A Physician’s Manifesto: In Defense of My Profession in Our World

11 Aug

This weekend the Ancestral Health Society had its annual symposium in Boston, MA.  Unfortunately for me I was home (on call none the less!) and was forced to follow the proceedings via the Twitterverse.  I also recently posted about how my change to the Paleo lifestyle has affected the way I approach three common chronic diseases: Hypertension, High Cholesterol, and Diabetes.  Several comments I read from the AHS and that I received on my blog post have got me thinking, and I need to get a few things off my chest.

First of all, I must confess to everyone that although I run a blog site called PaleolithicMD, I am still a common variety Internist in the South of our great nation.  I absolutely push Paleolithic nutrition to everyone in my practice, but it does not in any way stop me from prescribing medicines to my patients on a daily basis.  I am forced to ride the fine line between strict Ancestral Medicine and Modern Day Medicine.  Some may say that is a negative, I even had one comment from someone who chose not to apply to medical school because he could not deal with people who simply want a pill to fix everything.  I find that unfortunate, but respect the opinion none the less.

I had several responses particularly to my stance on aggressive treatment of hypertension.  Several kind readers directed to me to articles stating that the treatment of chronic hypertension with medical intervention to prevent disease is weakly supported.  What concerns me is the “blanket” nature of people’s opinions about high blood pressure.  I, like most practicing physicians in America and around the world routinely review the latest scientific journals pertaining to our field of specialty.  We are true life long learners, one of the aspects of my job that I most enjoy.  That said, arterial hypertension is a systemic disorder, with wide ranging system consequences.  Chronic untreated Hypertension is/will (among others):

-The most common major risk factor for premature cardiovascular disease 1

-Directly lead to Left Ventricular Enlargement and consequently chronic systolic Congestive Heart Failure and increased incidence of ventricular arrythmias 2

-The most common and important risk factor for ischemic stroke, the incidence of which has been shown to be markedly reduced with effective BP control 3

-The most common risk factor for the development of intracerebral hemorrhage 4

-Major risk factor for chronic and end-stage renal disease 5

It is cool and sexy to take a universal stand against all medicine, it must ALL be bad for you.  Not only that, EVERYTHING can be cured by changing one’s diet right!  Take this tweet for instance…

Disease can be prevented, treated and cured by food. Amazing results from research & studies being presented at #AHS12. Totally blown away!

What a far ranging statement!  Most common “Paleo” folk live in and out of gyms, hang out with their fit friends, and search far and wide for the cleanest restaurants to eat at.  We (I include myself in this crowd) source the best farm raised protein and organically grown produce…we live in this perfect little sustainable world!  I live in this world, but I also live in a very different world; one where I take care of very sick individuals.  How am I to care for critically ill patients without medicine to give them, or surgery to fix things? This leads me to my two favorite quotes from today on twitter, both from Dr. Wahls.

“Superior doctors prevent disease. Mediocre doctors treat impending disease. Inferior doctors treat actual disease.”


“The doctor of the future will give no medicine. You guys are the doctors of the future. I salute you.”

Let’s talk about each of them in turn.  The first quote is, how can I put it, an incredibly arrogant and asinine thing to say!  What Dr. Wahls is doing is playing to her crowd.  She figures she is in front of a group of AHS attendees who WANT to hear something like this.  Why not make a ridiculous statement and get a few oohs and aahs (I wasn’t there, so I admit some speculation here!)  Her statement takes a very far reaching stance that is dependent on one important thing…that ALL DISEASE is completely preventable by proper nutrition or following the right “Protocol.”  Make no mistake, her story is remarkable and inspirational, but it is not grounds to advocate that all disease is preventable, and that the only “superior” doctors are those who prevent disease.  I guess the ER physician who initiates the life saving care of a motorcycle victim, or the radiologist who diagnoses his injuries, or the trauma surgeon who saves his life from a ruptured spleen, or the orthopedic surgeon who repairs his broken bones, or the nephrologist who temporarily supports his kidney function through hemodialysis, or the critical care specialist who keeps him alive in the ICU until his body starts to heal itself, or the Internist who takes over his care once out of the ICU and methodically advances his care, or the Physical Medicine & Rehabilitation physician who expertly crafts his rehab program…I guess none of these doctors are “superior”…in fact, they are surely “inferior.”  One can read a statement like this by Dr. Wahls and feel all nice and tingly because WE can do this, WE can fight disease through Ancestral Health alone, WHO needs inferior doctors!!!  I can just hear William Wallace himself yelling “But they can’t…take away… our BACON!!!”  What if that motorcycle victim is your dad, or husband, or son…what about those inferior doctors now?  Is all disease preventable by eating more bacon and coconut?  I won’t answer that, you can do that on your own…  You may take this as simply a doctor being defensive, but that is not the case.  Thousands of doctors will be away from their families tonight on call caring for your loved ones with a great deal of compassion and heart.  I refuse to accept a fellow physician downgrading the status of 99% of her fellow physicians simply to get a rise out of a crowd or to advance her personal agenda.  Say what you will, so will I.

So what about the “doctor of the future” comment?  Amazing, talk about playing up to the crowd again with another far fetched statement.  I guess the future will have no doctors nor need any doctors.  All everyone will have to do is read a book on how to eat and live, and we’ll all live to be 120 years old.  Seriously, who will need a doctor?  Again, this is a “cool” statement to make, but it’s just ridiculous in my opinion.  You may agree with her, or just hope she is right, but I can assure you she is 110% wrong.  What will a doctor without medicine do for a broken bone, or a gunshot wound, or a pneumonia, or an appendicitis, or a cataract causing blindness, or a skin cancer caused by SUN exposure, or a congenital heart defect, or an abscessed tooth, or a kidney stone, or a… I hope you get my point.  The thought that the only thing doctors in the future will do is prescribe you their nutritional “protocol” is terribly short sighted and misleading.

Let me explain to everyone where I live, I live in REALITY!  One of the main reasons I started my blog was to stress that there is a real and valid place for both Paleolithic Nutrition AND Modern Medicine in each and every person’s life.  INCLUSION rather than EXCLUSION.  I agree with each of you who is saying things like “but wait, if everyone ate Paleo we wouldn’t have as much heart disease, or diabetes, or high blood pressure, or autoimmune disease, or osteoporosis, or whatever…”  You know what, I think you are absolutely right, but I also believe strongly that Paleolithic Nutrition is not going to be taking the world by storm any time soon.  My job as a doctor is multi-faceted.

-My primary role is to catch people early, before chronic diseases set in, and get them to buy into the idea that their actions, particularly through what they eat, can and will significantly affect their health both short and long-term.  As I like to say, Real Food…Real Health.

-My secondary role is to treat those who have not followed the right lifestyle and consequently have developed any number of chronic diseases.  The most exciting ones are those who are willing to re-adapt their lives and change the habits that got them in trouble in the first place.  The use of medication in these patients is necessary and frequent, but is also often diminished if they can adapt to following a strict Paleo lifestyle.

-My final role is to treat those who will simply not listen to what they are doing wrong, and want to live life the way that they please.  I have said it many times that I believe strongly in NOT JUDGING people in any aspect of life (no, I’m not perfect in this).  What am I to do if someone is unwilling to adapt their diet? Fire them as a patient?  Refuse them treatments that HAVE been proven in studies to help them live longer lives?  If I run a Paleo-Only medical practice I will do two bad things: go broke, and miss out on the amazing relationships and interactions that I have with most of my patients.  You see, just because someone will not give up their carbohydrates despite their terrible blood sugars does not mean that they are not a wonderful person, or that they don’t get benefit from seeing me.  Likewise, just because a physician will not abandon all modern practices and preach only a Paleo lifestyle as the treatment for chronic disease does not make him or her “inferior.”  

So many people advocate for social tolerance all the while berating the many American’s who for whatever reason, cannot adapt to the lifestyle we find so helpful to us.  Or for that matter, look down upon the majority of doctors who simply “push pills” to the benefit of them and the all powerful and evil drug companies.  What about the grandma with pneumonia, or the grandpa with a broken hip, or the mother of two whose husband left her and tried to kill herself, or the 17 year old college student with meningitis…what do I do, hang an IV of bacon fat or pureed beef liver and hope for the best?

This is not us against them, or “superior” vs “inferior” doctors, this is simply the story of humanity played out for all to see.  I’ll say it again, be INCLUSIVE and not EXCLUSIVE.  I absolutely love my job; I enjoy finally breaking through to the diabetic who agrees to give Paleo a try just as much as I enjoy laughing with the 86 year old who knew he was having a stroke because his cigarette kept falling out of the right side of his mouth.  I admitted this gentleman to the hospital, worked him up, put him on Aspirin, and sent him home…where he picked right back up smoking.  I can get mad at him, or just understand my role in his life.  What did he do about all this? He laughed!  The German’s didn’t kill him on the beaches at Normandy, and he’s not too concerned about what the cigarettes are doing to him at this point.

