AD as type 3 diabetes, educating family doctors

[MarcR]

That's what I really think.

Terrific post - love it!

From the Crofts/Kraft analysis and data, it appears hyperinsulinaemia may be a root cause of much of metabolic illness. Of all the ways to address this, Toronto nephrologist, Jason Fung's fasting approach appear to be the simplest and most effective.

I second this and would add that I think Fung's videos explain effectively to a lay audience, people like Mac's T2 friend.

[slacker]

yup. Whole lot of drivers of the current system here IMO

I work as a medical provider in the US, a profit based system, and still completely relate to what Stavia is saying about the time constraints and complete insanity of our "disease care" medical system. Personal lack of motivation and lack of societal support for lifestyle changes is definitely part of the problem, but it goes so much deeper than that.

In the US, if you want a provider that spends 30-60 minutes with you, and has time to teach during the visit and study in their "free time", you have to pay a concierge doctor ($1500 - $5000 annually in addition to insurance) or someone who is completely cash based and does not take insurance at all. This is care exclusively for the wealthy. And what is the source of these providers' information? Our tribe does not agree on many topics - neither do the "out of the box" providers. As another cog in the wheel, I'm not sure what the solution is, but am grateful that I am part of this group to further my own knowledge and awareness on AD in general and ApoE4 in particular.

[Stavia]

Thanks Marc, I was worried I'd offend.

Susan: good question re Cliff notes: it's either predigested simplified biased "educational" stuff from drug companies that comes with a free pen or mug or paper pad or food which we know from hard evidence induces a sense of obligation in the recipient, and the branding of such an everyday object is subliminal advertising. Don't even get me started on samples, a really underhand way of profiting from the patient's relationship with the doctor. Or it is organisationally originated in lecture format (on line or in person) for certification re-accreditation requirements. The latter has varying degrees of quality and the topics are randomly chosen by whichever admin person organises them and even if a doc is physically there in body or logged into the webinar to gain such "points" it doesn't mean they understand or even listen after a hard day's work. Of course there is the doc who is self-driven and searches out info from UpToDate or Medscape or Google with various degrees of effort, committment and understanding.

Slacker: correct, I see the poverty versus affluence divide as a huge determinant of health. Even if doctor consultations are free, poverty has so many intrinsic barriers: time off work to see a doctor, overcrowding and poor sleep, shiftwork, literally no time to excercise due to work and home pressures, and a huge factor is cost of food. Bread is cheap.

In your concierge model, do these affluent people have better health from just the doctor interaction alone and take more responsibility? Or do some think they are paying more so they should get better value which means the doctor has to do more and they do less?

Sigh.
Is my cynicism showing?

[MAC]

Fung's fasting approach appear to be the simplest and most effective.

Very much align with you George and Fung's concepts, practicing LCHF and daily 18 hr IF.

One Fung reference I wanted clarification: "However, fasting does not increase hunger. You’re less hungry". I can tell you I've been at this for 4 months, and pretty much feel the same hunger at 18 hrs that I did 4 months ago. Comment/context? Is he suggesting that the RMR (resting metabolic rate) will eventually go lower, thus reducing the level of daily hunger? And when is that?! LOL Honesty though, I don't even pay attention anymore, it's my reminder that I'm in IR crushing mode. If you'd like to comment on Fung's muscle mass management concepts re your experience, greatly appreciated.

https://intensivedietarymanagement.com/ ... asting-27/

When we socialize, and are doing meal preparation, we prepare as we normally would using an appropriate macronutrient offering that allows me to dial in my LCHF, others do and amend as they wish. We have many vegan and gluten fee friends, we don't give it a second thought. If someone is hosting us, I am really not ashamed to telegraph some basic macronutrients I could eat, and if not, I just will abstain/fast, it's really a highly motivated/survival driver at play. Anyone who would invite me to share a meal, I would hope they would respect me and my dietary wishes sufficiently and not be offended.

Sorry for the digression. But back to the thread...any thoughts on practically solving the problem for larger society? Those of us who've arrived at this forum are likely highly motivated/empowered, it's the rest of the population that policy/politicians need to address. I wholeheartedly agree with Stavia that Western lifestyle predisposes an entitled mentality re disease salvation backstop health care. Cancer and Alzheimer are tough, many people see these as fatalistic diseases, largely running their course with lifestyle intervention (since there's no cure or proven avoidance protocol) irrelevant. That's what we have to change re AD prevention.

[slacker]

In your concierge model, do these affluent people have better health from just the doctor interaction alone and take more responsibility? Or do some think they are paying more so they should get better value which means the doctor has to do more and they do less?

I do not have direct experience as a provider or patient (client?) at a true concierge practice, but believe the quality of care and patient expectations depend on the mindset of the provider and each person who walks through the door. I worked at a function medicine practice for one year that was transitioning from an insurance based system to a more lucrative business model (first what I call "low additional cost" concierge, to "out of network", then true concierge) Overall, the patients were self selecting, very motivated and educated. Very few just wanting to take a pill; it just wasn't the right kind of practice for that approach. Most patients were either interested in health optimization, or the desperate ill with conditions not easy to diagnose and/or treat in conventional allopathic medicine. Some of the desperate had already seen multiple doctors, and were very needy and impatient. Many of these self selecting patients had very strong opinions that did not always align with those of the doctor, kind of like our little family. My impression was these differences of opinion were not handled very well by either party, both typically thinking that the other didn't know what they were talking about (ie "idiots"). So it got pretty interesting. I took cynicism to a new level at that job!

