When Doctors Fail You

[Hockeylady]

Carina, your lab numbers are wonderful! And you completely know what you are doing, Ie. Trig and HDL!!
Congratulations and I am rocking glad to hear that you stood up and said no f’in way to taking any STATIN-SCARE. You rock!! Kcko

[justme]

Maybe our great, great grandkids won’t have to fight this battle - if they live long enough from the SAD and the poor medical care hat goes with it, which is also standard.

[richard]

Anyway, I just wanted to vent. I am tired of being my own doctor and trying to figure out everything on my own, all I wanted to know why my hair might be falling off, he just said he didn’t know but also dismissed all my theories without even listening to me … apparently my cholesterol is all that matters.

Sorry to hear about your Doctor. I can tell you his point of view is that he is tired of patients coming in after consulting “Dr Google” and wasting his time. It’s a cognitive dissonance, and he won’t be able to help you. I reckon you have the right idea to stop wasting his time, and yours

With your fasted insulin you are within the normal range but you aren’t easily able to get access to energy in storage even when you eat nothing.

This to me means it appears if you restrict calories, you can’t replace the shortfall from body fat, so your body will reduce optional caloric use. Hair development and maintenance requires energy, but hair is not essential for survival. This is why people can see additional hair fall whenever they change diet … any diet.

Your lipids look great. If you want to drop your total cholesterol get some sun and you’ll convert some into vitamin D and your total cholesterol will go down.

Wanna know where everyone got their associations between cholesterol and heart disease from? It was a study called the Framingham study where they followed most of the people from a town in Massachusetts for decades and watched what they did and how their health progressed.

This is the critical piece. It’s a table showing men and women segmented by their total cholesterol level - less than 200, 210-244, and 255 or more. And for each group they calculated how many people they would expect by the law of averages to have heart disease, and then how many actually had heart disease.

This is associational science it’s not adequate to infer anything until you see a 2x observation. So you see Men under 210 Cholesterol they expected 69 men in 1000 would have heart disease and they saw 35.2. That’s close … but still not 2x. If they had seen 34.7 then you be able to say “Ah well low cholesterol probably causes less heart disease”.

Men in the mid range of cholesterol they expected 70 and got 63 … that’s just noise. And men over 245 they expected 72 and got 120 … again it’s not 2x so it’s not significant.

Now look at women, the numbers barely budge. This is all pure noise. It doesn’t meet the effect size threshold for the Bradford Hill standard to infer causation.

So that’s what the people who taught the people who taught your doctor got wrong.

[Carina]

@richard, wow, thank you for taking time to respond with so much information, I was just giving you credit for the article I took, but hey, this is way better

Sorry to hear about your Doctor. I can tell you his point of view is that he is tired of patients coming in after consulting “Dr Google” and wasting his time. It’s a cognitive dissonance, and he won’t be able to help you.

I can see now that reading my original post you would think I was insane, truth is I was so upset it just came out like that, I just let the emotions fly wild hahah.

Truth is that in the office I was calm, when the cholesterol and statin talk started I asked why he wanted to give me statins, listened, and then I told him that those figures are just relative risk and that is not worth the side effects. Then, and this is what I can tell bothered him and stopped listening all together, I told him total cholesterol and even calculated LDL doesn’t mean much, specially on women, and that there is a lot of information about it. When I saw him dismissing me I told him I wasn’t just believing everything on the internet, reminded him I do have a degree in Molecular Biology and Genetics (which is true) and that I did my research, and tried to give him Good Calories, Bad Calories (not my copy, bought him a new one, the other one is my precious ) telling him that this is the book that got me to start researching all of it. He just looked at me and told me he didn’t have time to read it, and then told me anyone can just write a book. I attempted to explain who Gary Taubes is to no avail. The rest, me trying to give him the article you recommended (thinking at least read this, it’s nice and short), or attempting to give him the links to the lectures all happened while he was walking out of the room, and talking back to me (more like at me) without stopping - at this point I may have started to look like a travelling salesman trying to sell you something as you shut the door on me, I understand this, but why was I in this position in the first place?. You can imagine this scenario left me feeling so upset, and helpless, that the above post happened. I understand cognitive dissonance is a thing, but i suspect it has more to do with the fact that I am a young woman with a thick accent (english not being my first language and all) not blindly following what he tells me to do, but still, a little respect would have been nice, I believe I treated him with respect and tried to explain why I was against following his advice.

With your fasted insulin you are within the normal range but you aren’t easily able to get access to energy in storage even when you eat nothing.

