Doctor's Note

I hope my work is helping to fill the gap that medical professionals are not getting during training about preventing and treating chronic disease. That’s actually how this all started. I would make trips to Countway at the beginning of every month in medical school to read all the new journal issues. I felt I had a duty to my patients to stay on top of the literature. But hey, since I’m doing so much work, might as well share it! So what started as an email newsletter morphed into a medical school speaking tour into a DVD series and then now all online for everyone.

For more on preventing and treating prediabetes/diabetes, see:

For more on lifestyle medicine:

And for insight into the sad state of nutrition in medical training, Doctors Know Less Than They Think About Nutrition and Medical School Nutrition Training.

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  • HemoDynamic, M.D.

    Deplorable regarding the medical profession and insurance companies.
    It’s about time the fear stopped about helping patients get better.

  • guest

    I’ve cut down on the fat and sugar, but am still confused why I get chest pains if I eat both fat (nuts and dates) together. When I eat nuts alone….no pain. When I eat medjool dates alone…no chest pain. But together = labored breathing. I am assuming this manifests in other areas of body as well, and i get diabetic nerve pain when i ingest the nuts and medjools together. Anyone here understand the mechanism at play here?

    • Mikee

      Perhaps when you eat nuts and dates together, you eat more. You may be allergic to both of those but when you eat the two together, you simply consume more.

      http://www.healthboards.com/boards/allergies/12405-nut-allergies-chest-painwalnuts-hazel-almond.html

    • http://www.highcarbhealth.com Highcarbhealth.com

      Hello, the issue is due to the fact that nuts and fruits make a poor food combination. The high fat content of nuts requires a longer digestive processing time than the simple sugars in the dates. This can cause fermentation of sugars and therefore digestive discomfort. Eating sugars and high fat foods can also elevate blood sugars for longer than is considered normal. Hope this helps.

      • guest

        Thanks. Yes, I think you might be right about the elevated blood sugars sticking around for so long due to the fat.

    • Tia Haenni

      I’ve been hearing a lot about the elephant in the room most people aren’t talking about – that fat plays a big a role in diabetes as sugar. Fat traps the sugar in your bloodstream, regardless how well your insulin and sugar receptors are working.

      • Ann

        Depends on the kind of fat.

  • rijelkentaurus

    In the IT world we have “Managed Services”, where a company pays our consulting firm a flat fee and we take care of their network and devices. In turn, the company agrees to stringent guidelines regarding security, computer hardware/software updates, etc., allowing us to concentrate on preventative maintenance and overall IT strategy on their behalf versus battling viruses and old hardware. We eventually get an easy network to manage with far fewer fires and emergencies than a non-managed network, they get to keep working and making money with less interruption than they had previously. Win/Win.

    Why is there not (or is there) something similar in the medical world?

    What would you pay to have a doctor who was an actual partner in your health as opposed to what we have now?

    • largelytrue

      Have you heard of “Managed Care?”

      • rijelkentaurus

        Looks similar at 10,000 feet but the implementation has been a failure overall from what I can see, hence the skyrocketing of sick people and associated medical costs.

        Done improperly, IT Managed Services can quickly devolve into “don’t spend time/money”, and the network gets “sicker” as updates are not applied, hardware is not refreshed, tickets are not worked quickly (or at all). The goal is misunderstood simply as being “efficient” (read: get more clients to give you more money, but don’t spend that money on hardware/software/labor to do the job correctly, just get the money), rather than doing a proper proactive job from the beginning. In the short term, you “lose” money since you’re not as efficient (or overloaded, really) as your competitors, but in the long term you win big because you don’t have the client churn (and you’re less likely to get sued).

        Doctors don’t get to spend much time with a patient, they’re driven to get in, find out what’s wrong, prescribe a medication or other course of treatment, and then move onto the next patient. The doctor is effectively penalized for giving a damn and taking a few minutes to get things right. Half the time when I go to the “doctor”, I see a PA…the doctor is nowhere to be seen!

