Outliers need to be studied, not mocked

Christine helped her husband take back control of his life by a ‘dangerous and unsustainable fad diet’. Did his doctor help or hinder the process? Is she right to be ‘angry’? I think so.

We as doctors need to look really hard at the outliers. Why do some patients who do the opposite of our advice get better results?

This happened with knee reconstruction surgery back in the 1980’s. At the beginning of my training as an Orthopaedic Surgeon we used to put patients in plaster for 3 months. The patients that were non-compliant and took their plasters off and walked when they were told not to ended up doing far better with better functional results. That’s why we now have rapid rehab programmes.

The medical profession has to look harder at the patients doing it differently. Over to Christine.

My husband’s type 2 diabetes was way out of control a year after his close brush with death just over 18 months ago from an infected artificial heart valve and endocarditis with septicaemia, renal failure and much more. It left his previously well controlled insulin resistance extremely brittle and his fasting blood glucose readings were north of 27mmols whilst taking 2 types of oral hypoglycaemic meds and 4 shots of insulin a day.

His GP just kept increasing the insulin and wanted him on a statin urgently. At no time was there any interest or inquiry into his diet. We never eat processed or sugary foods or drinks but unlike me (a long term low carber) husband ate grain and fruit based foods 4 to 6 times a day with large quantities of milk (raging thirst from the diabetes) and pasta, rice, potatoes in preference to meat. Apart from full fat milk and yoghurt, he ate very little fat- although we chucked out margarine and vegetable oils a very long time ago.

I worked out that his ‘healthy whole grain’ based diet with 3 serves of fruit a day equated to an alarmingly high number of equivalent teaspoons of glucose.

No wonder his blood sugars were through the roof. I went with him to the GP and asked why he was being advised by the Diabetic Nurse Educator (over more than a decade) to eat this way when he is obviously deeply insulin resistant and not responding to the increasing dosages of insulin.

The GP said diabetes is progressive and irreversible and they just had to push on until they found the right insulin regime for him. He said what he ate was irrelevant and that it was insulin that mattered as the key aim was to bring down the blood glucose, get the HBA1c under control and get his cholesterol down with statins to protect his heart. He bemused that my husband and I questioned and refused to take the statin- he said “oh, you are another one who watched that ridiculous Catalyst program”!!

I had been watching all this unfold over twelve months and bit my tongue many times determined not to interfere in his medical management seeing as he had been so seriously ill. But I couldn’t stay silent anymore.

I told my husband he was doomed to diabetic complications, a life on dialysis and early death and/or dementia if he kept following along with this medical approach to medicating symptoms and ignoring the underlying cause of his insulin resistance.

He was already suffering cognitive decline, had a 6th nerve eye palsy and couldn’t drive, kidney impairment had kicked back in and he was in strong pain from severe neuropathy in hands and feet which was keeping him from sleeping and making him utterly miserable.

He was desperate and asked me what he should do. I took a deep breath and told him to try a very low carb diet with enough healthy fat to give him energy and plenty of non starchy veggies instead of fruit. He switched onto this immediately without a whimper and he is still on it today some 5 months later. Overnight it just became a new way of life for him- it has never for a single minute been about a diet or for a fixed time period. He knows he cannot handle very many carbs each day and he enjoys the delicious and filling foods we eat. I am a pretty mean cook with excellent food knowledge – that helps.

His blood glucose levels were normal in less than 3 weeks. His Hba1c is back in a good range. Triglycerides are low, HDL is high. BP is normal. Heart function is good. He is only on a small dose of metformin and was off all insulin at the 6-8 week mark. His LDL is up a bit- GP still wants him to take a statin but he steadfastly refuses. GP just sighs in disinterested resignation- clear implication is that we are misguided fools.

His eyesight is normal, cognition good, he is back doing his physical job 4 to 5 days a week and he has morphed from a constantly hungry carb snacker to a LCHF WOE and eats mostly only twice a day with no interest in snacks at all. He also stopped drinking 4 litres of milk a day. We have butter, olive oil, fat on our grass fed meat, eggs, free range bacon and loads of veggies.

But wait- that is a dangerous and unsustainable fad diet isn’t it????

Maybe he should go immediately back to the ‘healthy whole grains, gallons of milk and fruit’ eating 6 times a day so he can get his insulin and statin deficiencies sorted out properly by his qualified doctor……and when he gets all the diabetic decline symptoms back again, he can hop onto dialysis, get his feet amputated, go into a nursing home as his dementia kicks in and be kept alive for another decade or so on an endless array of taxpayer funded tests, medications and hospital admissions via ambulance for all the evidenced based medicine and surgery they have in store for such people. And when he is in hospital he can look forward to those wonderful dietician approved ‘diabetic breakfasts’ of white bread, margarine, jam, Special K and low fat milk!!!

So brilliant is our world class health system when it comes to advancing chronic disease.

Yes- class actions around the world are just around the corner. They have much blood on their hands.

I am very very angry. In fact I have a white hot rage burning in my guts. In my work, I see the tragedy of this huge public health blunder constantly and I lurch from sadness to despair and then wanting to shake people until they wake up and see these 1000 pound gorillas all around them in plain sight. For the rampant chronic and auto immune disease, obesity and mental illness epidemics we are not even midway through around the developed world, medicine doesn’t have a pot to piss in.

Hello Gary – getting back to you as promised. Husband’s results very good. HBA1C 6.5%; cholesterol 4.7; Trigs 2.7; HDL 0.7; LDL 2.8. Doc was impressed but advised him to take a statin to protect his heart. He declined. To give you more context, a year ago HBA1C was 10.9%; cholesterol 16.4; Trigs 23.8; HDL 0.8; LDL 2.5 and fasting BSL 27mmols.
[These are fabulous results in such a short time frame – GF]

I just keep coming across these conversations where the key theme is anger. As people fully grasp the monumental wrongness of it all, they are getting angry. And the anger is stronger as they realise how wilful and deceptive a lot of it is – profits and egos before truth and concern for people and their health. Husband: thanks.

He had been carrying around a big tight belly full of central fat packed around his organs for 20 years and now has a washboard flat abdomen. No doubt this must be a huge advantage for his recovering heart.

I just don’t get how the GP can miss the significance of what has gone on here. Taking such a huge turnaround for granted- and harping on about a statin?? He actually never has had a heart attack- just a calcified aortic valve, AF and then the gut leak/endocarditis. I know they are trained to use a statin for protection post heart attack but I can’t help thinking that he is failing to look at this particular situation fully and consider more carefully what is unfolding and how best to support it therapeutically.

If this man wasn’t married to me, his situation would be ghastly. How many thousands of people are trapped in this way and at what cost? Uuughhhhh!!!