[TheresaB]

Mac wrote: One Fung reference I wanted clarification: "However, fasting does not increase hunger. You’re less hungry". I can tell you I've been at this for 4 months, and pretty much feel the same hunger at 18 hrs that I did 4 months ago.

I’m with you. I’ve been listening to my husband George talk about being ketogenic and not feeling hungry any more. JEALOUS! I’m also ketogenic, fast approx. 16 hours a day, eat basically the same diet as he does, just twice a day vs his once a day and I still struggle with hunger issues. I will say my hunger is tamped down from before I started this lifestyle, but I still struggle. I will say during my 7 day fast, Dr Fung's quote was true, the hunger did not increase during the fast, in fact my hunger issues got better as the days passed.

On our lab results for Dr Gundry, my leptin (hunger hormone) has gone down from 18.4 (12/15) to 9.0 (6/16). According to the lab’s reference range, at risk is <2.3 or >64.2, so both measures are “good”, yet as I write this my stomach is gurgling with hunger (which in the Fung/Moore book they say sparkling water is good for that.)

George’s lab results for leptin started crazy low at <.8 (12/15) and has remained crazy low. As this is in the lab’s “at risk” range, this measurement was marked red, but in discussing our lab results with Dr. Gundry, he dismissed the red saying that’s what you want, you want it low. George, who used to deal with ravenous hunger cravings when he was a carb based vegetarian, now doesn’t deal with hunger issues, so maybe with time…?

Dr Ron Rosedale discusses leptin. I haven’t done a deep dive on the subject, but it seems to go hand in hand with insulin. You can develop leptin resistance much like you can develop insulin resistance. Leptin is produced by the fat cells in the body. Losing weight leads to reduction of leptin levels. George is very lean, I am considered “normal weight” but do carry fat I could lose, I would say our leptin measures reflect that. But while losing weight reduces fat mass, which leads to a significant reduction in leptin levels, this doesn’t necessarily reverse leptin resistance. The reduced leptin makes the brain think it is starving, so it initiates all sorts of powerful mechanisms to regain that lost body fat, erroneously thinking that it is protecting us from starvation.

In the Fung/Moore book, The Complete Guide to Fasting, they say “The body always wants to stay at a certain weight, and any deviation above or below that weight triggers adaptive mechanisms to get us to return to that weight.” i.e. feelings of hunger. This is how I explain my continued feelings of hunger as I have lost weight since by following Dr Gundry’s diet aided by finally having a surgery (it took 3 of them) that addressed the pain in my foot allowing me to walk comfortably again, return to an active lifestyle, and feel good about myself again. I just “power through” my continued feelings of hunger. Fasting does help me with the mental resolve that “this will pass” as feelings of hunger don’t grow, they do come and go in waves and since the hunger issues do seem to have gradually reduced, I am hopeful, they will only continue to reduce with time and continued fasting/weight loss and someday I can join my husband with his no hunger issues status.

[SusanJ]

Stavia, having just quit going to a concierge practice, I can talk about my N=1 experience. At $165/mo you have to have some wealth to afford that. And with wealth, likely comes an education and motivation level that is not the norm.

Once I got to a better level of health, I felt that the drive (2 hours) and cost were just not necessary. I'd say the quality was higher in the sense of up-to-date knowledge and that he was willing to do a series of labs to find some answers that my former doctors didn't. But my take is that once you have your answers, maybe concierge doctors should be viewed more like specialists (in sleuthing skills), who can put in the extra time to find individual answers.

[Tincup]

I had the opportunity to chat with Jimmy Moore, the coauthor on The Complete Guide to Fasting. As a part of his research, he planned to do a fast for all of January 2016. He had to break the fast into two parts. He said the break was caused by stress induced hunger. Specifically caused by travel, in his case. He'd noticed this at other times, too. I've noticed more hunger when I experience stress.

[MAC]

Thanks Theresa for the fasting reference, you do an AMAZING job giving us a 101 understanding of the issue at play! #1 benefit of participating in this forum, is this information exchange, and the iterative learning process.

I am not so much as bothered by the hunger itself, as I am trying to understand it from a physiological "state" re weight loss trajectory, metabolic impact/IR. I guess at some point, the leptin resistance will level out, thus abating the hunger sensations...and it clearly can modulate differently depending on where you start from, and n = 1 characteristics. Good to know Gundry sees no issue leptin going very low.

btw, any thoughts on the thread header?

[Tincup]

Dr. Gundry has 3 modes: concierge; pay out of pocket for phone consults; in-office under insurance/Medicare. We use the phone consult approach. Our labs are covered by insurance, but not the consult. From my experience on the FB support site for him, I would say the patients tend to be educated and motivated. Many who post are in-office Medicare patients. They get the same treatment as we do.