There is nothing inherently bad about you if you can’t fellow a 100% Paleo diet, nor is there anything particularly special about you simply because you can.  I see you as an amazing human being with as much to offer me as I have to offer you.  Guess all this makes me and Inferior doctor…and I’m very proud of my work and the influence I have on people’s lives.

Thank you. I came here tonight… and I didn’t know what to expect. I’ve seen a lot of people hating me… and I didn’t know… what to feel about that, so… I guess I didn’t like you much either. During this fight… I seen a lot of changing: the way you felt about me… and the way I felt about you. In here… there were two guys… killing each other. But I guess that’s better than million. What I’m trying to say is… if I can change… and you can change… everybody can change!          -Rocky Balboa


PS – Also, check out this like-minded quote from Dr. Emily Deans at her blog Evolutionary Psychiatry.

1 Established risk factors and coronary artery disease: the Framingham Study, Am J Hypertension. 1994;7(7 Pt 2):7S.

2 Prognostic implications of left ventricular hypertrophy. Vakili BA, Okin PM, Devereux RB Am Heart J. 2001;141(3):334.

3 Randomized double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. The Systolic Hypertension in Europe (Syst-Eur) Trial Investigators. Staessen JA, Fagard R, Thijs L, Celis H, Arabidze GG, Birkenhäger WH, Bulpitt CJ, de Leeuw PW, Dollery CT, Fletcher AE, Forette F, Leonetti G, Nachev C, O’Brien ET, Rosenfeld J, Rodicio JL, Tuomilehto J, Zanchetti A Lancet. 1997;350(9080):757.

4Risk factors for cerebral hemorrhage in the era of well-controlled hypertension. Melbourne Risk Factor Study (MERFS) Group. Thrift AG, McNeil JJ, Forbes A, Donnan GA Stroke. 1996;27(11):2020.

5Elevated blood pressure and risk of end-stage renal disease in subjects without baseline kidney disease. Hsu CY, McCulloch CE, Darbinian J, Go AS, Iribarren C Arch Intern Med. 2005;165(8):923.


Posted by on August 11, 2012 in General Paleo Discussion


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81 responses to “A Physician’s Manifesto: In Defense of My Profession in Our World

  1. geomert

    August 12, 2012 at 12:48 am

    I very much appreciate your words… I’ve eliminated grains, legumes, most dairy and sugar from my diet and have personally seen great health benefits. I find that I get so caught up in what the paleo community (the dozen or so people I follow online) is currently doing, that I’m unable to hold a conversation with friends without dropping random and often superior sounding bombs on them.

    I’m currently studying to be a health coach – and I know that what I need to practice most is being myself, remembering where I came from, and not judging. I find the science (and simplicity) behind this approach so appealing and real – it’s hard not to think I’ve found the fountain of youth. Of course you want to shout it from the rooftops, but then you run the risk of dismissed as a crazy person. As you no doubt know, passions run high when you believe you can save lives.

    Thank you for injecting some humanity and reality into this.

    • erniegarcia76

      August 12, 2012 at 12:57 am

      I was a bit nervous about posting this, so the positive comment is much appreciated! Thanks for reading

  2. cissyblue

    August 12, 2012 at 12:56 am

    Thank you Dr. Garcia. I really enjoyed reading this post. It’s very refreshing to hear a doctor speak candidly and honestly, and I really appreciate the perspective! It makes me feel very comforted to hear you speak of good relationships with patients. If only my doctor had the time…

    • erniegarcia76

      August 12, 2012 at 1:02 am

      Thanks for the kind words…there are many amazing doctors out there. Keep looking till you find one!

  3. sebledsoe

    August 12, 2012 at 1:32 am

    You think you have it tough? Try being a Bariatric Surgeon and living in the Paleo world. 😉

    I wholeheartedly agree with what you said. We see people all the time who honestly believe that if everyone ate Paleo there would be no need for doctors, hospitals, pills, operating rooms, or nursing homes. Everybody would have normal blood sugars, great blood pressures, be at their ideal body weight and leap tall buildings in a single bound were in not for the nefarious doctors peddling sickness to make money off the public. Get real!

    I’ve got news for those people. It’s nearly impossible to get people to quit smoking, much less eat grass-fed beef! There are people who willfully make disastrous health choices no matter what the consequences. There are truly repentant people who have permenent metabolic derangement and health problems from lifestyle decisions they made in their past. And there are people who lost the genetic lottery and will have health problems no matter what they eat or do. Our job is to (yes) educate but also to treat people and their diseases to the best of our ability. The best treatment could be dietary changes, a new medication, a procedure or all three.

    Enough of the grandstanding, there will always be a role for surgery. There will always be a role for medicines. There will always be a role for diet and exercise. Let’s work together to promote better health!

    • Brianna

      August 15, 2012 at 7:28 pm

      So when you say surely people will lose the genetic lottery & have health problems no matter what, as a believer in God myself, are you saying we have a faulty Maker ?

      • erniegarcia76

        August 15, 2012 at 10:30 pm

        Now, I believe it was Dr. Bledsoe who made the genetic lottery comment, but I certainly can give you my opinion on that. We do not have a faulty maker, we have a perfect maker. What we don’t know is his reasons behind his design. To us people may look “faulty,” but to him they are not. The bible is riddled with sick people, possessed people, epilepsy, etc. Now look, I’m no theologian, and I don’t pretend to be able to get into an in depth discussion about this (although Dr. Bledsoe is quite the Bible scholar!). All I can say is that I feel God’s design is perfect. My pastor said once “You can ask all the questions you want of God, you just can’t expect the answers.”

      • sebledsoe

        August 15, 2012 at 11:02 pm

        Of course not! The Maker isn’t faulty at all, but surely you’ve noticed that people have disease and sickness. Many times people are sick through no fault of their own (John 9:1-3). I do believe that God has a plan, even if we can’t comprehend that plan (Isa 55:8), but we can rest assured that, for the Believer, His plan is for our good (Romans 8:28) and His glory (Isa 43:7).

  4. sparkybeav

    August 12, 2012 at 2:19 am

    Your words resonate deeply with me. I am Paleo personally, a Clinical Pharmacy Specialist in primary care in a VA professionally. I was very frustrated with patients after becoming Paleo at first because they just couldn’t understand why their blood sugars were labile, why they couldn’t sleep well, why they were fatigued all day. I was frustrated constantly titrating insulin, antihypertensives, and statins. I decided to flip it and coach them about their health and invite them to make goals for change. like you said there will be those that just won’t change,but there are many who make small changes and have good health outcomes. There are also some very rewarding cases where I have used my skill to help TAPER OFF insulin and minimize statin doses. Healthcare providers are obligated to observe national guidelines, current research, and our patients’ history. We can provide information and evidence to educate our patients. It is the PATIENTS’ responsiblity to make lifelong change.

  5. Jesse

    August 12, 2012 at 7:39 am

    Great post. As an MSI I’m constantly being exposed to just how many things can go wrong with the human body (holy smokes there are a lot!) and it blows me away just how many are beyond our control, even with everything we know about eating and living healthy lives. I also really identify with your acceptance that not everyone has the time, money, or desire to take care of themselves. You can only explain to them what a difference it can make in their lives and leave the decision for them to make.

    Those statements were rather worrying as well. I’m interested in orthpedics and how would I be a bad doctor if I’m fixing bones and joints that have degraded or been injured?

  6. deniseregina

    August 12, 2012 at 9:06 am

    There’s that old book: When Bad Things Happen To Good People.” Even paleo-perfect folks will get DM, and HTN and CAD. Probably less frequently, but it will still happen. That’s why it’s called risk reduction, NOT risk elimination.
    PS I have a son teaching school in AR; I know you’re facing a tough road where you live and work, as well. Hang in there.
    Denise, RN

  7. Jenny D

    August 12, 2012 at 11:53 am

    I really love this post, and greatly appreciate your participation in the greater health care world. As you said, paleo isn’t going to take the world by storm, but every person that’s converted and every health care professional that’s converted is progress. While my personal healthcare views are in integrative/alternative approaches, I absolutely see a role for conventional care. If I broke my leg you bet I’m going to the ER and not the naturopath. The paleo approach has helped me with my seasonal allergies, and my husband with his asthma, but I still take Zyrtec on occasion and would NEVER want Bill to go without his albuterol rescue inhaler.

    I think where we paleovangelists get frustrated is that the majority of doctors and health care practitioners are not like you and I. As a broad generalization, physicians aren’t knowledgeable about nutrition beyond the basic recommendations (eat a low fat diet, eat whole grains, take a calcium supplement, etc.), and worse, don’t recognize this and refer to those who are (ehem, us dietitians). Years ago (before I went back to school for nutrition) I was confused about eating and needed some guidance with meal planning, etc and asked my PCP at the Lahey Clinic for a referral to a nutritionist. He refused, and said “You’re a smart girl. Just eat a low fat diet.” I see this attitude often in my experience as a dietitian, and it frustrates the bejesus out of me.

