Newly lost faith in health care

[Speaks]

Other casual observations:

1. "Health nut" in my experience has a high probability of just meaning "nut"...
2. Blood pressure meds are some, if not the, safest and most effective medications in existence. If my BP was genetically high (190/110, holy cripes) I'd be gobbling the BP meds.
3. Genetics are the end all. My grandmother smoked for over 40 year and lived to 85, basically completely healthy until the last couple months.

A person smoking for 40 years and not dying from it is not a proof point of anything. Even the popular add campaigns from several years back claimed "1 in 4 lifetime smokers die from it" meaning that 3 in 4 do not.

Out of curiosity, assuming your grandma did not take up smoking at 45 it sounds like she smoked from maybe 20 to 60? If true most of the risk would have been long gone long before she died.

Anyway I dont disagree that genetics are important but so it lots of other stuff, obesity kills a heck of a lot of people to claim that "genetics are the end all"

 

[Idaboy]

With all due respect...No...it is true. I didn't say all of them, just most. This is from Dr and nurses who have told me that. This is why there are dietitians and naturopath docs.

You guys have your talents and are highly trained and intelligent, and you have saved my life two times. But the majority do not even discuss diet options with any seriousness. And they should. There are a lot of diseases that have several factors with your diet bring one of the main biggest contributors.

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Pretty sure "most" get a fair amount of nutrition, biochemistry of metabolism, and lifestyle modification during medical education....and board exams for that matter.
Now, whether or not they retain that information, choose to apply to their patient care, or educate patients on it is likely where the divergence lies, and more likely where the gap exists in the delivery of health care for patients.
We have an F'd up system. But we also have great technologies and therapies in the US.
What guys seem to be arguing about on this thread (primary prevention, best practices, nutritional science and science of lifestyle) is unfortunately put in the rucksack of the primary care provider, whom are paid the least in our system. Let alone they need to know everything from the unborn, to pediatric kid, to an octagenarian with a crap load of health issues.
There's a lot of complementary options as you reference, and many people don't realize that besides seeing their doc, a functional medicine, naturopath or dietitian could really complement their care. I need a new PCP, but not sure I can get an MD right now and will probably need a PA/NP, which is fine, but also understanding they may be more knowledgeable on this stuff, or they may be pretty "green", and go ask the doctor for help......fortunately I got a week off in elk season, and I'm not due to see for my annual until 2026....good luck out there fellas, and be well!

 

[Pharmseller]

Pretty sure "most" get a fair amount of nutrition, biochemistry of metabolism, and lifestyle modification during medical education....and board exams for that matter.

That’s a bold statement.

Upon what experience do you assert this claim?




P

 

[OregonSteeler]

That’s a bold statement.

Upon what experience do you assert this claim?




P

He stayed in a Holiday Inn Express....Duh!

 

[JDBAK]

I just had my yearly physical and my results have me very frustrated. My lipid panel results showed LDL were “high”. No discussion was had about diet or exercise, nothing about my lifestyle or family history, just an immediate prescription for a statin.

-33yo, generally healthy (no major issues, some family history, some chronic pain etc)
-5’9” 185 lbs, <20%body fat
-moderately active throughout the winter and more into the summer and fall.

Not sure if this is a rant or asking opinions at this point. But I would like to find a doctor that is willing to talk through things, not just sign Rx and send me on my way

https://www.jacc.org/doi/10.1016/j.jacadv.2025.101686

I was part of this study. Lean Mass Hyper Responders: basically lean athletes on long term low carbohydrate diets with stratospherically high LDL cholesterol, but also low triglycerides and high HDL, nothing else obviously wrong with us (no diabetes, hypertension, etc), and no familial hyper-cholesterolemia.

Anyway, it raises serious doubts about diet heart hypothesis that we’ve been operating on for decades (high saturated fat leads to high cholesterol leads to heart disease). Maybe statins are appropriate, maybe they aren’t, but I wouldn’t take a doctor’s word on it just because LDL was high.

 

[Idaboy]

That’s a bold statement.

