Does your doctor value nutrition? These 3 questions might help you find out.

How much does your doctor value nutrition? This has been a rather hot topic of late, with the recent gagging of Gary Fetke in Australia, an orthopaedic surgeon who co-owns a nutrition clinic that employees dietitians to help clients. He has recently been ‘gagged’ by the Australian Health Practitioner Regulation Agency (AHPRA) and is not able to talk about the role of nutrition in preventative health, nor in the management of chronic illness on any social media platform.

That’s troubling to say the least. Nutrition and talking about nutrition is certainly a contested field, and perhaps there is some protection of the patch when it comes to nutrition advice. I’m not going to lie to you – I can get a little scratchy myself when I read prescriptive advice from people who aren’t qualified in nutrition that push the boundaries in terms of scope of practice. Mainly because of the potential fall out if they aren’t equipped with the knowledge to either resolve and issue or refer it on. But to prevent a doctor talking about nutrition is just madness.  Doctors SHOULD be talking about nutrition – especially given that some of the most common reasons people go to their general practitioner (GP) can be improved (if not resolved) by diet. Thank goodness similar shenanigans have not been taking place this side of the ditch.

To what degree GPs should have the authority to discuss nutrition with their patients is a bit of a ridiculous question if you ask me. I know many brilliant GPs that use a holistic approach to their practice, who know a LOT about nutrition, give guidelines when that is all that is required and also who refer their patients on to more in-depth nutrition help if necessary. More important is asking your GP to what degree do they value nutrition. If you feel nutrition is an important part of your overall health, I think that having a GP who feels the same is rather important, and these three questions I heard on a podcast could be a good start to give you confidence that your needs will be met by their services.

  1. What affect does nutrition have on my health?

This may seem like a weird question to be asking your GP. I mean, surely everyone knows that diet and health are intricately linked, and doctors – well, it’s their job to know this stuff, right? Given the number of clients I have who leave their doctor’s clinic rooms feeling stupid for even mentioning diet, I don’t think we can take it for granted that your GP is going to be open to the idea of diet being a reasonable therapy (or adjunct therapy) to any condition. Sure, the diet-health connection isn’t foreign to them – there is the lipid hypothesis after all. And if you’ve ever stepped on the scales and been told your body mass index (BMI) is too high, so you need to eat less and exercise more to lose a little weight and reduce your overall health risk, then clearly your GP didn’t sleep through their three nutrition lectures provided in the medical school curriculum. However I wouldn’t be surprised if you know more about diet being able to prevent or manage conditions such as auto-immune disease (including type 1 diabetes), mood disorders, inflammatory bowel disease or irritable bowel syndrome, metabolic conditions (such as type 2 diabetes), asthma and allergies and the like. Now I’m not saying your GP is an idiot – at all! But time is a resource many health professionals don’t have, and while your GP might be open to exploring alternative or adjunct nutrition therapy, they may not have had the time to research this avenue. That (in my opinion) isn’t so much of an issue. It’s not as important (in my mind) that your GP may not know as much as you; being open to you exploring it speaks volumes, though. If your GP isn’t interested, then that is a problem. Given some of the reactions that clients have reported when mentioning to their GPs they use diet as a way to manage their health condition, there are clearly GPs who choose to remain ignorant. If you are dismissed, laughed at, or told in no uncertain terms that diet will not help, alarm bells should ring in your head. My advice would be to look for another GP.

  1. What do you think about the difference between normal lab ranges and optimal ranges for nutrient status?

There’s a difference? There appears to be, or at least, some doctors argue that there is. Vitamin D is a great example of this. In New Zealand, the adequate vitamin D level starts from 50nmol/L but a published review determined that looking at endpoints on a broader scale than just bone health (including  bone mineral density (BMD), lower-extremity function, dental health, and risk of falls, fractures, and colorectal cancer) determined it best to have serum concentrations of 25(OH)D begin at 75 nmol/L (30 ng/mL), and the best are between 90 and 100 nmol/L.

Low to low normal levels of serum folate are related to increased risk of depression and increased severity of depressions and affective disorders. Our ‘normal’ starts at above 7 nmol/L and research has shown that people with chronic mood disorders have lower morbidity when their nutrient status is above 18nmol/L, and symptoms began to alleviate when supplementation brought the levels up to above 13nmol/L. Low folate is also associated with higher homocysteine levels in the blood which is an independent risk factor for atherosclerosis.

