how to respond to him so I thought perhaps giving him a book to read might be one solution. I was wondering if Dr. Vernon might suggest a book that she could give to her doctor that he might read? I know there are many books out there written for the average person who does not have a medical background. Is there a book that perhaps would carry more weight with an MD and not just be seen as a fad diet book? Because the doctor is probably not going to read that type of book.

BRIAN ASKS:
My low-carb doctor may lean even too far away from statins and other medications. When should I really think is the right time to take a pharmaceutical drug — in other words is there a risk of having too much of a low-carb friendly doc?

JOCELYN ASKS:
So, my friend went to see her doctor yesterday. Her HDL is 57, her LDL is 135. She got a heart scan a while back and got a value of 19. Her doctor prescribed a statin for her. My friend asked her Doctor to do a VAP test and the doctor said that she already knows that she is starting to have some heart disease starting, so she doesn’t need the VAP test. My friend has been starting to read Robb Wolf’s book and other Paleo people’s information, so, she’s getting wild ideas like saying no to statins. Her doctor is slightly insulted that my friend is ignoring her advice. “When you get heart disease will you go to your friends and the internet for help?” I told her to find another doctor, but she apparently wants to stay with this doctor. How would you approach this doctor? But, how would you educate a doctor who already seems to be on the defensive about learning new things about cholesterol and statins?

ROCHELLE ASKS:
I did attempt to speak with my doctor recently. I had recently gotten some blood work back and he said, for someone with such a high BMI (30) I didn’t deserve such good numbers.

Total Cholesterol 222, HDL=90, LDL=118, non-HDL=132, Triglycerides=68, Glu=84, HbA1C=5.1

I told him that I had started eating Paleo.

He did note that I still needed to lose some weight. I’ve lost about 30 lbs since starting Paleo. I asked him how he would suggest that I accomplish that.

He said he recently decided that he needed to get his BMI down. He did what he tells his patients to do. He restricted his calories and exercised more. It’s painful, but it works.

I asked him what he ate. He said a bagel in the morning. A yogurt for lunch and a regular dinner but no dessert. I asked him if he’d read “Good Calories, Bad Calories”. He said no, I don’t care about that. It doesn’t matter where the calories come from, you can eat 1200 calories of whale blubber and you’ll lose weight. I told him that I cut out the grains and sugar and it was *not* painful. He said, “Come back when you’re at your goal weight and we’ll redo all those numbers and we’ll talk.”

He is about ready to retire. Should I even bother trying to talk to him about other ways of eating and getting healthy? Or should I find a new doctor? I looked on both the Paleo physicians network and the low-carb doc site and there are a couple of oriental medicine practitioners and a chiropractor. They don’t seem to be on my insurance plan.

So…what’s a woman to do?

DAN ASKS:
I’m a type 2 diabetic who has been on low carb (Dr. Bernstein’s Plan) for about 6 years. Last year I found a low carb doc from Jimmy’s list. He favors South Beach phase 1. The only problem is that he believes in the lipid hypothesis. At my last visit, he told me that, as a diabetic, my LDL needs to be 70, even though my cholesterol would be “normal” for a non-diabetic. He said that controlling my blood sugar will not prolong my life. Only getting my LDL down to 70 will prolong my life. The strong implication is that I will die an early death unless I get my LDL down to 70. He is very pushy about statins, though I have resisted the pressure. I tried to tell him that the studies show no conclusive benefit to statins, but he won’t buy it. Do you have any suggestions on how to handle it in addition to being stubborn in refusing to take statins?

HAROLD ASKS:
I am a Type 2 diabetic. At the time of my diagnosis two years ago, my triglyceride/HDL ratio was 6 to 1. Now, after carefully watching my postprandial glucose levels (rarely, if ever over 110) my triglyceride/ HDL level is down to 1.6 to 1. My cardiologist couldn’t care less about my triglycerides and only focuses on my LDL (which were 120) and wants me on statins, I refuse them. Here’s my question, what can I use to convince her that controlling my diabetes and my trigs/HDL ratio are greater heart risk factors than LDLs.

  • Skigirlred

    Dr. Mary Vernon… yay! Should be a great interview!!

    • Anonymous

      I can’t wait Laurie. :D

  • http://www.facebook.com/profile.php?id=1588669041 Sandra Gillanders

    Can’t wait. Jimmy can I just listen to the podcast somewhere? I am not very well versed in techno stuff.

    • Anonymous

      It’s cool! The show airs on iTunes and right here with a clickable play button on Friday. :)

  • Jeanine

    i would love to know what Dr. Mary Vernon food pyramid would look like and what type of person is the present pyramid for and wouldn’t it make more sense to have a food pyramid for each type of person

    • Anonymous

      Great question, but it’s not on the topic we are discussing in this episode: What Questions Should I Ask My (Non-Low-Carb Friendly) Doc? If you have a question germane to this subject, then email that to AskTheLowCarbExperts@gmail.com or fill out the form to the right. :) Thanks Jeanine!

  • Elizabeth Miller

    Hi Jimmy,
    I don’t know if you’ve addressed my questions with any of the other experts, but I’d like to know why I re-gained weight rapidly when on 4 holidays occasions I ate some wheat and potatoes (seemingly unhinged from the caloric content) and have not been able to lose it when I return to my ketogenic diet. My fasting insulin and fasting blood glucose are low btw.

