Lies My Doctor Told Me Second Edition: Medical Myths That Can Harm Your Health by Ken Berry
My rating: 2 of 5 stars
So, I was excited to read this book. As a healthcare provider I am all too aware of our medical system's shortcomings, and I believe in being critical, even if it means pointing the finger at myself. That's part of learning. Part of growing. And unlike the doctors that Berry describes as intellectually lazy, I am a lifelong student who loves to read and devours books they way some people devour brownies.
Needless to say, the intro was strong, though I should have seen where things were leading. After all I've read enough of these books to know they have the same M.O. Tell people how they've been lied to, deceived and misled by the establishment. Take down the USDA guidelines one recommendation at a time, claiming lack of research and scientific support. Throw in some villains like the inept Big Government, greedy Big Pharma, evil Big Food, and irresponsible Big You Fill in the Blank. Then set the record straight without giving a shred of evidence to support your claims, which actually happens to be exactly what you've just criticized and chastised the establishment for doing. Offer up your own personal success story as irrefutable proof, and hope you throw enough reasonable sounding if not scientifically sound "truisms" at them so that they don't realize you're no better than the villains you're supposed to be fighting.
Here are some examples of the author's flawed logic:
Author claims that milk is not good for us because we are the only animals who consume another animal's milk.
Clearly, this is a flawed argument. I mean, surely he realizes that we are the only animals that can harvest another animal's milk. And it's probable, even likely, that a lion who kills a lactating gazelle consumes (and enjoys) her milk as part of the meal.
He also suggests that most people around the world can not properly digest milk. Unfortunately, he provides absolutely no evidence to support this claim.
Author claims the USDA dietary guidelines to eat whole grains is not only flawed but flat out wrong.
In providing support for his claim the author repeatedly uses "whole wheat" interchangeably with "whole grains," which is confusing and somewhat conflates the argument. Wheat is just one type of grain that we consume today that has recently received a lot of attention thanks to gluten, a protein contained in wheat that some people should probably avoid.
Interestingly, my daughter has Celiac disease and must avoid gluten, but that does not mean that she should avoid all whole grains.
Another point the author makes is just because whole grains may not be as bad for us as processed grains, that doesn't mean that they are good for us. And he is right, just because something isn't bad for us, doesn't mean it is good for us and certainly doesn't mean there isn't something better for us. But when discussing diet, we need to look at the overall content of the diet, the nutrient density of the foods, and the variety, balance, palatability, and sustainability of a diet. Just because we've only been eating grains for the past 10,000 years, doesn't mean we can't or shouldn't eat them. And just because some people don't tolerate gluten, doesn't mean that everyone needs to avoid it.
Again, he seems to be making a claim that just isn't supported by any meaningful research. This is not to say that what he is saying is wrong, only that the claim lacks the scientific basis that he insists we should have before making dietary recommendations.
He repeatedly criticizes the cherry pickers as he goes about picking his own brand of cherries.
He attacks the food pyramid, claiming that if anyone/anything is responsible for the obesity epidemic it is the USDA and their dietary guidelines.
Honestly, in one sense he's right. The USDA dietary guidelines are the culmination of input from scientists around the world that ultimately gets watered down by special interest groups like the Dairy Council and the Pharmaceutical Industry, etc. because not only does the government have a responsibility to protect the interests of individual citizens, it also has the responsibility to protect and promote American industry. So is it any surprise that the guidelines don't necessarily represent the best science we have?
That said, my experience is despite all their failings, the original guidelines really weren't all that bad. It has also been my experience that very few people followed them.
For example, I happened to be a Nutritional Sciences major in the 80s. The recommendation was not to avoid fat as the author insinuates...the recommendation was to limit fat to 30% of your total calories, with less than 10% of your total calories coming from saturated fat. We were also taught that for most of the population, cholesterol in the diet was not an issue as the body makes cholesterol, but that people with elevated levels might need to avoid it in their diets. The guidelines also suggested that about 60% of calories should come from carbs (and at least half should be from complex sources) including fruits and vegetables, whole grains, beans, lentils, legumes. The remaining 20% should come from lean meats and include 2 servings a week of fish. 2 servings of dairy was recommended and it was suggested that we should limit salt to under 2300 mg...although we were taught that for those who didn't already have high blood pressure, salt in the diet probably wasn't a huge issue.
I mean seriously???? This isn't all that crazy.
But you can't have a book like this without a villain, so there you go. Ironically, he warns about mistaking an association with causation. Just because weight has been steadily increasing since the introduction of the guidelines, doesn't mean that the guidelines are to blame...especially if no one was following them. And no one did. Like so much of the science, the guidelines were bent and molded (sometimes aggressively so into something unrecognizable) to suit the needs of all the someones trying to sell us their somethings.
He claims that hormone replacement therapy is not only safe but ideal.
I don't know enough about this topic to agree or disagree. It's something I'd like to learn more about. I have read that some of the studies that associated negative health outcomes with estrogen replacement were done on estrogens that weren't biologically identical, as he points out.
He briefly discusses the microbiome and blames the overprescribing of antibiotics for damaging it.
In some respects, he's probably right. But I also don't think it was part of some conspiracy. I just don't think we realized that there was a negative side to taking antibiotics, and now that we do, most doctors are responding appropriately.
He says we should use as much salt as we want.
I tend to agree with him. Unfortunately, I think the initial concerns regarding salt intake was more directed toward those who already had high blood pressure. At some point, the recommendation got taken out of context and ultimately bastardized.