While B12 levels in the blood are actually a poor indicator of B12 activity (as only 5-20% of the is bound to transports and able to be metabolically active), research has found a relationship between levels of B12 of 258pmol/L and lower in the bloodstream and depression. The ‘normal’ range starts at 170pmol/L, with borderline low from 110-169pmol/L. I know GPs who look for levels of 400pmol/L as being optimal for cognitive functioning and health. A sports doctor I am aware of uses higher cut-offs when it comes to haemoglobin and ferritin (both markers of iron deficiency) for athletes and will supplement to determine if a boost in iron intake helps address fatigue-related complaints or not, even if the athlete is within ‘normal’ range (see here).

Thyroid stimulating hormone, a commonly measured marker of thyroid function has a reference range between 0.5-4.0mIU/L. However, TSH is considered to be a poor indicator of thyroid function and the ‘normal range’ included people that had underactive thyroid or thyroid disease. The recommendation from the American Association of Clinical Endocrinologists association was to lower the range to 3, with a view of it lowering further to 2.5mIU/L because data from the National Academy of Clinical Biochemistry found more than 95% of rigorously screened normal euthyroid volunteers have serum TSH values between 0.4 and 2.5 mIU/L. Though this was recommended in 2003, it was contested by other governing bodies, potentially as it meant that the number of people in the US with subclinical thyroid function increased from 3 to 20% of the population, thus (as concluded in this paper) many more would require thyroxine medication as treatment.

These are just a few examples where you may fall into the ‘normal’ range, but may not be optimal according to the opinion of some doctors. At the very least, it may explain why you may be experiencing physical symptoms but these aren’t recognised by your lab test results.

  1. What will you do if my test results don’t marry up with what I’m telling you my symptoms are?

Important question, don’t you think? Let’s hope that your GP doesn’t respond with ‘perhaps you need to see a psychologist’ – as one of my clients reported. To be honest, I actually think there is a degree of psychosomatic issues that occur when someone is struggling with a health problem – most of us are familiar with the gut-brain axis and relationship between stress and digestive problems. This is partly driven by the return of seemingly ‘normal’ test results that don’t explain their ongoing concerns. However, to dismiss your symptoms as being unimportant because the results don’t reflect what you are reporting should (to me) set off alarm bells.

I think one problem could lie in the funding for lab tests. My GP is brilliant and will order me any test I want, but at my cost. I don’t blame her for this as there is pushback with GPs ordering tests. However I know that not all GPs are like this, and not all people can afford testing to get to the bottom of the issues. I think if more GPs appreciated the role nutrition can play in preventing, managing or reversing many of the chronic conditions people are dealing with today, then, then there would be more referrals to nutritionists or dietitians on the basis of reported symptoms or test results that may fit into the ‘normal’ range, but aren’t what is considered optimal.  From here, nutritionists, naturopaths and dietitians can order tests that delve further into hormonal issues, gut problems and even cholesterol levels if required. But this might not be necessary as they may pick up from your initial test results that certain nutritional strategies can help you optimise your nutrient levels without the need for further testing.

At the end of the day, you should feel confident that your GP values nutrition as much as you do.These questions may help you determine that and, if you suspect they do not, perhaps it’s time to find another GP.

Nutritionist

Obligatory doctor and fruit shot. I couldn’t find one with a steak.(PC: http://www.healthtrap.com)

 

Do you need some Headspace?

Do you sometimes feel like you just need more room in your head? Like there’s little space in your brain to concentrate on important things because you’ve got a lot of other tasks, thoughts and emotions which are taking up room? I did. On the encouragement of my mate Bevan I decided to give Headspace a crack. Headspace is described as a gym membership for the mind. A course of guided meditation, delivered via an app or online, that you can undertake sessions in length from 5-20 minutes per day. Apparently 80% of business leaders and entrepreneurs engage in some meditative practice daily, and while obviously not the sole reason these people are successful, some swear by it as the making of them. And this is daily meditation – not yoga for 90 minutes, 1-2 times per week, but small amounts of time to sit down and just ‘be.’ If you’re reading this then you’ll know I’m about more than just food; anyone who has come to see me in the clinic knows that I spend around two-thirds of the time talking about seemingly ‘non-food’ related lifestyle information. However most of you also realise that these elements of health can’t be changed in a silo – they all affect each other and help uncover whether your dietary habits are working for you or against you.