Upon what experience do you assert this claim?




P

Bold statement? So "most"'don't is not? But "most do" is a bold statement? I didn't say physicians devote their careers to diet and exercise physiology, and lifestyle counseling, but yes, these topics are required in their medical school, and board exams cover basic science and other risk reduction factors....it's really not that bold a statement, but if you feel it so, then so be it.

 

[Latewinner]

I second NealSO2 comments. Similar to dating, you probably shouldn’t apply experiences with one doctor to all. There are always going to be doctors that poorly communicate or lack compassion. Most are simply extremely busy and can only give you a very short amount of time.

My advice would be to go to each visit with clear goals you hope to accomplish by the end of the visit. Write down several questions that you want to read to the doctor and have answered. If the doctor only suggests medications for high cholesterol, respectfully push back and say you are really hoping to do this first with diet and lifestyle. “Can you offer me some professional suggestions or point me to a professional dietitian, athletic trainer, etc.” Your office visits need to be interactive, and you don’t want a doctor that doesn’t see you as an equal part of the decision process. After all, they have the knowledge and experience you’re paying to receive and just as important… It’s your body and ultimately your decisions.

All that being said, it’s totally fine if your visit only last 10 minutes. As a physician, I also don’t get very much time when I go to doctors visits. I need to make the most of my visit, expect to wait, and understand I may need to limit the scope of the appointment and come back later for preventative care, new topics, etc. Make the most of your 10 minutes and tell the doctor that you need another visit later to talk about another issue. It’s also perfectly fine to pay for a concierge doctor. If you really want 45-60 minute comprehensive visits, timely phone calls from the doctor about questions, or better customer service, a concierge doctor is the way to go. Routine healthcare is simply the Greyhound bus and it cost more to have a private shuttle. I have lawyers, accountants, and numerous professionals that simply don’t have time to address my entire portfolio in one visit. Just break up the visits as needed and view it as a long-term process. Best of luck… Remember most doctors take a lot of pride in their work and want to help.

 

[Idaboy]

https://www.jacc.org/doi/10.1016/j.jacadv.2025.101686

I was part of this study. Lean Mass Hyper Responders: basically lean athletes on long term low carbohydrate diets with stratospherically high LDL cholesterol, but also low triglycerides and high HDL, nothing else obviously wrong with us (no diabetes, hypertension, etc), and no familial hyper-cholesterolemia.

Anyway, it raises serious doubts about diet heart hypothesis that we’ve been operating on for decades (high saturated fat leads to high cholesterol leads to heart disease). Maybe statins are appropriate, maybe they aren’t, but I wouldn’t take a doctor’s word on it just because LDL was high.

That's a super interesting study. Kudos to you for contributing to clinical research....there's alot we think we know about cholesterol or LDL, but really so much we don't know about LDL levels for a specific person....that's the issue with "evidence based medicine" while maybe some of the consensus medical science "thinks" or advises a certain practice or level of LDL, how does that apply to the individual (when studies have large N)....definitely need more research on the ApoB stuff.....thanks for sharing

 

[Idaboy]

He stayed in a Holiday Inn Express....Duh!

No I didn't....it was a SO teepee!

 

[Pharmseller]

Bold statement? So "most"'don't is not? But "most do" is a bold statement? I didn't say physicians devote their careers to diet and exercise physiology, and lifestyle counseling, but yes, these topics are required in their medical school, and board exams cover basic science and other risk reduction factors....it's really not that bold a statement, but if you feel it so, then so be it.

In post #134 you ask

“Do have a resource you could reference to that statement?”


So I’m asking the same question of you. When you say

“Pretty sure "most" get a fair amount of nutrition, biochemistry of metabolism, and lifestyle modification during medical education....and board exams for that matter.”

From where do you get this information?





P

 

[MThuntrrr]

In post #134 you ask

“Do have a resource you could reference to that statement?”


So I’m asking the same question of you. When you say

“Pretty sure "most" get a fair amount of nutrition, biochemistry of metabolism, and lifestyle modification during medical education....and board exams for that matter.”