        I guess I envision a doctor or group of doctors going into private practice and consulting with individuals and businesses regarding healthcare like we do regarding IT. That might be simply impossible, I do not know what legal restrictions they would find, what their potential liability might be….

        But wouldn’t it be great if Dr. Greger or Dr. McDougall or Dr. Barnard, etc., was managing the healthcare for you or your business? They could charge a premium to do “preventative maintenance” on you and your people, ensure and enforce compliance from the “end user” (per the terms of whatever contract), and everyone would be happy. Win/Win.

        Or maybe those people ARE out there already…I just started looking. I’ve turned over to a PBWF diet over the last 6 months or so, seeing some immediate benefits personally and wondering why this information wasn’t pounded into my skull ages ago. Makes me feel like Neo waking up from the Matrix…I had no idea about the machinery that has been working against us all this time!

  • Jill

    As a nutritionist, I specialize well, in food. A doctor, in our current system, specializes in the treatment of disease. If we combined efforts properly and sincerely, the outcomes for the clients would be better. What if a patient sees the doctor for triage (analysis and diagnosis) and then sees a nutritionist for the next couple of appointments for personalized nutritional care (not just a specific country’s food guide with standard portion sized food groups), then follows up with the doctor for further testing and analysis and then continues the path to health with the nutritionist, etc. I maintain that the doctor doesn’t need to know all the ins and outs of specific therapeutic food approaches, they just need to know, I mean really know (and believe) that food is true first line therapy and should be treated as such and referred to a professional that has a proven track record. Getting people to pay for this is a problem. Personal responsibility for health may be at an all time low in North America.

  • Annette153

    In spite of the fact that medical schools are not teaching lifestyle medicine/nutrition, surely there are some family practice docs out there who have come to recognize that it makes sense to address the root of the problem rather than just load patients up with more drugs. How do I find a family physician who practices lifestyle medicine and sees the benefits of a vegan diet for longterm health??? I’m in NE OH and there are plenty of docs here but I can’t seem to find one that I really feel comfortable with. Dr. Greger, please speak to this issue! Thanks!

    • Rita Salm

      Pam Popper is in Columbus,OH with her center, The Wellness Forum. Her focus is good health using WFPB nutrition check it out. http://www.wellnessforum.com/

      • Annette153

        Thank you, Rita. I will check that out.

    • Thea

      Annette153: In addition to the great suggestion you already got, I thought I would throw out another idea: Join a local vegan social or education group and ask around those members. For example, you might look into a vegan Meetup group in your area. I was able to get some great doctor recommendations by networking with the vegan people in my area.

    • The Power

      Sure, lifestyle modification works, but only to a certain extent. Furthermore, getting some people to change their lifestyle is like asking them to stop breathing; it’s not gona happen. All medical schools teach lifestyle modification where it has been shown to work but remember, medicine is a constantly evolving profession so even when you get out of school you never stop learning. The current trend for guidelines is to get away from relying on lifestyle modifications since they have been found to, in MOST cases, not have the significant effects that medications have so waiting around for a patient to implement lifestyle modifications that he/she may or may not do just delays the time to start effective treatment with medications that have been shown to save lives.

      • Thea

        The Power: re: “The current trend for guidelines is to get away from relying on
        lifestyle modifications since they have been found to, in MOST cases,
        not have the significant effects that medications have…”

        I would not agree with this. I know you said “most” and not “all”, but there are so many examples on this website, time and time again, on how a proper diet does the same or better than the drugs–without the horrid side effects that the drugs come with. Here is just one example:
        http://nutritionfacts.org/video/amla-versus-diabetes/

        And while I don’t have a link to it right now, I know that lots of people would happily change their behavior if they truly understood the benefit. We know this because lots of people do so. (Of course, lots of people also do not change their behavior even to save their own lives. But those people are lost anyway…)

        I think the evidence shows that if doctors and the government actually sold nutrition and lifestyle instead of the way that they currently sell drugs, that would save a lot more lives than what we have now. That’s my 2 cents anyway.