    As background I lived on a very high carb/ very low fat diet for 3 1/2 years and gained 50 pounds — the so-called heart healthy diet (whole and complex etc. – no white or SAD stuff for me). Mind you I was not over-weight when I started the experiment – I was trying to prevent heart disease. I have never felt so sick in my life! Anyway, I lost most of the weight via low carb, but regained a bunch of it as I said above when on 4 occasions I ate some wheat and potatoes. Have I now broken my metabolism to use carbs completely. Although I do not lose weight when I go back to low carb, thankfully I don’t gain either.

    I think part of the frustration with the low carb/paleo diets we’ve been reading around the interwebs is due to the fact that low carb stops working.

    Thanks in advance.

    • LLVLCBlog

      I wouldn’t say “low-carb stops working” if you are eating wheat and potatoes…sounds like high-carb isn’t working to control your weight gain. If you want to be successful on a low-carb lifestyle, then you really have to commit to being on it and staying on it for life. Sure, you’ll have the occasional time when you’ll want something off plan. But then you get right back on plan. Taking an entire holiday season off from the program is just asking for insulin to rise and the weight to pour back on. Even worse, your health is then compromised which then makes it more difficult to get your weight back under control. It’s a ruthless cycle. I’m happy to ask your question to a specific expert who is addressing your topic. THANKS for listening!

      • Elizabeth Miller

        Jimmy,

        I don’t think you understand my dilemma. I know I gained weight when I ‘cheated’ — rapidly. Much more than would be expected — I ate some wheat and potato — not a huge amount mind you, and put on 8 pounds each week on two occasions I went to Portland, five pounds in one week to Baltimore and 6 pounds during a 3 week holiday in France last September. I felt like I’d become a fat making machine. I hoped it was just water weight – but it wasn’t. And there’s no way I ate an additional 94,000 calories — I didn’t indulge that much by a long shot.
        It’s as if my body saw the presence of some starch as an opportunity to sequester fat – and not let go.

        I had no problem going back to my ketogenic ways and have remained on it. The ketostix are always nicely purple. Overall I have been on the diet for at least ten years. I stay on it because I like the other healthy results – large LDL, high HDL, etc. But the scale does not budge any more — that’s what I meant when I said the low carb diet has stopped working. My fasting blood glucose is always low and my fasting insulin is always under the low end of the lab’s range. In fact a salivary test for insulin was too low two hours after a carbohydrate meal I had to eat last year. My normal meals rarely send my blood glucose up much at all and it rarely goes up past 110 and usually doesn’t even break 100.

        After carefully reading a lot of the paleo blogs of late many of them report that ‘low carb’ stopped working and that paradoxically they found weight loss resumed by adding some starch. I obviously am afraid to try that approach because of my body’s tendency to add fat by even looking at starch — or wheat.

        Any way, I would appreciate it if you could ask any and all of your experts what they think is going on and how I might tweak the diet to get fat burning going again. Thanks so much for all that you do.

        • LLVLCBlog

          Go back and listen to my interview with Mark Sisson on ketosis. You don’t want to be in “dark purple” all the time on the Ketostix. Until you start burning ketones for fuel by becoming keto-adapted (fat-adapted), then weight loss will be a struggle.

          • Elizabeth Miller

            I’m usually just trace or small — not dark purple. The crazy thing is that I live on the same diet that I lost weight on previously – but now doesn’t work. In fact, I’m somewhat amazed at how stable my new higher weight is. But I’ll listen to it anyway.

          • LLVLCBlog

            You’re not alone. Some of us are so damaged from years of poor eating.

  • http://www.facebook.com/mindy.noxon.iannotti Mindy Noxon Iannotti

    Jimmy,
    I’d like to know what Mary thinks we should say in response to the prodding to eat carbs from our docs. I have an appointment next week – my doc will encourage me to have more fruit as she always does (I have small bits now and then), and she will push yogurt. She won’t push grains, she knows we have celicac in the family but otherwise she would. By the way, my “issue” is low energy – I have Hashimoto’s and adrenal fatigue diagnosed by cortisol tests – otherwise she might not care what I’m eating – so what does Mary suggest my “come back” should be?? Maybe I should just nod, smile, and do what I’m gonna do!

    • LLVLCBlog

      Mindy, you got it! I didn’t see this question before the interview, but when you listen to it in the podcast you’ll see you are spot on. Email me your questions to AskTheLowCarbExperts@gmail.com and I’ll do my best to get them on the air for you. :)

  • Heidi

    I can’t believe I missed this tonight! I absolutely love hearing what Dr. Vernon has to say, she is so positive with her message. Thank you to both of you for the excellent information.

  • Feinman

    Jimmy,
    Haven’t you incorporated this stuff in Tom’s speech at ORI conference?

    • LLVLCBlog

      What stuff specifically?

  • Feinman

    That is, have you? Smart type is in a negative mood.

  • PaulL

    Hi Jimmy,

    I just finished listening to this episode and loved it. However, I was looking for the “show notes” or links like you have on LLVLC.

    Specifically, I’m looking for more information on:
    - Eric Westman ? The person who showed that the Atkins diet was more effective for lowering trigs/cholesterol and the Amer. Diabetes Assoc. recommended diet
    - Eric Freedman? – wrote an article mentioned that I’d love to read
    - It was mentioned that American Diabetes Assoc. now recommends a low-carb diet. Links?

    I was driving while listening to the podcast, otherwise I would have taken notes! I’m hoping you have some quick links to this stuff, if not, I’ll go an re-listen to the podcast with a notebook handy :)