    A LOT of improvements can be made in prevention and treatment of disease. And it starts with food. I think that was the sentiment behind Dr. Wahl’s (inflammatory) comment.

  8. maxsmom77

    August 12, 2012 at 12:22 pm

    Just SO glad to read what you have written. Having PCOS and severe insulin resistance has been difficult. As hard as I try the insulin does not go down into normal levels. It does go down from obscenely high levels. But I will always, most likely live with this (even eating 20 or less carbs a day did nothing for this). I need meds to help me and hate being made to feel like I’m not trying hard enough. I caught my daughter early (she’s 20) and her insulin resistance is mostly controlled by diet. She went from 3 Metformin a day to 1 and we may soon be taking her off of that as well. You didn’t mention those with mental disease. They NEED meds, and although I’m glad that diet has improved/cured ADD or ADHD in kids, my daughter who is bi-polar has had no change from diet. Thank GOD there are meds for her.

    When I read one woman who was “fully committed”, ate only raw meat and it got rid of her PCOS, I wondered if I wasn’t “committed” enough. I know that’s ridiculous, but I honestly believe that people in this world who have say, 20lbs to lose and get super fit and low body fat, is completely different than someone who is pushing 50, lived with PCOS and IR for about 30+ years and needs to lose 100lbs. I just wish there was a little more understanding going around. Sounds like you have your head on straight.

    Thanks again for your honest candid post!


  9. Nannette Silvernail

    August 12, 2012 at 1:18 pm

    Just wanted to let you know that my husband and I were very thankful for your previous post about walking the MD/paleo line. My husband has pre-hypertension. We have a terrific family MD, and our tendency was to refuse increasing his meds when he wasn’t bringing the BP down to where it should be via diet, exercise and weight loss. When my husband would tell our MD he’d bring the BP down without the drugs, she was always willing to make a deal with him–“I’ll let you go another 3 months and we’ll check it again” because my husband was sure if he stopped cheating on paleo (we really are about 90% paleo–not bad) he’d bring the #’s down. My husband has lost 40 lbs. since initial dx, so…nothing to sneeze at–efforts paying off. (That did bring his cholesterol to healthy levels.) But after reading your post, I told him, “If you want to increase the meds, go for it. I’m convinced that BP that high for this long is dangerous.” So… thanks for participating in the paleo blogosphere despite the negativity of purists and anti-realists. I think the Paleo-cures-all mentality could have led my husband to a cardiac event, so maybe that post saved a life.

    BTW, our MD and the cardiologist who saw my husband both said he was the first patient to ever say to them, “How do I address this without drugs…what do I need to do?” Which is evidence of the mentality out there. That you have patients open to change of diet to address their issues is impressive. That my husband did bring his weight and cholesterol down (without drugs) is lending him credibility in our doctor’s eyes, so…maybe we’ll brave telling her we follow a paleo lifestyle sometime soon. 🙂 (Yes, GF beef, bacon and real butter brought his cholesterol to very healthy levels.)

    Thank you, again, for sharing for free with us your realistic and educated perspective and experiences.

    • erniegarcia76

      August 12, 2012 at 1:24 pm

      Thanks so much for the feedback. The key is that you guys are teaming with your doctors to make the best plan for you. I am always willing to give patients a chance to improve things on their own, but the proof has to be in the pudding! If the pudding isn’t good enough, then you go to Plan B. Your doctor should know the best plan of action from here. And again, I truly appreciate the positive response, and you following my blog 🙂

  10. aek

    August 12, 2012 at 2:16 pm

    Hi! I just found you via Emily Deans’ post. I didn’t hear Dr. Wahls yesterday, but I saw her engaging with AHS12 attendees. One impression with no way to validate – I wonder if her physicians statement is in part a reflection of her own worry about the loss of control she has over her own health problems?

    I can’t comment using my WP account on Emily’s blog, but my comment is there under the perishedcore ‘nym, and I elaborated more about where I’m hoping the healping professions go with ancestral health. I’m also looking for a constituency within which to advance ancestral health standards of care and practice in my field, but am so far unable to find any welcome. It’s been disappointing, and ironically, as presenters were advocating engagement and participation, members are ostracizing and isolating those who are “different” from the observed ideal demographic. Think non child bearing age, female, observable health problems/disabilities, poor, non-white, not highly educated, non Crossfit/gym participants and non-physicians. That’s a problem.

    Glad I found your blog. Best to you as you practice and blog.

  11. js290

    August 12, 2012 at 3:33 pm

    You seem to be equivocating chronic illness with trauma. My guess is Dr. Wahls is referring to the former. In your own experience, what do doctors deal with more often?

    • erniegarcia76

      August 12, 2012 at 3:51 pm

      We deal with both acute and chronic illness frequently. Note that Dr. Wahls made no distinction herself, she made a very blanket statement. Without intervention many acute diseases turn into chronic ones. Regardless, there will ALWAYS be acute and chronic diseases that can be helped by nutrition, and there will ALWAYS be acute and chronic conditions which can only be helped by medical intervention. The pathology that affects the human body is vast to say the least…therefore affective treatment options will also be vast.

      Trauma is a completely different issue. None-the-less, per the statement about doctors, once a bone is broken, only an “inferior” doctor will have the qualifications to fix it 🙂

      • js290

        August 12, 2012 at 10:01 pm

        That’s sort of like Dr. Richard D. Feinman picking bones with Dr. Lustig because Lustig doesn’t publicly present all the dirty details of fructose metabolism exactly correctly. Sometimes the public message has to be presented in such a way that’s more easily consumable, particularly when the conventional wisdom is so wrong. It’s up to each person who’s interested to explore the details after being pointed in the right direction. So, if Dr. Wahls chooses not to make a distinction for effect, I’m not really going to make a stink about it because ultimately I don’t need her to tell me who’s a good doctor and who isn’t.

        FWIW, my coworker fixed his hypertension problem through diet. His doctors had prescribed him all sorts of bp meds that had weird side effects, like turning his skin red. He watched Dr. Lustig’s Sugar The Bitter Truth lecture, bought Robb Wolf’s The Paleo Solution, and ordered a uric acid meter. He cut out sugar, started eating paleo, and his hypertension is completely under control. In fact, he knows that his bp is sensitive to caffeine and fruit.

        BTW, I bet an adequately trained nurse could fix a broken bone for cheaper. 😉

      • erniegarcia76

        August 12, 2012 at 10:04 pm

        Possibly so, but the nurse can’t afford the malpractice insurance to do it 😉

        Good for your coworker! Many of my patients have gone strict Paleo and done the same, but many have had to continue their BP meds. We also have many excellent BP med options that cause very little in the way of side effects.

      • Alex krohn

        August 12, 2012 at 11:02 pm

        She surely and obviously was talking about chronic diseases. Then you go on to use an example of an acute traumatic accident to get your point across. I don’t get it? Your story about the motorcycle accident is irrelevant to what Dr Wahls tweeted and makes her out to look like a monster. Try fitting cardio vascular disease, auto immune diseases, cancer, arthritis and diabetes into a relevant example to disqualify her statements.

      • erniegarcia76

        August 12, 2012 at 11:19 pm

        Easy! Just replace the motorcycle victim with a heart attack victim…Grandpa is a church and suddenly goes into Ventricular Fibrillation and passes out…

        …I guess the ER physician who initiates the life saving care of a heart attack victim who has a sudden cardiac event concurrently falling and braking his hip, or the radiologist who diagnoses his injuries, or the cardiologist who stents the occluded artery (normally in LESS than 45 minutes as a standard in the US…try having a heart attack in the UK), or the orthopedic surgeon who repairs his broken hip, or the nephrologist who temporarily supports his kidney function through hemodialysis, or the critical care specialist who keeps him alive in the ICU until his body starts to heal itself, or the Internist who takes over his care once out of the ICU and methodically advances his care, or the Physical Medicine & Rehabilitation physician who expertly crafts his cardiac rehab program…

        MD Anderson Cancer Center in Houston is one of the world’s top cancer centers, and it must be filled is hundreds of “inferior” doctors who treat ALREADY DIAGNOSED cancer on a daily basis. I know an abundance of “superior” cardiologists, cardiothoracic surgeons, rheumatologists, oncologists, and endocrinologists who approach acute and chronic disease in many ways (among others, just trying to cover your examples). As I stated in my response to Dr. Wahls I believe her characterization of ALL physicians in her statement is unfortunate. We will also agree to disagree 🙂

      • Alex krohn

        August 12, 2012 at 11:49 pm

        Okay you are right that those doctors are not inferior and they should never be accused as such. However those great doctors are working for an inferior medical system that puts much more attention into reacting to disease rather than preventing it. See, if those people would of had good doctors from the beginning or early on in their disease process who educated their patient about an evolutionary protective chances are they wouldn’t need those great doctors in the final stages to keep them alive.