        • The Power

          Please familiarize yourself with the latest guidelines regarding diet modifiable disease states, ie. diabetes, hyperlipidemia, hypertension. Yes, lifestyle modification is regarded as important but these guidelines have come to grips with the fact that lifestyle modification is very difficult for a lot of people and it will not fix 100% of the problem even when implemented perfectly.

  • Joe Caner

    There is no big mystery here. The current state of affairs is perpetuated by an avaricious alliance among the AMA, big pharma and the insurances industry and the influence it wields with campaign contributions in our system of legalized bribery that we euphemistically refer to as American democracy.

  • Han

    If it is true or not is not relevant: There is this story I heard that in China doctors get payed for their healthy patients, they have to pay if a patient get sick.

    That system sounds like a great solution!

  • Plantstrongdoc M.D.

    Thoughtprovoking. ” The fundamental approach to medical education has not changed since 1910″ – imagine if this also was the case for telecommunication – we would never have met – no dr. Greger, no HemoDynamic, no Veganrunner, no Thea, no Darryl, no Toxins, no BIBI VIRO, no Coacervate and no all the other wonderful caring people on this site! My point is that there is something fundamental wrong with “medical thinking”. Where are the medical quantum leaps !? Cancers are still treated with toxic drugs, heartdiseases are still treated with old drugs and hopeless surgery, hypertension with diuretics, psychiatric disease with (sometimes dangerous) drugs with a lot of sideeffects, antiepileptic drugs does not cure the fundamental disease, but only controls the seizures, the prognosis for malignant braintumors are still very poor, treating chronic pain still doesnt work, new drugs have the same mechanism of action as the old drugs, but are heavily marketed, screening programs only helps very few AND SO ON! Within few years we have seen quantum leaps in telecommunication (my son doesnt know what dialing a number means!), computers, transportation, television, foodproduction and even sports. Only minor progress in treating diseases – the principles are nearly the same as 100 years ago. Why? Legislation? Conservatism? Money? Stupidity? Lack of innovation? Or are we simply on the wrong track in the understanding af health and disease…..

  • james

    why not just ban processed grains ? after all drugs are ban so anything that is as bad as drugs should be too.

    • rijelkentaurus

      That will just make donuts more attractive. ;^) Hasn’t worked for any of the drugs yet, either.

      Seriously, however, I think for this to work over the long haul it has to be an organic thing, and as more people come on board with it, then purveyors of junk food will either adapt or (hopefully) die.

      • Thea

        rijelkentaurus:
        re: “That will just make donuts more attractive.” I was thinking something similar.

        My idea for meat, dairy and eggs is not to ban it, but to stop subsidizing it in any way *and* to start making the industry pay full costs for all their planet depletion acts. The results would a dramatic increase in the cost of those products. That’s how you get your organic change. If the cost goes up, people just naturally look for alternatives. Then we can go back to only the rich people (being the only ones who can afford meat, dairy and eggs) getting those terrible diseases.

  • Christine

    Thanks for sharing the medical know-how doc!

  • Daniel Wagle

    I have had some debate on other forums with low carbers who insist that whole grains have a high glycemic index and therefore they are bad for diabetics. I quoted research which showed that whole grains help prevent diabetes, just like in this video. Some low carbers swear that cured their own diabetes by eliminating the grains. Maybe it was all the meat and fat they eat they make them more glucose intolerant, such as to the grains, and insulin resistant. I also stated that there is good evidence that saturated fat in red meat and dairy promoted insulin resistance. Low carbers seem to think that meat is good for preventing diabetes because it has no sugar in it, but they don’t stop to consider that meat makes a person less tolerant of sugar.

    • Toxins

      I think people on both sides of the debate forget that meat also raises insulin, more so in some cases compared with carbohydrate containing foods.
      http://ajcn.nutrition.org/content/66/5/1264.full.pdf+html

      Also, as Jeff Novick has argued, the Glycemic Index is not always the best tool in determining the healthfulness of a food.
      http://journals.cambridge.org/action/displayAbstract?aid=8234629

    • Charzie

      Daniel, I cured my own diabetes by switching to a low fat high complex carb WPFB diet, absolutely including whole grains! It took less than a month to normalize my blood sugars eating like this after taking medication and following the ADA’s dietary advice for almost 2 years! Maybe we are different based on where our ancestors developed, I don’t know. Alls I know is, without a doubt, what worked, and continues to work, for me. I love the idea of the 30 day challenge. Commit to it whole-heartedly for 30 days, and see how it affects you. That was my initial plan but by the second week I was more than sold when more positive changes began to happen than I could count.