From where do you get this information?





P

USMLE (United States Medical Licensing Exams) includes biochemistry, nutrition, etc among numerous other related required topics. I can only speak to what a US MD board certified physician goes through for training. Can you say the same? Judging by your user name, I’d guess a pharma rep or pharmacist? To say an MD curriculum was unique or unusual because it included nutrition is false. It is required for all US board certified docs. To what extent a medical student retains or brings into their practice as an attending is highly variable. He’s not saying every MD is an expert in nutrition, which nobody is claiming on this thread.

 

[Marble]

False. I’m an MD and nutrition was a significant piece of the curriculum. During medical school, I heard the same rhetoric about MD’s not learning much about nutrition. I considered myself a nutrition/health nut prior to medical school, and I assure you my understanding was vastly deeper after medical school.

Well, I'll politely disagree that doctors are trained in a way where they look at nutrition specifically. Lifestyle, i have seen in some cases. But going through what someone eats and providing advice has never happened from a dr in a comprehensive way. If you do that, that is awesome.

I've gone through cancer three times, and only one hospital system had any nutritional doctors or staff that actually went through records and assisted me. This has been going on since 2014. Otherwise, it's been focused on drugs (which were very helpful), surgery (which was necessary), and hoping to keep me in their system. Because I beleive, I represent a large amount of money to them. They wouldn't even refer me to a specialist who did the surgery I needed. Which was highly complicated.

I'm not trying to say you don't know your stuff about nutrition, etc. But I believe a lot of the chronic health issues facing large amounts of Americans are directly a result of a poor diet and poor lifestyle choices.

If you experienced it from a patient's perspective, you feel my frustrations. But i think you also have a leg up on most of us because of your education and training.

I've learned to be my own advocate and although I knew more than most about nutrition, the amount I've learned since then, specifically related to my issues, has changed my health for the best.

Sent from my SM-S918U using Tapatalk

 

[Speaks]

Well, I'll politely disagree that doctors are trained in a way where they look at nutrition specifically. Lifestyle, i have seen in some cases. But going through what someone eats and providing advice has never happened from a dr in a comprehensive way. If you do that, that is awesome.

I've gone through cancer three times, and only one hospital system had any nutritional doctors or staff that actually went through records and assisted me. This has been going on since 2014. Otherwise, it's been focused on drugs (which were very helpful), surgery (which was necessary), and hoping to keep me in their system. Because I beleive, I represent a large amount of money to them. They wouldn't even refer me to a specialist who did the surgery I needed. Which was highly complicated.

I'm not trying to say you don't know your stuff about nutrition, etc. But I believe a lot of the chronic health issues facing large amounts of Americans are directly a result of a poor diet and poor lifestyle choices.

If you experienced it from a patient's perspective, you feel my frustrations. But i think you also have a leg up on most of us because of your education and training.

I've learned to be my own advocate and although I knew more than most about nutrition, the amount I've learned since then, specifically related to my issues, has changed my health for the best.

Sent from my SM-S918U using Tapatalk

Every single time my dad has been in the hospital which has been relatively frequent they ask him if he would like a consult with a nutritionist, they will spend as much or as little time with you as you would like and go as far as proving a dozen or more specific recipes and meal plans. Weird you wanted that and it was refused when they really push it here, I guess different hospital systems are different.

I think much of what they have is standard food pyramid stuff which you may or may not think is helpful at all.

Honestly when it comes to the PC talking about exercise and nutrition is it possible that for someone who has not put in enough effort to learn that fast food is garbage and exercise is good that the advise would be a waste of time for both parties? Clearly something like cancer is a totally different thing and a nutritionist totally makes sense. But for the average unhealthy person going to a PC they know what they should be doing and are not.

 

[Predator_SD]

Every single time my dad has been in the hospital which has been relatively frequent they ask him if he would like a consult with a nutritionist, they will spend as much or as little time with you as you would like and go as far as proving a dozen or more specific recipes and meal plans. Weird you wanted that and it was refused when they really push it here, I guess different hospital systems are different.