He claims that the medical community is responsible for the lie that all calories are equal.
Once again, he feels the need to identify a villain. I'm not sure the medical community ever agreed that all calories are equal, though I think that many people (doctors also being people) ultimately developed that impression. Part of the problem is that when it comes to nutrition, the public isn't getting educated by the experts, people who actually study nutrition, but by doctors who don't really know that much about nutrition and by special interests that have ulterior motives. (I dated a physician for several years while in PT school and he laughed when he told me that the nutrition advice he gave his patients came from his mother.) Sounds about right.
He claims that hypothyroidism is underdiagnosed because doctors rely only on TSH levels for a diagnosis.
Actually, my experience is that most doctors do a TSH along with T4, but I think he's right in that many doctors simply look at ranges and no longer correlate blood tests with physical findings and patient complaints. I have some personal experience here. In my twenties, I suffered from cold intolerance, severe constipation, and fatigue. I was young, fit, and not exactly what you think of when you picture hypothyroidism. And so I suffered until my gynecologist, who was examining my neck, asked if I had been tired and constipated lately, and I about fell off the table. Apparently, my thyroid was enlarged, a key physical finding. So I went to my primary care who did the blood tests. Both my TSH and T4 were in the range but at opposite ends. He told me my thyroid was fine despite the fact that I had extreme cold intolerance, severe constipation, fatigue and had started to lose the outer third of my eyebrows (another classic physical finding) and an enlarged thyroid. Clearly he was not a good doctor.
I ended up going to a specialist, an endocrinologist, who actually correlated my symptoms with my blood work and prescribed treatment. I have been fine for the past 2.5 decades, no thanks to my doctor.
I have a client right now who fits the hypothyroidism profile. She is overweight and can not lose weight despite following a healthy diet. Her blood tests are normal but on the outer ranges with a high TSH and a low T4. She also has mildly elevated fasting blood sugar at 100. She also complains of feeling tired all the time...and she's in her 40s. I suspect that her thyroid is petering out...or that she has Hashimotos. Of course, because her labs are technically normal her doctor says she is fine. Which would not be so bad, if her doctor were doing additional testing to determine the cause of her symptoms.
So, yeah. He makes a point. Doctors need to be able to put the pieces together and not simply depend on lab tests and normal ranges to make a diagnosis. Unfortunately, in a managed care setting, doctors have become more dependent on labs.
He makes a big stink about vitamin D and needing more, much, much more.
Anyone who has been in the nutrition field for any significant period of time understands it is always good to be skeptical when some new "super vitamin" comes out. In the '80s it was the antioxidants Vitamin A, C and E. In the '90s it was fish oil. Come 2000 it was vitamin D.
Talk about jumping on a band wagon. Not only does the author suggest that we all need vitamin D supplements, he also suggests without evidence that our blood range should be much higher than the established safe minimum range, but offers no basis for how he arrived at that number.
Interestingly, if you follow this sort of thing, you'll know that the vitamin D craze has lost steam, and there are many studies now questioning the role of vitamin D supplementation as well as its long term safety.
He claims that we need to stop slathering on the sun screen and start soaking up the sun.
Ironically, given sufficient exposure to the sun, our skin can make vitamin D. So maybe if we got more sun, this whole vitamin D think would never have started. Truthfully, I've long been skeptical of the call to avoid the sun at all costs, though I understand the concerns regarding skin cancer based on what we've been told. The author, however, claims that sun exposure isn't the problem. It's our diet. According to him, the quality of our skin is impacted by our poor diets and it is our diet that is making skin cancer more prevalent, not a hole in the ozone.
I'll admit, I find this idea intriguing, partly because I've always had a hard time believing a little sun was detrimental. I kind of want to believe what he says is true, although I'd have to read more on the topic to have an informed opinion.
He claims fiber is bad.
Ah, I can't even respond here as I think he wants so badly validate his new found love affair with keto, that he'll go anywhere his new love takes him. I think there is a lot of science that would refute this whole section. Period.
He claims that not only is red meat not bad for us, but neither are processed meats like bacon and sausage.
So, I might be willing to hear him out on red meat as I don't think that red is innately bad, though it's also not innately good. It's a food that provides certain nutrients that might be good and might be bad depending on the context of the diet and the person's health. But bacon? Seriously, you want me to believe that processed meats like lunch meat, bologna, sausage, spam for God's sake are not only not bad for me but good for me. NOPE. NADA. Me thinks somebody needs to do a PubMed search and soon. This is a classic example of cognitive dissonance and one of the things that irks me most about the Keto enthusiasts. It's almost like a religion where people will go to any length to explain away any inconsistency because delegitimizing one aspect of the religion tends to bring the entire religion itself into question.
I agree with the author, clinicians are often decades behind the science. I also agree that we are giving our profession away to alternative medicine. Somewhere along the way, we forgot that medicine is an art as much as a science...partly because the science is everchanging. I also wish that more doctors and clinicians were more open-minded. It's possible to remain skeptical but still willing to hear alternative ideas.
I also agree that the best clinicians are the ones that continue to read and learn. The ones that challenge themselves and are willing to be wrong so that they can be right.
Unfortunately, I think this particular doctor has parked his car in the keto garage and in doing so has stymied his own intellectual growth when it comes to matters of nutrition as it relates to health. His logic and his arguments are often as flawed if not more flawed than the ones he's supposedly debunking.
Ultimately, I think that this doctor in trying to jump outside the box has simply landed in another box, a different box (maybe a slightly better box, maybe not), but a box all the same. Bacon...??? Seriously?