      • Russell

        Charzie,

        Like you, I’ve also taken control of my glucose over the past year (I’m pre-diabetic) but in the opposite direction to your own nutrition regime. I eliminated all grains (which I guess makes me a vegan “low-carber”) but have kept up being a vegan, which I’ve been for about 30 years and may have caused my pre diabetes in the first place. The result is my A1C has dropped to just 5.3, a truly normal value. But I had to increase my fat content to about 30% to avoid getting too skinny (BMI 20), mostly avocados, nut and seed butters, and then proteins like seitan, tofu, etc. The result — my LDL is respectable (120), my HDL is excellent (90), triglycerides too (40), and LDL particle size distribution is superb. And my carotid scan shows no plaque. So… perhaps a high-fat diet can work as well. Just sayin’.

        • Charzie

          Ha ha, too skinny? I doubt I’ll ever have that problem, but that’s okay, having lost over 150 lbs. As I said, we are all different and have to find what works best for each of us…the only way to do that is to try it out and see.

    • http://twitter.com/MacSmiley MacSmiley

      I find that sometimes people will only listen someone who’s attractive, endearing, and ex-vegan. For example…

      http://m.youtube.com/watch?v=KFfK27B_qZY

      • Toxins

        I think its interesting that the healthy lifestyle of a plant based diet is led by doctors in the field who have extensively researched nutrition as a career and published research or who have practiced medicine for several decades. On the other hand, the low carb movement seems to be led by bloggers, personal trainers and journalists. I think this is a telling distinction.

        • http://twitter.com/MacSmiley MacSmiley

          For a split second, I was going to write, “Fair point.” But then I remembered…Drs. Grain Brain and Wheat Belly. Throw in Hyman, Mercola, Weill, and Oz for good measure.

          Well, actually not good. :-(

          • Toxins

            Mercola and Oz are more of a quack on both sides of the debate. But yes I agree, I think my point is more of a general impression rather than an absolute truth.

          • Plantstrongdoc M.D.

            I think Toxins has a point. If we look at the good old plain, average, moderate, doctor – no doctor recommends increasing the meat and saturated fat intake, and lower the intake of fruit and vegetables, to prevent or reverse diabetes, hypertension, cancer, heartdisease, stroke and so on. Opposite – they recommend to lower (which is not good enough) the intake of red meat, saturated fat and increase the intake of fruit and vegetables. So 99.9% of the doctors agree on the trend! In my country we had a doctor who was famous for claiming that smoking was not bad for your health. One out of thousands of doctors – and still some fools believed in this clown. I suggest we ignore the 0.1% of doctors

          • Toxins

            Here is a great read by Campbell regarding current l;ow carb studies and pitfalls plant based proponents may fall into. Its very informative.
            http://nutritionstudies.org/low-carb-hot-air/

          • Jean

            Thanks. The article by C. Campbell really puts the whole picture in a more sensible light for me. Animal products vs whole foods plant based eating styles.

          • Timar

            Since when is Andrew Weil a proponent of the low-carb movement!? The fact that his anti-inflammatory diet is not vegan but essentially pesco-vegetarian, may annoy those advocating a strictly plant-based diet, but that does not make him a low-carb proponent. Yes, he warns against the dangers of refined carbohydrates and recommends to eat low-GI whole grains instead – just like Greger, McDougall, Esselstyn et al.

            Your are an intelligent commenter Melanie, please don’t fall for the fundementalist fallacy (i.e. “either you are 100% with us or you are against us”). It is extremely unfair lump Dr. Weil together with those shady people just because of his popularity and the fact that he doesn’t promote a vegan diet. He is actually doing tremendous work to transform the health care system exactly the way called for in Dr. Gregers video.