I think much of what they have is standard food pyramid stuff which you may or may not think is helpful at all.

Honestly when it comes to the PC talking about exercise and nutrition is it possible that for someone who has not put in enough effort to learn that fast food is garbage and exercise is good that the advise would be a waste of time for both parties? Clearly something like cancer is a totally different thing and a nutritionist totally makes sense. But for the average unhealthy person going to a PC they know what they should be doing and are not.

A nutritionist is not a doctor though. I think people are specifically speaking to how much MDs are trained or practice nutrition.

 

[KenLee]

Uhhh where is this computer in my office? Nothing tells me what to prescribe. I give my patients options, then we make a decision together.

Every dr I've seen in last 5 yrs is attached at the hip to a laptop and has their nose buried in it.

 

[omicron1792]

Every dr I've seen in last 5 yrs is attached at the hip to a laptop and has their nose buried in it.

You can thank the government and their rules on emr and documentation.

 

[MThuntrrr]

Well, I'll politely disagree that doctors are trained in a way where they look at nutrition specifically. Lifestyle, i have seen in some cases. But going through what someone eats and providing advice has never happened from a dr in a comprehensive way. If you do that, that is awesome.

I've gone through cancer three times, and only one hospital system had any nutritional doctors or staff that actually went through records and assisted me. This has been going on since 2014. Otherwise, it's been focused on drugs (which were very helpful), surgery (which was necessary), and hoping to keep me in their system. Because I beleive, I represent a large amount of money to them. They wouldn't even refer me to a specialist who did the surgery I needed. Which was highly complicated.

I'm not trying to say you don't know your stuff about nutrition, etc. But I believe a lot of the chronic health issues facing large amounts of Americans are directly a result of a poor diet and poor lifestyle choices.

If you experienced it from a patient's perspective, you feel my frustrations. But i think you also have a leg up on most of us because of your education and training.

I've learned to be my own advocate and although I knew more than most about nutrition, the amount I've learned since then, specifically related to my issues, has changed my health for the best.

Sent from my SM-S918U using Tapatalk

Dieticians/nutritionists break down the basics and go through meal plans/prep etc. This role is not done by a physician, but it doesn’t mean they lack a significant amount of education regarding nutrition. Entirely different roles. Nobody is arguing that lifestyle and nutrition aren’t responsible for the vast majority of chronic illness. Physicians are left dealing with 60+ of years of bodily harm from smoking, alcohol, lack of excercise, etc. Making healthy choices in life is a behavioral issue, not a lack knowledge in the vast majority of cases

 

[MThuntrrr]

You can thank the government and their rules on emr and documentation.

Exactly

 

[Speaks]

A nutritionist is not a doctor though. I think people are specifically speaking to how much MDs are trained or practice nutrition.

Yes I dont disagree. I honestly dont know to what extent they are trained on it, people like Peter Attia and Huberman claim its basically zero (though in their best interest to say that) and if they are trained is it standard food pyramid stuff that is as at best suspect.

I was responded to not having access to nutrition information while going through cancer treatment and how surprising that is to me. While not for your annual physical, during a hospital stay here its standard practice to offer it. My dad may have been in the hospital one week and met with a nutritionist and then we he is back the next week they have him see one again. I think he saw four of them in Jan all while never once asking for one.

My second point on to what extent PCs should be talking about it has more to do with to what extent its worth the effort. The number of people who are unaware of at least the basics of healthy eating and exercise is very low, the number who ignore this common knowledge is very high. Im really not sure docs would have to know a lot to offer some basic advise to their average patient who will not follow it anyway.

I also see people telling me they switched from eggs to oatmeal with brown sugar because their doctors advised it due to slightly elevated cholesterol in which case they likely should have kept the advice to themselves. Whether they got it from a standard print out or learned it in medical school.

 

[waspocrew]

Every dr I've seen in last 5 yrs is attached at the hip to a laptop and has their nose buried in it.

I’m lucky, we have scribes so I can actually examine and talk with patients. Hard to do skin exams while at a computer.