It has been around a year now since I changed to a Paleo lifestyle in my own life, and I thought it would be interesting to look back on my practice and see how I think I have changed in how I approach three common problems: Hypertension or High Blood Pressure, High Cholesterol, and Diabetes. I can’t stress to everyone how fundamentally different a “Paleo” way of thinking is compared with what I was taught in school. Most physicians are simply not exposed to information other than the status quo, and whose fault that it is a long story…so, let’s just look at me!
High Blood Pressure: Statistically, this is the number one problem that I treat in my office on a day to day basis. 95% or so of hypertension (HTN) is of an unknown cause, and is known as “Essential HTN.” Even over the 8 years I have been out of training our approach to HTN has changed. We are much more aggressive from the start in treating people’s blood pressure because the more we study the problem, the more it is linked with medical badness in the form of strokes, heart attacks, and kidney failure (among others). There used to be something called “Pre-Hypertension,” which is now simply known as Stage I HTN. There are lots of conspiracy theories on the internet about Statin medicines for cholesterol and the evils that they bring. Notice this though, you DON’T see much bad press for high blood pressure treatment. The simple answer for this is that HTN kills, and treating it helps prevent death. It’s very clear cut, our medication options are affective and affordable, and the standard of care is to be aggressive with medical treatment.
Another interesting thing about HTN is that it does not traditionally respond tremendously to weight loss. Although you can see modest decreases in blood pressure with the shedding of pounds, it’s not often as effective as people wish it would be. Don’t get me wrong, it helps, but shedding 15-20 pounds rarely leads to the elimination of HTN medications for the grand majority of people.
The one side of Paleo that does certainly help HTN is the decreased sodium intake which accompanies the elimination of processed foods from one’s diet. What this does is help control a patient’s BP with LESS medicine in many cases. I used to tell patients that HTN is like a train rolling down the tracks…it’s always rolling, even ever so slowly, and we would have to increase their meds over time to keep up. I suspect that lowering sodium intake over time MAY help shut the train down. As I said, the train will likely still be there, just more under control. Ultimately if I can control blood pressure and keep it from getting worse I will be happy.
So how has Paleo changed my treatment of HTN? I recommend Paleo to all as an overall way to best improve their health, but I don’t expect people to be able to stop their BP meds, particularly if they are on multiple meds with difficult to control blood pressure. I emphasize Paleo to limit lifetime drug burden and keep things controlled with hopefully less medicine. I never partially treat high blood pressure with “watchful waiting.” Take home: don’t mess with your blood pressure! If it’s high, see your doctor and control it one way or the other.
Cholesterol: This is a condition that has certainly changed when it comes to the way that I approach patients. I have always been very aggressive as a doctor overall, and I was typically aggressive in getting a patient’s cholesterol down. Don’t get me wrong, I still am! I just may approach it a little differently. I’ll concentrate on one particular patient type.
In generally healthy patient’s with high cholesterol, but without a known history of cardiovascular disease or strong family history of CV disease, I am definitely less quick to prescribe a statin. I have an honest discussion with the patient and explain that we need to decide whether or not to treat their high cholesterol. I am increasingly ordering a more sophisticated cholesterol profile known as a VAP cholesterol to help make that determination, along with assessing how serious the patient is in changing his/her diet to create a generally healthier cholesterol environment in their bloodstream. What I’m interested in is lowering the bad cholesterol in their body, and also changing the characteristics of that cholesterol from a more dangerous small/dense cholesterol to a less dangerous large/fluffy cholesterol. If we can do that with a Paleo lifestyle, awesome! This is ALWAYS my first choice. If patients are unwilling to do that, the next step is cholesterol meds. The newer statins have indeed shown the ability to shift particle size in the right direction, but I feel it is no where near as powerful as the shift we can see with a strong Paleo lifestyle. This is my BELIEF, and it is my hope that over time we will have the data to support that.
I treat people, and some people are more willing and able to approach medical problems with lifestyle changes, while some are simply “give me a pill” type of people. I encourage, but I do not judge. I’m honest and realistic with all my patients, and I just want to try to help everyone that I can. I explain my position, and allow them to take a position they are comfortable with…after all, I am treating THEIR health, not mine!
The use of statins in patients with known heart disease is a very complex topic fraught with questions, controversy, and medico-legal issues I’m not up for entertaining. It would be easy, but foolish to preach on this subject. If you have known heart disease I’ll simply tell you: educate yourself, consult a physician you are comfortable with, and come up with a plan together you are each comfortable with.
Diabetes: This is the condition I probably have been most affected by when it comes to my approach to patients and the Paleo lifestyle. I have had many diabetics commit to a Paleo lifestyle, and the results have been remarkable. I am currently working on a prospective study looking at the effectiveness of going Paleo on diabetics over a three month period (but more on that later!).
For me, treating diabetes has always been the most difficult of the big three because of how much a patient’s habits ultimately decide the “success” of my treatment regimen. Blood pressure high?…I can bring it down no problem! Cholesterol up?…just take this medicine and you’ll look great on paper in 6 weeks! Diabetes on the other hand is no where near as simple. Patient’s can quite easily overwhelm their pancreas’ ability to produce insulin, a medicine’s ability to assist their pancreas, or both!, by simply eating the wrong things. I became quite frustrated as traditional “diabetic” diets seemed useless at improving LONGTERM control of a patient’s disease process.
My Paleo journey began as a personal one. I did it to feel better, get fitter, and live longer. The more I researched the science behind it, the more it was obvious to me that it should be a tremendous treatment for diabetes. It may not eliminate the treatment of the disease with pills or shots, but it could be a great baseline on which to manage everyone. Again, there is no argument that elevated blood sugars are bad for you, and must be corrected at all costs. I see Paleo as an alternative for patients to keep their blood sugars lower with LESS medicine! In the end, only one thing matters…get those sugars down. Paleo adds another weapon in the arsenal.
Again, with my diabetics I sit down and explain why I feel Paleo will benefit them. I do this in detail, and utilize some simple handouts I’ve written up as to how making the right food choices can truly help control blood sugar. I then discuss the experiences my other patients have had after adapting their lifestyle. I make it perfectly clear that in my opinion, their best chance for long term sugar control and limiting the meds they will need to use is to adapt an 85-90% Paleolithic lifestyle. If I can get them to bite, I hand them a flash drive with my clinic’s Nutrition Guide we obtained from our friends at Whole 9 Life. This is all they need to be successful right in the palm of their hand. Do all patient’s follow through? Absolutely not. But, it’s a crack in the armor. Eventually we will have the discussion again, and the next time they may be more willing to give Paleo a more serious try. As always…one patient at a time.
I’ll admit, it really bums me out when people won’t give it a try. I practically beg for patient’s to try it for 30 days because I know they won’t go back. Literally, I have not had one patient who went 30 days go back to eating non-Paleo. 100% success rate for my patients…not too shabby.
There are many applications of the Paleo diet to chronic disease, but my passion at the moment has to do with it’s application in the diabetic population. From the hormonal standpoint it strikes at the core of the disease, and offers AMAZING potential for REAL change in people’s lives. I have so many plans…and so little time…
My personal journey in the Paleo lifestyle is far from over, as is my re-orientation as a PaleolithicMD. I would have never thought a year ago that I would have changed my personal health and diet so much, or that my views on the treatment of these three diseases would have changed so much. I certainly would not have guessed I would be moderating this blog in an effort to spread the word that Paleo is a valid addition to the traditional fight against chronic disease. Basically it shows that you can indeed teach an old dog new tricks! So, let’s see what the next year will bring!