          • http://twitter.com/MacSmiley MacSmiley

            See for yourself.

            http://youtu.be/aoQGRJqGQTs

          • Timar

            You can’t take such mainstream media sound bites at face value. In contrast to most vegan diet gurus, who are content with mostly preaching to the converted, Weil is clever enough to start his sermon from were the people (which means to a certain extent: the fads) are. Judge him by the dietary advice he gives in his own lectures, on his website and in his books. Here are some quotes from his website:

            – “The distribution of calories you take in should be as follows: 40 to 50 percent from carbohydrates, 30 percent from fat, and 20 to 30 percent from protein.”
            – “Eat more whole grains such as brown rice and bulgur wheat, in which the grain is intact or in a few large pieces.”
            – “Eat more beans, winter squashes, and sweet potatoes.”
            – “Reduce your intake of saturated fat by eating less butter, cream, high-fat cheese, unskinned chicken and fatty meats, and products made with palm kernel oil.”
            – “Decrease your consumption of animal protein except for fish and high quality natural cheese and yogurt.”
            – “Eat more vegetable protein, especially from beans in general and soybeans in particular. Become familiar with the range of whole-soy foods available and find ones you like.”

            Sounds like your usual low-carb diet, does it? For the record: I personally think his recommendation for protein is somewhat excessive, but at least he specifies where it should come from.

          • http://twitter.com/MacSmiley MacSmiley

            Sorry, Timar. I’ve seen him endorse LC on Dr. Oz as well. I remember how dismayed I was to hear him do so, because I had been to his website which stated otherwise. I just cannot take someone so inconsistent seriously. And being in front of different audiences does not cut the mustard with me.

          • Toxins

            Mac Smiley is right, he believes saturated fats are better then carbs.
            https://www.drmcdougall.com/misc/2010other/news/weil.htm

        • Leila Mcdanielmuto

          I do not agree with her because there are so many pesticides in raw foods that it is the cause; for vegan deaths here in America. The synthetic hormones are giving us heart disease and Cancer, so she is not very good with the research she is lecturing about.

      • Charzie

        Wow! She actually got it! Kewl!

      • VegEater

        I am impressed by her honesty. It seems that I was unfair to Denise Minger.

    • b00mer

      Do those people who have eliminated grains restrict other sources of carbohydrate as well? If they claim to have cured their diabetes, but are eating low-carb overall, then they haven’t cured anything, they’re just managing the symptoms of their intracellular fat-induced disease through restriction (paper towels as opposed to turning off the faucet as Dr. G might say). A physiologically properly functioning human can consume plenty of carbohydrate and process it efficiently without entering a diseased state.

  • Angela Himm Wolfenberger

    There is a group already trained in lifestyle management of chronic disease. They are called registered dietitians. Perhaps if the doctors were to refer individuals to these licensed professionals, they would not have to change their own medical education. No need to reinvent the wheel.

    • Toxins

      I am currently in training to become a Registered Dietician (RD). Even with an education in nutrition, none of this is taught in school. What is taught is moderation and following the USDA food guidelines. A small percentage of Americans come close to the guidelines, and even if they did, the guidelines would not protect against chronic disease.

      The dietary guidelines of 1995, quite similar to today’s guidelines, do not appear to significantly prevent chronic disease risk when evaluated using the healthy eating index developed by the USDA. Women are unprotected from all forms of chronic disease while men have a 28% reduced risk of heart disease.

      http://apjcn.nhri.org.tw/server/apjcn/17/s1/75.pdf

      RD’s currently are ineffective in preventing chronic diseases, all they can do is treat them or prolong the inevitable, not cure them or prevent them. Thus, the studies shared on this website are powerful and necessary. The strength of a plant based diet needs to be taught to RD’s. Sadly, the American Academy of Dietetics, the organization that structures the educational path of an RD, has its own biases.
      http://nutritionfacts.org/video/academy-of-nutrition-and-dietetics-conflicts-of-interest/

      • Plantstrongdoc M.D.