      • erniegarcia76

        August 13, 2012 at 12:00 am

        Although our health system has flaws, it is the best this planet has to offer in my opinion. I trained with doctors from the UK, France, and Canada, and each and every one of them felt the same way.

        I completely understand your frustration with our health system, and we likely share many of the same concerns. I just don’t like my fellow physicians being characterized as “inferior” because of mainly “political” views. Just because you work in a flawed system does not inherently make you flawed. I don’t run a political blog, and I think you are waging more of a political argument. I’m a doctor, I LOVE what I do, and I’m proud of what I do. I was simply defending my profession because it is filled with many compassionate and noble individuals.

        I truly appreciate your input and dialogue on my blog. In the end we are all on the same team…and we will never get anywhere without sharing ideas and coming up with new solutions.

      • Alex krohn

        August 12, 2012 at 11:52 pm

        *evolutionary perspective

      • Alex krohn

        August 13, 2012 at 1:13 am

        Thank you very much for your dialogue! I come from the perspective of someone who became very ill with an autoimmune inflammatory bowel disease and although I was treated by very smart doctors their way of treating failed me miserably. I was prescribed prednisone and other heavy duty immuno suppressants to cover up my symptoms as best as possible for years all while being assured that diet had nothing to do with my condition. I went to crohns and colitis support groups which I later found out are basically run by big pharm which control the information that is delivered through the support. I suffered for years until I was ultimately at the point of needing a colonectomt that would have been performed by a great doctor who does countless of the same surgeries on people who have similar conditions. Thankfully I discovered the paleo diet before the surgery took place and guess what happened after I adopted it? I went into full remission, soon got off all immuno suppressant medication and I have been asymptomatic for several years. I see many people who suffer from similar conditions as I had and the information that is given to them by their doctors is more than inferior, its down right wrong and cruel. Cruel because of ignorance not malicious intent, but still cruel. While politics is a big part of the puzzle as to why things are the way they are, my argument is more about humanity and people who are needlessly suffering. You and Dr wahls are both amazing doctors in my book and prescribing a paleo diet is more than awesome, however youre seemingly condoning the current system while she is doing everything she can to change it.

  12. goncalomoreira

    August 12, 2012 at 4:16 pm

    Great post!

  13. WellEvolvEdU

    August 12, 2012 at 4:56 pm

    I appreciate your work the efforts to not only have a positive influence on your patient’s health, but also the behavioral aspects of Creating Change, as this is what must take place to see a shift from dys-ease to health. I am a Physical Therapist and while I treat patient’s for a variety of musculoskeletal injuries, pain and dysfunction, I see this as an opportunity to effect a change toward positive health balance. The patient that steps through my doors begins this process. Thank you for the Great Manifesto you provide. The content you provide is excellent educational information. (WellEvolvEdU). Take Care-Randy Bauer

  14. Jack Kruse

    August 12, 2012 at 9:07 pm

    Dear Dr. Garcia,

    I loved the message of your blog here today, but I think you got Terry’s true intent quite mixed up in my view. I hope she posts here to clarify it. She is training future ancestral docs now in Iowa City and I think she has the perspective of a primary care physician/researcher and as an AI patient to draw upon. The system failed her completely in her quest for optimal health and she had to take control of her own care. We can not lose sight of that battle she fought. One of our own should not have to face that. Millions of patients with AI are being mistreated today by modern medicine and Terry knows it full well from both sides of the equation. MS and a humerus fracture are not equivalent clinical situations in this context. Our profession failed her in her quest for health because of how we approach these specific and particular conditions. Treating HTN and bone fractures is not controversial to most in our profession today. However, treating chronic diseases using Darwinian principles is a pretty radical concept today in the USA. Moreover, it clearly is where we all need to move our practices toward. I think Terry is far ahead of her time in this regard. I understand and felt her frustration in those tweets. Maybe it is because her and I had diseases that our profession misunderstands even today? I understand her perspective because she fought a battle for life with little help from our vaunted profession. Her plight had to be terribly frustrating as a physician and a patient. This is a position many MD’s don’t get until they themselves get ill.

    I hope some day to meet you. I enjoyed this post, but I disagree that Terry’s tweet’s were misguided. I think maybe they were misunderstood and not put in there proper context. To get transformational change in medicine we need a total perspective change. Letting the paradigm fail is the only way I see creative destruction occurring, and Darwinian medicine coming to fill that void. I do not hold the belief that change can occur gradually as some MD’s in this community seem too believe. If we go that route I think many will die and suffer needlessly until they pull the same play from the playbook that Terry did. She took control of her care directly and did not rely on our profession. I think Thomas Kuhn’s ideas on paradigm change are quite applicable in this specific case. I have no sense that modern medicine is ready for evolutionary medicine yet. There can be no doubt her customers truly are, but our profession is not in tune to their wants or their needs just yet. A simple stroll through any hospital today will prove that point. That is the frustration of where Terry’s tweets came from in my opinion. She wants change yesterday and she knows change is not coming soon enough for many of our customers.

    Jack Kruse

    • erniegarcia76

      August 12, 2012 at 9:22 pm

      I completely hear what you are saying, but I still feel such blanket statements about the quality of physicians is a dangerous thing. Many in the “Paleo” realm have an almost innate distrust of modern medicine as a whole, and comments like this, in whatever context they are meant, can in my opinion lead people down the wrong road. I have seen people almost reduced to absolute shame if they feel forced to resort to traditional medications for certain conditions, particularly if they attempted more “natural” solutions without success. MS is very different from HTN or a broken hip, but the word “doctor” is an all encompassing word which does not leave any grey area for interpretation.

      I applaud Dr. Wahls for her story, and for her efforts to help fellow MS patients with her nutritional protocol. In fact, I am going to point it out to one of my partners as he is slowly losing the battle with this terrible disease. That said, I feel it is important to fight for a proper role for both evolutionary medicine and modern medicine.

      Thanks for reading and interacting on my blog! Without question we need more Dr. Wahls’ in this world, my contention was only with her choice of words.

    • erniegarcia76

      August 12, 2012 at 11:50 pm

      I also wanted to thank you for driving up traffic for me by linking my blog from your forum 🙂

      I assure you there is nobody “behind” this post but little old me…an Internist from the south who moderates a Paleo Blog in his spare time. I really don’t consider myself a “paleo facade creator” either. I follow a pretty stringent Paleo lifestyle, and if you consider me a “facade” because I don’t fire all patients from my practice who will not or cannot for whatever reason adapt to a Paleo lifestyle then I guess I’m guilty as charged 🙂 By the way, I live in a brick house, not an “Ivory Tower Fishbowl” in case you were wondering.

      I also completely understand Dr. Wahl’s perspective, I simply disagree with her characterization of doctors as “inferior” unless they only prevent disease. As LinD points out on your blog…

      ..Unfortunately, some of us are beyond prevention and MUST get into damage control…

      I’m in to prevention AND damage control, and that’s my whole point. There must always be more than one way to skin a cat; it all depends on the type of cat, and the equipment you have to skin it with.

      • sebledsoe

        August 13, 2012 at 12:21 am

        As an MD, how can you NOT be into prevention and damage control? If you are a PCP and someone walks into your clinic with no medical conditions, you have the luxury of inserting some good preventive care into that patient’s life. Their life will be enriched because of their encounter with you. But the flip side happens as well. The patient walks into the ER having a hypertensive crisis. If you don’t treat them with more than “eat grass fed beef and avoid dairy,” you are committing malpractice (IMHO) and you deserve what you get. You treat them with appropriate anti-hypertensives and follow up in the office for a frank discussion about healthy diet and exercise. Hopefully, they will listen. Even if they go strict Paleo, that doesn’t ensure they will get off their meds, although you have increased their odds of doing so.

        Point being, prevention is awesome, but often, it is a luxury. I had a patient a few months ago in the emergency room for a bowel obstruction. This man was a survivor of the Bataan Death March. The last time he saw a physician was in the 1960’s for appendicitis (the cause of his obstruction). I tried to get him to see a PCP upon discharge, but he refused. He wasn’t too worried about those pesky blood pressure numbers. This man isn’t the only person like this either. Many people only show up at a doctor’s door only when they “feel sick” and sometimes prevention isn’t an option at that point. Ultimately, people make their own decisions, and we have to meet them where they are at and treat them with the dignity and respect they deserve.

        BTW, I don’t consider you a “paleo facade creator” either!

      • erniegarcia76

        August 13, 2012 at 12:25 am


      • Jack Kruse

        August 13, 2012 at 7:22 am

        Ernie I was not talking about you. I was talking about the Dr. you linked to below. I am sorry I was not clear.

