After disparaging remarks regarding my rudimentary basic science explanations of diabetes mellitus and lipid transport, I was graciously told to “stay in my lane.” I would like to make it clear that I do not treat people FOR metabolic disease, but I treat way too many patients WITH metabolic disease. My practice consists of managing patients with such poor protoplasm that they’re unable to heal wounds or their fractures, which sometimes leads to multiple surgical procedures, delayed recovery and prolonged recumbency. Management of wound dehiscence, delays in wound healing, atrophic nonunions, infected nonunions, wound infections, osteoporosis, osteoporotic-related hardware failure and fragility fractures are all associated with overall poor health and metabolic disease. Failing to realize that these conditions, as well as the myriad medical problems these patients suffer, are a manifestation from a common origin is willfully missing the point. Because of the necessity to address patients’ abysmal metabolic derangement in order to achieve a healing environment for their tissues, this is a lane in which I belong. There are many talented physicians that have dedicated much of their life to helping patients and this is no attack on their practice, I’m suggesting that there is an important nutritional component in which we are all improperly trained. Our training is disease-centric, not health-centric. Patients often do not present to our offices without symptoms, unless they are having their annual exam. With the limited time we have to spend with patients in order to be profitable, we are unable to provide individualized care, unless in a unique clinical setting. Additionally, the remarks also attempted to educate me on the physiology of pancreatic exhaustion as a necessary pathophysiological state that requires insulin. If we fail to recognize that pancreatic exhaustion is not end organ failure from chronic overconsumption of carbohydrates, specifically fructose, then we will never succeed in our quest to obtain optimal health for our patients.
Being an orthopedic surgeon, it is implied, by some, that I do not have the properly enumerated credentials to present a reasonable argument regarding sickening patients and worsening metabolic aberrancy. Choosing orthopedic surgery as a career path does not preclude me from understanding metabolism or health. I currently measure many parameters of my metabolism on a daily or continuous basis with a Dexcom G6 continuous glucose monitor, Lumen (to understand what I’m predominantly metabolizing through my respiratory exchange ratio), Oura ring (for sleep analysis, heart rate variability and body temperature changes as they relate to certain living conditions) and occasionally checking my ketones with a ketometer to ensure that I remain in nutritional ketosis and continue metabolizing free fatty acids, depleting my overabundant fat stores. Orthopedic surgery is my profession, but I have taken a particular interest in keeping myself healthy to avoid chronic conditions that a lot of my patients suffer from. Suggesting that I am in the wrong profession to discuss metabolism is irresponsible as the people making these comments have no idea how much time I spend educating myself about leading a healthy life. Because I don’t treat lung cancer, chronic bronchitis or emphysema, should I not tell people to stop smoking?
I do not provide this information in haste or without providing reference to the claims that I make. There are a group of individuals that I find very intelligent that provide a wealth of knowledge and research about metabolic syndrome and obesity. Most of them are physicians, some are researchers, and they have extensive knowledge and expertise in this field. Here is the list (not comprehensive) with a few of my favorite links to their lectures or podcasts:
Thomas Dayspring, M.D., FACP, FNLA
- Part I of V: An Introduction to Lipidology (podcast interview)
- Part II of V: Lipid Metrics, Lipid Measurement, and Cholesterol Regulation (podcast interview)
- Part III of V: HDL, Reverse Cholesterol Transport, CETP Inhibitors, and Apolipoproteins (podcast interview)
- Part IV of V: Statins, Ezetimibe, PCSK9 Inhibitors, Niacin, Cholesterol and the Brain (podcast interview)
- Part V of V: Lp(a), Inflammation, oxLDL, Remnants, and More (podcast interview)
- The Latest Insights into Cardiovascular Disease and Lipidology podcast
- Gary Taubes video lectures
- Bad Science and Challenging the Conventional Wisdome of Obesity (podcast interview)
- Good Calories, Bad Calories (book)
- Why We Get Fat (book)
- The Case Against Sugar (book)
- The Case for Keto (book)
Robert Lustig, MD (pediatric endocrinologist)
- Sugar: the Bitter Truth (lecture)
- Metabolical (book)
- Fructose, Processed Food, NAFLD, and Changing the Food System (podcast interview)
- A Hacking of the American Mind (lecture)
- More video lectures by Robert Lustig, MD, MSL
David Ludwig, MD, PhD (pediatric endocrinologist)