        I think it was Caldwell B. Esselstyn M.D., who said: Moderation kills!

      • Plantstrongdoc M.D.

        I think Esselstyn also said: Heart disease is nothing but a toothless paper tiger that need never exist and, if it does exist, need never progress.

      • Angela Himm Wolfenberger

        There are groups within the Academy of Dietetics–Dietitians in Integrative and Functional Medicine and Vegetarian Practice Group that are certified in just this material. The Academy has also come out with a position statement that Plant Based diets are the best way to prevent chronic disease. If you are in school to be an RD–please do your homework.

        • Joseph Gonzales R.D.

          And the Oncology Nutrition Dietetic Practice Group (DPG), amongst others. Thanks for mentioning them. I am part of a few. It is good to see the research coming out of the DPGs because we need it for our patients.

        • Rami Najjar

          I am reporting what is taught in the education system, plant based diets are NOT thought of as healthful or necessary in my experience with professors and other RD’s. In fact, several of my professors are on the low carb bandwagon, the opposite dietary protocol of a plant based diet. Please see the link I provided above regarding the once ADA.

  • yorkie3nme

    I’m completely convinced that our health is directly impacted by what we take in not only food wise but otherwise, such as; toxins (outside food sources), mental food (movies, books, music, etc.), and emotional atmosphere. Of course, we don’t always have complete control in all of these areas and so we do as much as is possible. My question surrounds the area of toxins and the medical world regarding vaccines. What science do you claim in this area, if any? I used to be pro-vaccine, unquestionably, no longer. There is a lot of science and published works that tell a very different tale than what we hear from our pediatricians and family physicians. Dr. Tenpenny and others are at the forefront of established research and offering this information to the public, much as you are doing in the area of what we eat. What is your view of the safety of vaccinating the masses?

    • Angela Himm Wolfenberger

      Have you ever met a smallpox or polio survivor? I have, and they might disagree with you.

  • Tia Haenni

    What happened to “do no harm”? Replaced by the compensation model that says I recommend what pays the best? Shame on you, doctors (not including the plant based advocates such as Dr. Greger of course).

  • Linda Cantey Slonim

    Whole grains? OK, but what about the genetically modified grains we eat in today’s world?

    • b00mer

      Aside from corn if you consider it a grain, no other grains are genetically modified.

  • FrankR

    Hello Doctor. Dr. Lustig just posted a lengthy blog saying low carb is the way to go, and that avoiding saturated fat is a dead hypothesis. He cites A study called “Effects of Low-Carb and Low Fat Diets” by Bazzano.

    I’m wondering what is your reaction to this study findings and his proclamation?

    Thanks

    • Toxins

      Lustig is notoriously dishonest. The study has many issues. The high carb diet consumed primarily processed carbs, they were not even low fat, and the low carb group ate less calories. This is hardly evidence for a low carb diet.

  • Joe Tilman

    I was thinking back to when I was first diagnosed with prediabetes, and the first thing the doctor suggested was metformin. That doctor left to open her own practice, so my first followup was with an FNP, and her first suggestion was a diabetes nutrition class at the community health education center, and a general advice to get off my butt.

    My diet change has been evolutionary, first making better choices at the grocery, then the farmers’ market, then switching almost entirely to CSA produce – having awesome produce makes us actually *want* to cook. I always used to view cooking as a chore, but the preparation of produce is a completely different world from opening packages. We are not vegan, yet, but tend to be moving that way more each year. Having some fresh eggs from our backyard chickens may be slowing that transition :)

    I have been an occasional-to-part-time bicycle commuter for 20 odd years, the nurse merely suggested making it my primary vehicle. We eventually sold off our second car to provide me with “incentive” to bicycle to work full time, and the money saved has allowed me to upgrade to a nicer bicycle (to be perfectly honest: more than one).

    I now maintain an A1C of 5.5+/- with no drugs. Not perfect, but tolerable.

  • ud6

    Excellent video. Thankyou