    • S Andrei Ostric

      August 13, 2012 at 10:10 am

      Well Said. I think I Dr. Garcia brings up a good point, but I don’t think that represents Terry Wahls and the spirit of her work.

  15. Spencer Nadolsky DO

    August 12, 2012 at 9:33 pm

    Great post. As a resident physician I feel awesome just knowing I am able to get about 2-3 out of 10 of my patients to switch to a paleoish lifestyle. Can’t get em all unfortunately. It’s also unfortunate that most hardcore paleo people don’t understand the medical literature and what we go through. Good to know there are more good docs fighting on the front lines. 🙂

    • sebledsoe

      August 13, 2012 at 12:28 am

      If you’re able to get 1/3 of your patients to with to Paleo, you are doing great! My advice to an up-and-coming colleague is to keep trying to convince as many patients as you can but treat their diseases (even the self-inflicted ones) to the best of your ability. If they refuse to eat how you direct them, keep on treating their diseases like you know how and keep working on them to improve their health. Sometimes, all you can do is convince them to come back and see you in 3 months. That’s a small victory in and of itself. Sometimes, you’ll be able to convince them to quit smoking. Major victory! Every now and then, someone will see the light and adopt a totally healthy lifestyle. Awesome! Keep improving their health, even if its one small victory at a time!

  16. cissyblue

    August 12, 2012 at 9:37 pm

    I am not a physician, but one thing seems clear as I read over these statements. The medical field is very divided, as far as physical and mental health go. A physician I knew once remarked that cognitive/behavioral therapy should be part and parcel of treatment for someone with depression. And that is hardly ever the case. My own doctor thinks that I will probably be on anti-depressives the rest of my life. And I clearly want to lower dosage, and explore if I can be taken off. So there is a big divide, from where I sit, and a need to integrate some protocols. Of course, if psychiatric treatment was available in America, aside from $350 an hour cash practitioners, more primaries would refer… they know it’s impossible for most people. This is a really good post and it certainly brought up a lot of issues. Good work, Dr. Garcia. Keep talking “Paleo.”

    • erniegarcia76

      August 12, 2012 at 9:52 pm

      You’ve hit on a very difficult subject. You might find it interesting that when I see a patient, I cannot bill the primary diagnosis of the visit as any psychiatric issue such as depression, anxiety, bipolar etc. It can be a secondary diagnosis, but I cannot treat a person ONLY for these conditions. This is very frustrating because as you said there are very few Psychiatrists in America, and most insurance companies simply do not cover for these services anyway. So we are put in a position where we have to care for issues we are not 100% trained for or comfortable treating (not to mention only being able to offer pharmaceutical treatment as we are not in any way qualified in cognitive behavioral therapy), and patients are forced to receive care for these debilitating chronic diseases from their PCP and not a specialist. I do my best but there is no question we need more qualified Psychiatrists to refer to, and our patients need more reasonable access to them.

      Thanks for reading my blog!

  17. Terry Wahls

    August 12, 2012 at 10:30 pm

    At the AHS – I had two slides that generated concerns:
    Ancient Chinese Proverb
    A superior physician prevents disease
    A mediocre physician treats impending disease
    An inferior physician treats actual disease
    I stated that by that standard I and most of modern medicine were inferior physicians, experts at treating disease and knowing very little about preventing disease or creating optimal health

    Thomas Edison quote from a 100 years ago
    The physician of the future will use no medicine but will interest his or her patient in the care of the human frame, the proper diet and the cause and prevention of disease.

    I stated that like most physicians knew little about the proper diet, instead was focused on drugs, surgeries and devices to make my patients well until I became a patient with a chronic disease.
    That would turn out to be a profound gift, for it would lead me to learn about the true cause of our chronic diseases.

    I then went on to tell my story of using a paleodiet which was structured to provide the 31 nutrients that I had through my read of the literature and functional medicine – lead to the dramatic restoration of function after 4 years in a tilt recline wheelchair due to secondary progressive MS. I reviewed the clinical trial which was underway and the positive results which we have – with one individual moving from cane/ walker to jogging within one year.

    At the conclusion of my talk I saluted AHS as the superior physician of the future because AHS is devoted to showing people how to create health.

    I would have expected these two quotes to be heralded by those physicians who are looking to ancestral health for guidance on how to create optimal health. My perspective is that our profession is failing to create health. Fortunately there are several organizations that are discovering it is possible to create health through nutrition and lifestyle. AHS is one of them.

    The medical profession is focused on treating disease – and not on creating health. As a result we rely on drugs, diets, devices that we invent – instead of turning to the ancestral wisdom. I saluted AHS as the physicians of the future – the superior physicians because it is AHS who is learning how to create health. Yes we will still need to deal with traumatic injuries – but we still need to create health – and by focusing on how to create health we will help people recovery more quickly from traumatic injury and the chronic diseases of modern society.
    I salute the AHS – and functional medicine and integrated medicine- they are all doing very good work. It is – those are the groups that are doing much about creating health for our societies. There will be always a need for addressing trauma, but if our society adopted diets and activities to match the ancestral patterns the need for medications, doctor visits would sharply decline. The productivity of our economy would dramatically increase.
    I am teaching the internal medicine doctors about the power of nutrition.
    I am doing clinical research, testing the power of nutrition in the setting of secondary and primary progressive MS – with results that are remarkably positive.
    The benefit to me of coming to AHS was meeting with other physicians and other researchers who are interested in conducting and collaborating on the research involving ancestral nutrition and chronic disease. If we are to get ancestral health accepted by conventional medicine – we need more than me doing active clinical research. Note – that I am using my personal funds to fund the next pilot study we are doing using paleo diet in relapsing remitting MS and have created a fund with the university foundation to raise money for a much larger study.
    If you want to see these kinds of studies happen – we need to find ways to do crowdsource funding. These are not going to be funded by NIH or any of the current disease foundations. The critiques I receive from the grants I have submitted to the NIH and the MS society – “clearly Dr. Wahls does not understand pathophysiology of multiple sclerosis”. I am working on raising funds to continue and expand what I am doing. Budget for the next study I’d like to do is $300,000.
    If we want to medicine to accept ancestral health principles – we need published research – inn top tier journals.

    Terry Wahls, MD
    Prof. of Medicine
    University of Iowa,
    Iowa City, Iowa 52246

    • erniegarcia76

      August 12, 2012 at 10:58 pm

      Thanks for your very eloquent response! We share many of the same beliefs, but I will agree to disagree on the Chinese Proverb. I see my role as an Internist being to prevent disease AND treating disease. I shutter at creating too much of an “us against them” mentality in health care as we all need each other to bring about the changes that are needed to win this battle. While there are unhealthy people to take care of, someone must take care of them…even those who are unwilling to approach their health with a more diet based philosophy. I have duel citizenship you might say; in the Ancestral Nation, and in the Modern Medicine Nation. My goal is to unify these two realms, not push them apart. Your quotes in my opinion do the latter, thus my post.

      On a different note, I do in fact have a partner in his early 50’s with progressive MS. I am quite excited to talk to him tomorrow and refer him your way and try to convince him to adapt your protocol. I wish you continued success in your studies and hope you can secure funding for them.

    • S Andrei Ostric

      August 13, 2012 at 10:16 am

      You can not apply a rescue care paradigm to the prevention of chronic, degenerative illness. To me, It’s that simple.

      Dr. Wahls, I had no training in nutrition and prevention in medical school. NONE. The textbooks just don’t teach that. Not one course. Here in lies the biggest problem from my perspective. The inculcation of these paradigms of rescue car and technology for EVERYTHING starts early.

      I am sure your story is quite similar. All I ever learned from about nutrition is from biochemistry, and what I can put together from dedicated people like you and courses that I take, my own self-teaching, and my knowledge of anatomy, physiology, and my clinical experience.

    • Jenny D

      August 13, 2012 at 10:29 am


  18. Samuel Bledsoe

    August 12, 2012 at 10:39 pm

    @Dr. Kruse- I’m glad to hear there was some context that is clearly missing from theTwitter posts. It’s hard to develop a point in < 140 characters. But when you see those posts without context, it's easy to see them as a bit condescending to those of us who treat acute diseases and the ravages of uncontrolled chronic disease (like you, Dr. Garcia, and myself). Thanks for the clarification. My guess is Dr. Wahls will be explaining herself soon in this forum or another.

    I did want to ask you what you meant by, "Letting the paradigm fail is the only way I see creative destruction occurring, and Darwinian medicine coming to fill that void." Just curious. Thanks!

  19. Jack Kruse

    August 12, 2012 at 10:40 pm

    That is what I thought Terry. Thanks for saying it here. You are a paleo MD leader for sure.