Eric Westman, MD (fellowship in obesity medicine)
David Perlmutter, MD (Board Certified Neurologist and Fellow of the American College of Nutrition)
Jason Fung, MD (Board Certified Nephrologist)
- The Diabetes Code (book)
- The Obesity Code (book)
- Fasting as a Postent Antidote to Obesity, Insulin Resistance, Type 2 Diabetes, and the Many Symptoms of Metabolic Illness (podcast interview)
- Losing Weight & Fixing Diabetes with Fasting (podcast inverview)
- Understanding Cancer (podcast interview)
- Podcast Interview with Joe Rogan
- Ted Talk on Ketogenesis and Uses in Cancer
- Podcast Interview with Tim Ferriss
- Ketosis, n=1, Exogenous Ketones, HBOT, Seizures and Cancer (podcast interview)
Ronald Krauss, MD (Board Certified in Internal Medicine, Endocrinology and Metabolism)
Independent researchers from McGill University (in 1994), Harvard University (in 1987) and UCSF (in 1994) all found that cutting 25% of fat in our diets and 33% of saturated fat in our diets, to lower our LDL, would increase our lifespan, on average, from a few days to a few months. Marshall Becker, a professor of public health at University of Michigan suggested that avoiding dietary fat to prevent heart disease is “analogous to stewards rearranging the deck chairs on the Titanic.” I’m not claiming that I’m a nutrition or obesity expert, but I read a lot about it, listen to many experts and follow the true experts in an attempt to increase my lifespan and health span. Gary Taubes’ work is particularly interesting as he has been researching diet and disease for over 20 years. He has looked at dietary recommendations from a public health, governmental and disease (mainly heart disease) manifestation perspective and how the implementation of carbohydrates (mostly fructose) into our diets have negatively impacted our overall health. His work looks at pre-World War II and post-World War II studies on diet and disease. The contemporary research doesn’t always tell the whole story. Ben Hecht, a famous screenwrite/director/journalist said, “trying to determine what is going on in the world by reading newspapers is like trying to tell time by watching the second hand of a clock.” This applies to our concentration on the contemporary scientific studies, but not understanding historical perspectives.
The term “misinformation,” that has recently been thrown around carelessly, allows people to bury their heads in the sand and avoid understanding, comprehensively, the counter argument. It’s not “misinformation,” it’s simply alternate information that some people choose to ignore because it doesn’t fit the hypothesis they have worked out in their heads. Negative data is more important than affirmative data. When we are so sure that we are right, we tend to focus on data that affirms our hypothesis/opinion. We call this affirmation bias and we are all guilty of it. To be clear, this blog is my opinion with supporting evidence. I’m not treating patients outside my scope of practice, I’m trying to educate people that are interested in reading what I have to say. They may not agree, and hopefully this will lead to fruitful debate, but not anonymous online attacks without evidence to the contrary, saying that I’m spreading “misinformation.” Citation of my sources I find important so people understand the information in which I base my opinion. I appreciate all that have taken interest in my blog, positive or negative, hopefully the former is more abundant.
4 thoughts on “Let Me Be Clear”
Blake thank you for having the bravery to speak out despite the potential consequences. I’m disgusted by the number of doctors that gladly put on their blinders every day
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I truly love your posts. They are thoughtful, informative and have a view point that is clear and concise. They welcome discussion, even healthy debate. Those that are unable to engage in such, do not command respect.
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I sincerely admire a doctor who is open-minded enough to see a patient holistically and not just as a configuration of parts. I respect that even as an orthopedist who does not treat diabetes, you treat patients who have it. My husband is recovering from a hip replacement right now – obesity, diabetes, arthritis all created the need. But he was told he would not be allowed to have the surgery unless his A1C was at 7, as orthopedic doctors have made the connection between poor post-surgical wound care in uncontrolled diabetes. He used his Freestyle Libre monitor to hold himself accountable and he earned the right to have the surgery. Glucose and wound care are tied together. I think the other doctors who feel the need to criticize have forgotten that just because they specialize in a part of the human body does not preclude them from treating the whole of the human body. Glad to see a doctor who sees the big picture.
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