About this, I had expected it to be high, but when I saw it was so much higher than 5 I was a little disappointed to say the least. Do you think trying a low dose of metformin might help me lower it? (I know you are not a doctor, but since you do take it for this purpose) I wanted to ask him about that, but because it is in the “normal range”, he just told me that there is nothing wrong with it in the first place, that it shouldn’t be affecting my weight loss at all.

This to me means it appears if you restrict calories, you can’t replace the shortfall from body fat, so your body will reduce optional caloric use. Hair development and maintenance requires energy, but hair is not essential for survival. This is why people can see additional hair fall whenever they change diet … any diet.

I didn’t get the results until I got there, so, I didn’t have a lot of time to process them beforehand, but you are right. I hadn’t really associated it because it started about 7 months after starting keto, but thinking about it, it started close to when I started dabbling into prolonged fasts. I didn’t think much of it because I didn’t get any of the other symptoms of my metabolism slowing down, like cold or lethargy, but maybe the reason I didn’t was because my body decided to cut out other things, like hair. This is sad, because I enjoy fasting, but I guess I will have to stop for a while. Maybe keep a 24hr fast a week with a proper fast the day before won’t be as bad. I was also considering hormonal reasons, because I changed birth control, but thinking about time frames, yours makes more sense.

Your lipids look great. If you want to drop your total cholesterol get some sun and you’ll convert some into vitamin D and your total cholesterol will go down.

I love this advice, and I think I took it to heart way before you even gave it to me, getting heat exhaustion 2 times this summer, but what can I say, I love me the outdoors. If anything I thing I am vitamin D-ed out

So that’s what the people who taught the people who taught your doctor got wrong.

That’s what I was taught too when I was pre-med and I just accepted it at the time, but I don’t think that is an excuse. I followed that advice for years, and I even explained it to other people (now I feel so bad about it). But along the lines I never stopped reading on things, although that might be because I went into basic science instead after that (not any more though, the way the science field worked where I am from wasn’t for me, so I moved on to computers instead, but I will always be a scientist at heart), and science is an ever changing field, so we know things evolve and accept change a little easier.

One last thing, that contributed to my anger and the crazy post, don’t read this if you are bored already, it’s not related to the original. My husband had an appointment too, right after mine, he wanted to ask about his gastritis and fatty liver. About the gastritis, he has had it for years, and has been controlling it with medication, so we decided that now that we moved, maybe here they know something different that can help him. We asked him about it, more specifically, we asked if there was a way to determine the root cause of the pain, so he wouldn’t have to take medication all the time. The doctor’s opinion was, if the medication works keep taking it and problem solved, there is no possible way to know the source but hey, if you really want to not have any pain then death is an answer. Yes, he said that, death. Then I asked if we could have an order for liver enzimes panel (I wanted to check the fatty liver progress since he started keto). His fatty liver was found my chance on an ultrasound looking for other things (not by this doctor btw) , and it wasn’t that bad, but still a cause for concern. To this the doctor gave us the order, but also said, hey you are not a kid anymore (he is 33), you will have a little fat in your liver. It was just a long crappy day in the medical world for me.

[Duncan_K]

Your doctor sounds like a bored car mechanic who only does just enough to patch up a motor to get it rolling out of his shop.

[richard]

if you really want to not have any pain then death is an answer. Yes, he said that, death.

Interesting choice of analgesic. I’d be tempted to

1. Change physician to someone committed to working with you to improve your health
2. Report this one to the medical board so that he isn’t inflicted upon anyone else

I can see now that reading my original post you would think I was insane

Sorry didn’t think that at all. I thought there is someone with a bad doctor, one who can’t be bothered to think their way out of the rut they are in.

Do you think trying a low dose of metformin might help me lower it? (I know you are not a doctor, but since you do take it for this purpose) I wanted to ask him about that, but because it is in the “normal range”, he just told me that there is nothing wrong with it in the first place, that it shouldn’t be affecting my weight loss at all.

Then he is simply not aware of the literature. That simplified chart I posted comes from https://www.ncbi.nlm.nih.gov/pubmed/2573554 and the actual chart is

Showing that Diabetics have a little more leeway because in their deranges state their fat cells become less insulin sensitive. Note those of us who were Diabetes, went keto and then lost massive amounts of weight for 5-6 months and then plateaued … have become insulin sensitive in our fat cells and are more like the non-diabetics.

Note that that chart is absolute (in units of 100 μMole) not relative as in the simplified chart I usually show.