  20. Sally

    August 12, 2012 at 10:48 pm

    I am also not a doctor. I believe that emergency medical care in the US is quite good. It is truly amazing what doctors can do to patch us back together. But I also believe that, generally speaking, regular, primary medical care in the US is disastrous. I was put on blood pressure medicine, which did reduce my BP to manageable levels. But when I went on a very low carb diet, my BP immediately reduced. I cut my medicine in half after a week, and eliminated it entirely after a couple weeks.

    Previously, when I asked my doc how could I possibly lose some weight, after being stuck at the same level for years, she suggested I look at Alli, for blocking fat absorption. After I lost weight on the VLC diet, she wasn’t even curious about how I obtained this miracle. Instead of exclaiming over my greatly increased HDL, and greatly reduced triglycerides, she just expressed disappointment over my slightly increased LDL.

    It was the last time I went to that doc. She seemed to just be looking for signs of degrading health, which is all just age-related, you understand… My doctor wasn’t even treating impending disease. She was just waiting around so that she could treat the actual disease that was bound to develop. Inferior sounds like an apt description.

    • erniegarcia76

      August 12, 2012 at 11:05 pm

      I always try to point out that your physician was approaching disease in the way she was taught to do so. It is really hard to grade her as “inferior” given that. Every patient is different, and I have had just as many people adapt Paleo and get off their BP meds as I have that could not. Our medical system, though flawed, is the best in the world in my opinion. Thanks for following and chiming in!

    • Joni

      August 13, 2012 at 11:01 am

      Same here, Sally. I have to find a new primary doctor, too. After seeing him Oct 2011 for a yearly physical, he made NO mention of the 35# loss from when he saw me just nine months prior; plus no comments at all on my improved bloodwork.

      Very disappointing, to say the least. I even asked the nurse to see what my weight was in January, but my file was already whisked away.

      Any good docs out there willing to run labs/prescribe potentially needed hormones in the D/FW area?

      • Joni

        August 13, 2012 at 11:02 am

        (forgot to add that I am an MS patient, too.)

      • erniegarcia76

        August 13, 2012 at 11:02 am

        I commend you on your weight loss! Certainly something that should be celebrated 🙂

  21. Jack Kruse

    August 12, 2012 at 10:53 pm

    Sam I do not believe paradigms can slowly change to something they are not fundamentally built upon. They must fail in their glory and be replaced. Thomas Kuhn’s work is seminal here and so is Joseph Schumpeter’s in economics. I know Mr. Wolf’s talk was based upon economics and if you look at it from a numbers point of view the system is built to make money off of sick people who remain sick. My sensibilities are quite different about how modern medicine and Darwinian principles will co mingle. I think they will clash big time in the hospital setting. In a clinic, the battle is different. The paleo MD will have to navigate waters carefully. The risks are great and that is why some practice paleo but do not preach it in their place of employment or work. The healthcare complex is built for a sickness approach not a wellness approach. They are incompatible and incongruent on most levels. That is why I think Kuhn’s principles on paradigm change will play out. Modern medicine wont change until it fails. Moreover, the meme led by some of the linked MD’s is not how we all feel. I think there is room for a divergent view of how the battle will be fought and won for Darwinian medicine. The battle that non MD’s fight will be radically different than what we MD’s will face. I think those of us who are battling this personally and professionally see the winning battle strategy quite differently because of the unique facets it requires. Terry and I stand together in that regard.

    • sebledsoe

      August 13, 2012 at 1:11 am

      While I’m on board with the health aspects of the Paleo diet, I’m not sure what to think of the political/economic health care strategy you are talking about. Principally, I don’t know what a failure of modern medicine would look like. Do people go without medicines or health care for a period of time? Do hospitals and clinics get boarded up? Or is this just a shift in thinking while maintaining access to care?

      I like the idea of prevention and most doctors love prevention. But the realities of their practice prevent them from practicing preventive care. In my experience (which is very one-sided I grant), patients often won’t show up until they “feel sick.” Hopefully, intervention can be at the diet/exercise level, but sometimes not. The medical establishment has to be able to handle BOTH sickness and wellness. We have some work to do on the wellness side of the equation, but dismantling the sickness side isn’t the answer either.

      Love the discussion. Thanks!

      • Jack Kruse

        August 13, 2012 at 7:35 am

        Seblesdoe it is happening as we speak with the new passage of the health law. The system will be burdened with new huge regulations on care and record keeping and allow 60 million uncovered people in to the system. They are being instructed by RD’s and nutritionists to eat the SAD and being supported by the USDA so they can be feed more drugs. This is the current paradigm, a pill for every ill. The USA population demographics make the model unsustainable from a dollar perspective. The practice of medicine has radically changed already for many of us. If Mr. Wolf is ‘half right’ on his numbers, the current system will blow the federal budget by 2035 when we expect the maximum full effect of the baby boom generation who are among the most unhealthy generation ever to live in our country due to what they have faced during the last 50 years of their life. In the last ten years there is not a hospital based physician who can deny the fact of how the acuity of our patients illness have risen dramatically. 15 years ago I never saw AD or osteoporosis in a 40 year old and now I see it twice a week. I really do appreciate what Ernie is saying here because I understand we physicians have been assaulted on two fronts here. One by the complex to practice evidence based medicine, which is also flawed badly and by patients who shunned us because of the bad advice we have dispensed for some time, I just happen to believe that the individual physician will make the decision for themselves that total paradigm change is a better decision than an incremental change. I know not all of us will see it that way but even in this community some of us see it differently now. I just think we all need to be mindful of the difference because patients right now do not truly understand the difficulty MD’s have in advocating for Darwinian medicine at this time.

  22. Steve Parker, M.D.

    August 13, 2012 at 3:29 am

    Just chiming in to let you know I’m glad I found your blog, Dr. Garcia. FWIW, I agree with nearly all points in your manifesto.

    I’m particularly interested in the paleo diet as an approach to T2 diabetes. I know Dr. Lynda Frassetto (UCSF) spoke on it at AHS12, but I wasn’t there. She’s done controlled clinical research. When time allows, I’ll return here and see what you’ve written.


    PS: I practice office-based internal medicine in Pensacola, FL, for 12 years, but switched to being a hospitalist in 2001 because Medicare didn’t pay me enough to keep my office open.

    • erniegarcia76

      August 13, 2012 at 12:14 pm

      Thanks for checking in, I will also try to take a closer look at your blog tonight when I have time. Paleo and Diabetes is quickly becoming the focus of my efforts here. I’m working with the Hartwig’s at Whole 9 Life currently on a prospective study with Paleo and Diabetes. I’m just not a research doctor, so it’s a slow grind! Thanks so much for reading, and keep up the fight!

      • Ann Wendel (@PranaPT)

        August 16, 2012 at 11:42 am

        Dr. Garcia,
        I just wanted to share that as healthcare providers we are always kind of caught in the middle between conventional medicine and alternative/Ancestral/Paleo. As a physical therapist, I often say that the difference between being a technician and a therapist is that the technician follows protocols and the therapist looks at all of the factors involved in a patient’s care to decide the best course of action. That’s where the magic of “therapy” happens – we evaluate each patient as they are on that day, and decide the best course of action. Then we see how our plan shakes out and modify accordingly.
        I was at AHS12, and I did listen to the talk given by Dr. Wahls. I want to say that as we were all “live Tweeting” we were spitting out snippets of information as fast as we could. Her sharing of the Chinese Proverb was appropriate in the discussion, and then failed to translate properly in 140 characters to those who were not in the room. I would encourage everyone to take that into consideration.
        Additionally, Dr. Frassetto’s talk was very exciting, and I was able to discuss her research with her at length. For anyone interested in the effects of nutrition on diabetes, I would highly encourage you to read her work. As an aside, I was fortunate enough to do a poster presentation at AHS12, on the Effects of Ancestral Nutrition on Type 1 Diabetes. This is an area that few people are looking at, and it is important to get information about nutrition to T1D’s as well as T2D’s. If anyone is interested, please visit my website/blog, as I will be sharing the poster for anyone who wants to see it.
        I think that as healthcare providers, we all want to do what is best for our patients, and that may look very different from one provider to another and one patient to another.
        Thank you for starting the discussion – I appreciate it,

        Ann Wendel, PT, ATC, CMTPT

    • S Andrei Ostric

      August 13, 2012 at 12:29 pm

      That’s sad, Dr. Parker. I love your blog, and I imagine you are an excellent clinican…wlecome to the new world order of medicine…at least you have time to put out very informative and interesting blogs.