I’d resisted Headspace (and any kind of meditative practice) as I thought that you had to be quite ‘Zen’ to even do it. Which, when I think about it, is kind of ridiculous given that the whole purpose is to help you sit with your own thoughts, not try to get rid of them or shut them down. I also thought that I had to do it for at least 20 minutes every day in order to experience benefits (and who has 20 minutes?!) Again, this is also incorrect. In fact, these misconceptions were really the first of many I’ve discovered after doing Headspace consistently over the last 100 days, some I’m sharing today.

I am a person prone to anxiety. These things run in my family. My nana wasn’t a particularly happy person until she went on medication for her anxiety – quite frankly, this didn’t dramatically change her personality but it certainly made a change to her disposition. Others in my family are also more likely to feel depressed or worried and anxious, so I would use the label when describing to people (or even when I thought of myself) as the type of person I am.

But, actually, I’m not.

This isn’t just about engaging in meditation – my brain definitely calmed down when I ditched processed food actually, however I still identified with being an anxious person. After around a month of Headspace it dawned on me that the physical and emotional signs of being anxious weren’t actually present. It wasn’t until, during the anxiety sessions of Headspace when we were asked to try to disengage with the thought patterns associated with anxiety that I realised they weren’t actually there (this thought was actually quite distracting!)

I have thought a lot about this over the last couple of months. I don’t think Headspace enabled me to view the world so differently that I don’t respond with an anxious head and heart – I think what it has done is enable me to view myself differently. I had set up this belief in my head that I was a person with anxious tendencies, and with this firmly planted in my head it dictated how I described myself to others and, more importantly, how I responded to the world around me. Do you know how liberating it feels to be free of this? I actually can’t describe it, but it has noticeably changed my thought patterns and subsequently my actions. The thing is, beliefs do that – they create this lens with which how you interact with other people and the environment without really realising it. People who have started and stopped diets multiple times in their lives almost unconsciously label themselves as a failure when it comes to eating well. Is this you? Do you embark on a ‘diet’ or ‘way of eating you already ‘know’ that you will fail? Changing these belief structures are key to changing whatever emotional or physical road blocks that might exist when trying to change your diet.

Headspace has also made me realise that I needed to get rid of a lot of things that were either in my emotional space or in my physical space. I’m not a minimalist (though not a fan of trinkets), it’s more of a ‘get rid of things that don’t matter’ declutter. Books I don’t need yet I have hung on to. Clothes I don’t wear yet can’t get rid of.  I’ve deleted over 400 people from my personal Facebook page. And if you’re one of them, it’s not you it’s me (genuinely).  I have tried a few times over the last two years to do this but I could never make the start as I would scroll through the list of friends, hand hovering over the ‘unfriend’ button, and come up with reasons as to why I couldn’t delete that person. This time I went into the exercise with a different set of questions. As basic as it sounds (and perhaps you can concur), the first question I asked was ‘do I actually know you?’ I used to love Facebook as a way to connect with friends, old and new and this is just a way of bringing it back to the reason why I signed up in the first place. And, the reality is, the people that have ‘unfriended’ probably just never got around to doing it first and likely won’t even realise I’ve done it. Again, this may not just be about Headspace, but I think it made me more aware of ‘stuff’ that takes up unwanted space in my physical and emotional surrounds and this helped me make a start and declutter. What about you? Do you feel burdened by ‘stuff’ to a point where you feel you’re wading through quick sand but not getting anywhere? Do you need to declutter your physical space, your emotional space, maybe even people around you to create room for behaviours, habits, feelings and people that will serve to help move you forward rather than hold you back? If you don’t really know, then meditation can help you step back and evaluate the ‘stuff’ that is important and positive and the stuff that is not.

When I bring the idea of meditation up with people in my clinic I get a mixed response. People are so willing to change their food, their exercise and even their sleep habits actually before trying to change their thought patterns. In fact, without the latter most people are not going to see any sustainable, positive changes in the former. I get it. In today’s fast paced, stressed-to-the-max world where there are demands on your time from every corner, it’s difficult to imagine where you are going to find more time to do one more thing. However, you really can create more time by doing some form of meditation. It’s just difficult to believe until you try it.  And, hey, maybe you don’t need it. However, if the idea of taking 10 minutes out of your day to sit down and just ‘be’ sets you in a panic because you are just far too busy, then perhaps you do need Headspace*.

Buddhify is another popular app. Or even Youtube some meditation practices if you’re unsure of how to start. There are so many of them out there that if one doesn’t grab you, I’m sure you’ll find another that does.

Image from hinesight.blog.com

Image from hinesight.blog.com