Your fasted insulin in pmol is around 72, and you can see for yourself that you have very little access to energy from body fat. I would ask your next physician to treat your high fasted insulin. That treatment will likely be metformin. But I’m not a doctor

BTW Both Jules and I experienced increased hair shed from the point when we started the diet.

Normally we go through 3 stages of hair growth, Anagen for several years which is the growth of hair, Catagen for a few weeks where the hair is cut off from it’s blood supply, Telogen for around 3 months where it chills, and then it eventually falls out to start a new cycle. During times of energy stress we shed up to 70% of the chilling telogen stage follicles - it’s called telogen effluvium. Extended energy stress can shorten the Anagen stage.

What it means is hair loss is usually just a trailing indicator of a dietary change, and transitory. You can supplement with biotin to give the follicles a chance to be a little more robust.

[Carina]

Thanks everyone. Richard, I am switching doctors of course, I decided that the second I left his office. About the shedding, I also lost some extra hair when I started keto, but not like now, now it’s falling out in clumps, like a crazy amounts (the dogs and I are now share the blame for all the lose hair around the house), but after getting the insulin results and looking at your chart, I am positive I overdid it with the extended fasts, guess I will refrain from those until I can lower my fasting insulin, for now imma KCKO

[jilliangordona]

What have you done about your Hashimoto’s? My doctor insisted on putting me on synthetic hormone and I refused.

[EZB]

@jilliangordona, A synthetic hormone is the standard course of action for Hashimoto’s. As an autoimmune disease, Hashimoto’s disease is characterized by the immune system attacking the the thyroid and reducing its function over time. There are generally two courses of action that can be taken:

(A) Reduce the autoimmune response
(B) Correct for the hormonal imbalance resulting from decreased thyroid function

Most doctors will only choose option (B), which means the disease is almost always degenerative and the synthetic hormone levels the patient takes will increase over time. Some doctors advocate for option (A), but this course of option is patient dependent. That is, what works for option (A) will be different for each patient. For many, going gluten free, low carb/ketogenic, or dairy free may work to varying degrees. There are so many things that can reduce the autoimmune response. At some point, however, it is likely that a patient employing option (A) successfully will reach a point where no improvements can be made. In these cases, the progression of the disease is significantly reduced, halted, or even reversed! However, I don’t personally know of any that have reversed completely such that all lost thyroid function was regained. It is entirely reasonable that virtually all hashimoto’s patients will require some level of synthetic hormonal replacement.

Also, note that thyroid hormones are CRITICAL TO SURVIVAL. If you have diminished thyroid function and are not supplementing with a synthetic hormone, you are probably putting yourself at serious health risk, which could even result in death.

[jilliangordona]

Thank you for the insight! However there are too many negatives to synthetic hormone. If I take anything it will be Armour Thyroid, not a synthetic hormone.

[EZB]

That works, too. Some have issues with excess T3 though with natural hormones. My wife and my son have Hashimoto’s. The synthetic hasn’t been an issue.

[Carina]

I am switching doctors of course

Just an update, I found an amazing doctor! We discussed everything and she gladly accepted the book and articles I brought with me. She is more paleo than keto, but also acknowledges they are very similar in nature just with the extra of carb restriction, and she is on board. She is not a keto expert, but she is not against it at all. We discussed how the dietary advice that has been given to us for ages is all wrong, Didn’t try to push statins on me, but did tell me she is going to keep monitoring my lipid levels closely (i guess she has to for standard of care). I expressed my concern over my elevated fasting insulin (that is in the normal ranges according to the lab, but it’s way above optimal, 12) and asked to try metformin even though I am not diabetic to see if that would help, and she said that it is common to use metformin for insulin resistance (like in pcos cases and so on) so we can try a low dose and monitor how it goes.
I am over the moon. Oh and she had a med student with her too, and she was the best, super excited about reading all the research, and also on the low carb - whole foods wagon herself. Even better.

Anyway, I just wanted to share this, because we are quick to share and complain when something goes wrong and just accept it when i goes right, so here it is. It took some trial and error but it payed off.

I don’t know if it would be ok to share her name in here (i didn’t ask her), but if anyone from the Austin area is looking for a doctor and want to know her name pm me and I will gladly respond.

[justme]

I celebrate with you as well!

[KHAN]

[PaulL]

Just an update, I found an amazing doctor! . . .

A happy ending, yay! So glad you finally found a doctor who pays attention. I love it that she has a medical student and is training her right. I know this is probably sexist, but it always seems that women are more open-minded than men. I hope her practice really prospers.