  23. S Andrei Ostric

    August 13, 2012 at 10:07 am

    Dr. Garcia, I think your blogpost was awesome. I really do. I think there are 2 issues at hand. 1. Rescue care, which our system does VERY well. and 2. preventive care, which virtually not time is spent because it’s not really profitable. So, we apply rescue care to chronic illness that needs to be PREVENTED. Nobody minds because it makes money. The incentives are misaligned. Throw in medico-legal concerns, and guess what? You get even more tests and procedures and medicines becoming ‘the standard of care’…

    In this way, Dr. Wahls is right, and of course, you bring up the critical point that there needs to be someone when the horse is out of the barn, and like you said, they do a good job. None of us believes in pixie dust. Pixie dust is profitable too. But I don’t believe in pixie dust. We are not sure what causes all diseases and it is ridiculous to believe that we can address it ALL with diet, although we can certainly go a long long way–and I think that is ultimately the point.

    Let’s clean house a little, and in some cases a lot, should be the motto. In my case, operating on carpal tunnel syndrome on someone with metabolic syndrome without addressing the metabolic syndrome is a big problem from my view. It’s unsustainable and ineffective. That’s what I think is at issue here.

    Likewise, I do think patients HAVE to have some skin in the game. The doctor patient relationship HAS to be a partnership, and right now, it isn’t. Doctors like you, and the vast majority of doctors want this to be the case, but for reasons political and monetary, that critical dyad between the doctor and the patient is not the central focus of health care anymore. WE have a lot of pie chart graph technicians and eggheads and social economic engineers with intersecting x and y coordinates telling people what is good healthcare, when docs like us, all of us here, who roll up their sleeves everyday and practice medicine, aren’t even asked to comment, much less brought to the table to negotiate for a better system.

  24. Kathylu

    August 13, 2012 at 11:25 am

    Dr. Garcia, first of all I want to say that your blog is a breath of fresh air! I’m glad I heard about it and will certainly check in here in the future. It’s rare to find a doctor who “gets it” and is trying to get his patients on board.

    I understand, though I do not agree with your comments about Dr. Wahls twitter feed. I think her comment clears up any misunderstanding. She is not attacking physicians, but the the paradigm that almost mandates continued sickness as a model for health care. I don’t think anyone disputes that the US is a champion of and model for excellent acute care, but chronic illness is the looming disaster for our nation and much of the rest of the world too. However, I understand your gut reaction…you have studied for years and devoted your life to a profession whose purpose is to ease suffering and improve health, so it would be difficult to contemplate the meaning of the quotes above.

    I am another example of a patient who was being led down the wrong road by conventional medical care. Not that they weren’t trying their best, but when the basic premise for care is “pill for every ill”, the patient who is crying “help me find and eliminate the underlying cause, not just treat the symptoms” gets totally ignored by the system. My fervent wish is that there will be a miraculous and radical change in our health care model that will emphasize the CORRECT preventative care (not just more of the SAD and conventional wisdom), though I am not hopeful that it will occur soon.

    You cited a poignant example in your “About Me” tab…a 60 year old patient whose issues by every measure were well controlled by current standard of practice and he died anyway. That was the event that made you start to ask “why is what we are doing not working?” and that led you to where you are today. I don’t envy your position. It must be gut wrenching to know that you could help your patients immeasurably by getting them to adopt the correct diet and lifestyle modifications and realize that your own profession, big pharma and the government will try to stop you at every turn. I hope you ignore the critics and keep doing what you know is right.

    • erniegarcia76

      August 13, 2012 at 10:20 pm

      Thanks for your feedback, and encouragement. Dr. Wahls response certainly helped clear up her point, and I have emailed her to apologize for being a little bit too direct at criticizing her.

      You are right though, it is quite frustrating at times. It would be wonderful if preventative care was more emphasized, but even if it all changed today we would be left with a great deal of disease to work with. We could likely prevent much disease with nutritional change, but trust me, there would be plenty of disease left to go around. Where is the middle ground? Guess we will keep working to figure that out!

  25. Sara

    August 13, 2012 at 1:43 pm

    Finally Dr Garcia gets better recognized! All along his posts had few comments thus low readership, I suppose. We need more Dr Gs around us – these are the docs who should be courted into the AH paradigm of practice. Thank you Dr G! Now, don’t let your surrogates start answering your posts 🙂

    Like someone commented up there somewhere, maybe even Dr G, we are not all x-fitters (nor do we want to be so), still menstruating/males in the prime, early adopters. By definition we are late forties and above, doing our best to catch up, with a lot more stress than younger generation(s) (finance, caring for elderly parents/sick kids, etc).

    I purposely followed the “in crowd” twitt’ updates during the AHS-C — they were partying and high fiving and Rting and so forth. They have a great message, but they are clueless as to how much farther some of us have come, based mostly on nonavailability of information thus NOT of our own doing (metabolically disadvantaged from WAY more years of SAD). Twenty or thirty (GULP) years ago I would have freakin’ delighted in this knowledge AND more, the shift of what exercise is and how it can be performed i.e. Olympic lifting, HIIT, etc.

    Anyway, I don’t really have a point here, other than I am grateful for the Dr Gs and all the awesome AH knowledge

    • erniegarcia76

      August 13, 2012 at 2:08 pm

      Thank you so much for the positive feedback! My main goal in my blog is to be inclusive to everyone. All too often Paleo is typecasted into only the CrossFit world; but this lifestyle can benefit EVERYONE, no matter the circumstances. Most overweight 40 year olds shutter in fear at the term CrossFit, and I don’t want that to hold anyone back. There is no reason to fear CrossFit, and there is also no reason you HAVE to CrossFit to eat Paleo. Most of my patients cannot physically CrossFit regardless, and the Paleo lifestyle needs to be the backbone of improving health.

      We have a great deal of work to do, but I feel strongly physicians need to be more involved. The comments are nice, as is the web traffic, but in the end we all need to just help on improving lives.

  26. Jamie

    August 14, 2012 at 9:23 am

    Amen! I agree with you, I’m a nurse and understand your viewpoint, you do your best to help others out, whether or not you agree with it! I’ve been an advocate of WAPF’s dietary guidelines minus the grains (essentially Paleo) for 12 years and I still don’t follow it strictly. No one can. If you do, you’ll go nuts.

  27. Angela

    August 14, 2012 at 9:49 am

    I wish you were my “inferior” doctor. The world could use a lot more Doc’s like you.

  28. Scott Sterling

    August 14, 2012 at 12:51 pm

    Dr. Garcia, I can tell from your post that you are a wonderful doctor, and I thank you for that. I would like to raise a serious concern and ask you for your thoughts, as well as those of your readers.

    In your post you rhetorically asked whether you should fire patients who will not comply. Mercy and kindness seem to dictate that the answer is “no”. Certainly, a great many patients do not comply.

    Here is my concern: by not firing them, are you not contributing to the non-compliance problem?

    Does the patient not think something like this: “I love Dr. Garcia, and I’ll hear him out, but I know he’ll keep seeing me and treating me anyway.” And if you did fire them, will they not just go to the next wonderful doctor who will not fire them?

    I would like to propose that true mercy and kindness would be to lovingly tell a patient (who does have a fixable problem): “John, you know that in my practice we treat type 2 diabetes in such and such way. I understand that you have decided you don’t want to follow that treatment recommendation, so it seems best that you would transfer to another doctor who is a better fit for you.”

    If enough doctors stood up for doing the right thing, eventually many patients would become more compliant because seeing that you have the courage of your convictions would inspire them. If someone has a curable or reversible disease and you as their doctor do not have the courage to insist that they follow your recommendations, you are implicitly giving tacit approval to their non-compliance.

    Eventually if enough physicians did this I believe more patients would follow your recommendations and most importantly, they would become healthier and live longer, better lives.

    • erniegarcia76

      August 14, 2012 at 6:00 pm

      Scott, you bring up excellent points, but to me there is really no dilemma. There are many things that come to mind, but here are just a few.

      By dismissing everyone from my practice that will not follow Paleo, I am casting significant judgement on them concerning their ability to do so. Do I stop treating smokers? People who drink too much? Females for example in an abusive relationship because “medically” it is the right thing for them to dump the guy, even though they won’t? One of the things I love most about my job is the long term nature of the relationship I build with my patients. With smokers for example, some patients have absorbed my constant rantings about them having to quit for over 5 years, and then suddenly decide to stop! If I had fired them, they likely would have never stopped. I am very sensitive to my patient’s “life circumstances” and to demand certain things out of patients “or else” is in my opinion the worst thing a doctor can do: basically abandon a patient. People may not change, but they hear about the changes I want them to make EVERY SINGLE VISIT!

      [As an aside, Let me ask you this, should non-compliant patients have insurance? Why should an insurance company pay for the consequences of years of an unhealthy diet in a patient? If I abandon the patient, won’t the government be next? We all know smoking causes 98% of lung cancers, what if a smoker gets cancer from his actions, is it ok for his insurance company to tell him he is on his own? Is not our health care system continually contributing to the non-compliance problem by paying for the results of these bad habits? But…I digress]

      As I have often commented, my faith in God is the most central thing in my life. I take it very seriously, and I know I am a better doctor because of it (that is just me people, I am not casting judgement on anyone). I try very hard not to judge others, am I perfect…no! Am I 100% Paleo compliant all the time?…No! I feel God has placed me in my patient’s lives for a reason, most choose to come see me and they have many options. I will work with them diligently and let God lead the way.

      Lastly is a simple evolutionary fact…survival. If I fired all patients who won’t follow Paleo, I’d have only a handful of patients left. I’m not sure what your line of work is, but I’m pretty sure you would not demand actions of 99% of your clients if you knew they would just find someone else to do business with! If you would, I’d call you stupid 🙂

      Thanks for stopping in, hope you keep reading and look forward to any response from you!

      • Scott Sterling

        August 14, 2012 at 10:49 pm

        Ernie, thanks for the insights in your reply, and especially for your passion to help people. I believe your faith will lead you to have a timely word, in season, for each person you see.

        My wife and I have recently seen two family members reverse type 2 diabetes, with our help, and we’ve seen several friends experience health turnarounds. I also know how frustrating it is when people I care about just keep heading down the wrong road.

        My faith in God is the most important thing to me too. It’s kind of funny that some of the folks like Robb Wolf who have helped teach us about the paleo diet are quite non-religious, but I’m profoundly grateful to them anyway! God works in mysterious ways to help people and he’s very patient.

  29. Vanessa

    August 15, 2012 at 8:02 am

    Very glad I found your blog! Your post rings very true to me; I’ve been Paleo over a year now and am the healthiest I’ve ever been. However my husband and I are the 1 in 8 that suffer from infertility, and while the fact that we’re at our healthiest certainly doesn’t hurt, our diet is definitely not going to get our IVF done for us!

  30. Derek Weiss

    August 18, 2012 at 4:23 pm

    Paleo enthusiasm can cause the movement to put on the horse blinders and forget about the real world. The real world being exactly what you mentioned, that despite hanging out with a bunch of healthy, like minded individuals, there is the real world of medicine that can’t be ignored or beat down with nutrition alone.

    However, the statistics of less than 25 hours of nutrition education during all of medical school is still disturbing.

  31. Erica G

    August 19, 2012 at 9:25 am

    This has been a great discussion to read! The one thing I ask from the Paleo-sphere is similar: to not generalize RDs. Dr. Kruse writes above, “They are being instructed by RD’s and nutritionists to eat the SAD and being supported by the USDA so they can be feed more drugs.” While this may be true for some dietitians, there are dietitians who follow alternative recommendations based on science. As a dietitian, I see the same things that the doctors see… There are people who are willing to change, and people who are not yet willing to change. We work with them not as general patients, but as an individual. How can their individual diet improve, and what are they willing to do at this point in time? So, my request is: Please stop generalizing RDs. We worked hard to study nutrition, and we (at least the good ones) stay current in the science-based evidence to make the best recommendations for each client. I, for one, do not prescribe a SAD and certainly do not support the foods the cheap food brought about by the food subsidies. It sounds like Jenny D. (who posted) doesn’t as well.

  32. Jeremy

    August 20, 2012 at 1:46 pm

    I enjoyed your post. I think there’s a fourth role the physician plays: treat the inevitable illnesses that strike even when someone makes all the ‘right’ lifestyle choices. I know this is implicit in your argument, but it can’t be stated enough. Healthy lifestyle and diet can drastically reduce the illnesses we will face in our lives, but illness (not just injury requiring surgery) can strike even the most virtuous. Our health is a mix of genetics, lifestyle, environment, and luck. Reducing health to only one of those is a fallacy. In my experience, lifestyle movements (including paleo) tend to gloss over their members who fall ill through no fault of their own – often blaming the illness on some imagined transgression against the lifestyle. One of the most cruel events I’ve ever witnessed was a group of lifestylists blaming a late mutual friend for the pancreas cancer that took him in his 30s. That he lived a healthier life than any of them didn’t save him, either from the disease or their scorn.

  33. drfmd

    August 25, 2012 at 10:06 am

    Couldn’t agree more with the article. I have had some astounding reversals of disease processes with patients introduced to the Paleo Lifestyle, but all disease is not preventable and all medication is not bad. Thank you for such a well written critique.

  34. David

    August 26, 2012 at 5:05 pm

    Great post Dr Garcia. I definitely struggle a bit as a clinical dietitian (RD) working in rehab and long-term care. I’m not always prescribing paleo, that’s for sure, and I’ll admit sometimes I use Ensure-like drinks for people who don’t eat enough! It pains me a bit, but it is probably better than nothing. The real world of healthcare today is not paleoland. I do, however, encourage paleo-type living any time I can and I think that’s the best I can do at this point.

  35. Whit

    September 4, 2012 at 10:04 pm

    Thank you for supporting the need to be inclusive and nonjudgmental. I do believe that there is a place for the kind of far-reaching statements of Dr Wahls, it is in research and policy and population based medicine. Her goals especially in research and establishing the credibility of Paleo are laudable but the tone was unfortunate and would definitely alienate some who could benefit. When it comes to treating the individual in front of us, we need to treat them in the context of their situation, which is often a great deal less privileged than we are.

    I’m an Emergency Dr, so the idea of “firing” a patient isn’t available to me. I often do see patients presenting with chronic problems that would benefit from the kind of advocacy and education you’re promoting, they have issues related to poorly controlled diabetes, obesity, constipation, and those are merely some of the most obviously grossly linked conditions. All I can do is be respectful, gentle, encouraging … And refer them back to their PCP in the hope that that person isn’t burned out dancing to the insurance company puppeteers.

  36. Patti

    September 22, 2012 at 2:27 pm

    I appreciate your post, and I also appreciate what a huge impact diet change had on Dr. Wahls. I applaud physicians who are including healthy lifestyle advice beyond the FDA Plate to their patients. I personally have a wonderful physician who really tries to educate his patients on changes they can personally make to impact their health in a positive way. Sadly, many just don’t bother. But even those who do, like myself, need medical care from time to time. I have long standing autoimmune issues and orthostatic hypotension, which have not (yet, hopefully) gone away with a Paleo diet. Due to the OI, I have to take a medication that increases my risk of infection, like the strep throat I’m currently battling. I’m oh so thankful for antibiotics when I really need them. I doubt the day will ever come, even with perfect diet and lifestyle, where no one has any health challenges. We are all very complicated organisms with our own unique genetic baggage. While we can improve our health greatly by our choices, I personally don’t see a future where we are impervious to all illness and mishap.

  37. Luke Day

    October 24, 2012 at 3:39 am

    Dr. Garcia et al.-I hope this post finds you well, I TRULY appreciated this post, and your recognition that while diet and exercise is a huge part of peoples health, we as physicians still have much to offer.

    I am a young Emergency Medicine physician, just graduated from residency and beginning my practice. I have become more and more invested in the Paleo lifestyle, originally coming to it through Crossfit, and now attempting to practice it full-time myself.

    I am writing to inquire about your insight into incorporating the principles of Paleo and Primal living into one’s traditional allopathic practice. While we both have distinctly different specialties and different patient populations, I imagine that we would both have the same difficulties in incorporating these practices into a system that finds them status-quo challenging.

    Are there any particular resources, either scholarly or otherwise, that you refer to regularly?

    What types of patients do you find typically do well with Paleo eating plans?

    How do you integrate the experience of different practicioners with different training backgrounds, some of which (naturopaths or chiropractors, for example) have very different training, and sometimes very different approaches to evidence based medical care?

    Any insights you might have, or other practicioners you might be able to point me to, would be greatly appreciated. I’m still very young and very green, and I’m trying to figure our how far on both sides of this tricky issue to stand.

  38. emeducator

    October 24, 2012 at 3:40 am

    Dr. Garcia et al.-I hope this email finds you well. I TRULY appreciated this post, and the defense of what we, as traditional MD’s, are and are not capable of doing for our patients.

    I am a young Emergency Medicine physician, just graduated from residency and beginning my practice. I have become more and more invested in the Paleo lifestyle, originally coming to it through Crossfit, and now attempting to practice it full-time myself.

    I am writing to inquire about your insight into incorporating the principles of Paleo and Primal living into one’s traditional allopathic practice. While we both have distinctly different specialties and different patient populations, I imagine that we would both have the same difficulties in incorporating these practices into a system that finds them challenging.

    Are there any particular resources, either scholarly or otherwise, that you refer to regularly?

    What types of patients do you find typically do well with Paleo eating plans?

    How do you integrate the experience of different practicioners with different training backgrounds, some of which (naturopaths or chiropractors, for example) have very different training, and sometimes very different approaches to evidence based medical care?

    Any insights you might have, or other practicioners you might be able to point me to, would be greatly appreciated. I’m still very young and very green, and I’m trying to figure our how far on both sides of this tricky issue to stand.


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