Let’s celebrate:

[Rheal_Cyr]

I agree with you, I have a female doctor and after years of male doctors and their arrogance it was such a great feeling to have a doctor actually listen to me and discuss treatment options not just impose their views and write prescriptions.

[Anniegirl9]

1000 cal/day is rediculous, even for a LF diet. I’m 5’2 134lbs and would do 1200-1400 cal/day for weight loss when doing LF. You will put your body is starvation mode lower than that.

[Asmit2487]

I know that this post is a year and a half ago, but I just wanted to throw in my experience as well. I have been failed for the last 3 years by every single doctor I have visited. I started out with a general doctor in 2015. YES, it has been since 2015 and no one has yet to figure out my issues.

In 2015 my TSH levels were at a 35. You heard that right… not a .35 but a whole 35 lol. It was unbelievable to the doctor how I was still standing. She sent me to a specialist two hours and a half away. I went to the specialist very excited to be getting some advice and results and everything else you would hope would come with a doctors appointment ( especially with it being 2 and a half hours away, right?). I literally was in and out of the doctors office in 15 minutes. He saw me for maybe 5…

Fast forward a year later to when I was diagnosed with PCOS. At this point my weight had went from 118lbs to 145lbs in less than a year. I am 5’1 and have never went over 120lbs in my life. She put me on Metformin but also said my liver enzymes were extremely high so she wanted to send me to a GI Tract doctor.

I went to the GI tract doctor and instead of him speaking to me about my liver enzymes and how to manage those or what to do with all the information I was given… he decided to tell me for a complete hour visit how fat I was. Verbatim he said " It is simple science: You eat less and move more.". I literally had a freakin MELT DOWN. I couldn’t even contain my anger when he said that to me. A DOCTOR a GI DOCTOR thought he would find the need to tell me how easy and simple it was to lose weight! Ignorance at its finest!

The minute I left his office I called my Gyno and I cried and cried and cried to her on the phone telling her what he had said. She was actually shocked and said " your weight wasn’t the reason for the visit" ( I guess thinking I had brought it up). I told her I was never going back to that man ever again.

Fast forward to present. I am now 160lbs and fatigued to the point I don’t feel like I can function daily if I don’t get some type of nap in. That is with the 9 hours of sleep I get at night. My TSH is apparently fine and they refuse to give me cytomel for my T3 even though it was a 63!

They blamed my fatigue on the way I sleep ( I don’t even snore) and said I should see a pulmonary doctor. They also sent me to a cardiologist ( I still have yet to figure THAT one out yet! ) which that appointment was absolutely pointless and a whole 130 dollars down the drain!

They have even told me that maybe I need to be sent to a psychologist for my anxiety and depression. WELL if I was able to lose weight, feel like myself again, NOT WANT TO SLEEP ALL DAY, literally fog brain every single day, I wouldn’t be depressed! I swear the doctors not caring MAKE me depressed… no one giving a crap that I feel as awful as they come… that makes me depressed.

I would never actually " off myself" because I am afraid of dying, but I do understand why people do it. When you feel like all hope is lost in the world and you literally believe you will never feel better… you honestly just want an out. Sad thing about that, when you do that, you just become another statistic in the medical journals that these doctors read yet they don’t get any of the blame.

I understand your pain and I have also been prescribed to phentermine and been told I needed to go lower than 1000 calories. To be exact I said " what if I lower my calories and I still can’t lose weight?" the clown of a GI tract doctor said, " then lower them even more… lower them to the point you see results". UNBELIEVABLE!!

I am disgusted with doctors and it sucks I have to keep going back to waste time and make sure the medication I am taking is on the right track.

I have been on the keto diet for 6 days now. I am seeing if this will help me. If this doesn’t… all hope will surely be lost!

[ctviggen]

Keto will help. Here’s the ninth in a series of posts by Dr. Fung:

https://idmprogram.com/pcos-anovulatory-cycles-and-hyperinsulinemia-pcos-9/

If you go “backwards”, you should be able to find the first post. Read from there up until the ninth post.

You might benefit (in the short term) from taking metformin. I recommend keto and fasting once you can do that, and getting off metformin if you get on it (no drug is good).

[LizinLowell]

I really feel for you! Hang in there. Decide to do keto for at least 3 months before you make your mind up about it. All the symptoms you describe are ones helped by going keto but it takes time to heal. Wishing you well & excited for you because I believe you are on your way to feeling better! It took me 6 weeks to become fat adapted so hang in there. Read the forums!!