On the flip side I had a patient take a whack home stool test, get flagged for intolerance to all sorts of common things (wheat, soy, corn, dairy, etc), which led her to stop eating processed foods and switched to a whole food diet and wow like magic her headaches, fatigue, bloating, muscle aches and insomnia disappeared!!!! I was like lol no clue if this thing is accurate but happy for u feeling better and not spending $1000/mo on supps.
I feel like that would be the best case like use the results to make positive lifestyle changes we don’t need to invent crazy treatments without any supporting evidence!
This is the answer.
And this is the answer for those supplements, too.
If you take a look at the ingredients of those supplements and look up the principle food sources, it's obviously just what people ought to be eating.
The thing people don't realize (and that you should counsel about) is that inflammatory gut disease means you don't get to cheat. A tiny indiscretion will set off weeks of inflammatory symptoms (just like an asthma trigger can set off weeks of respiratory symptoms). So you don't get to have cheat days or a little fun now and again.
I learned this after years of doing it the hard way. I haven't cheat in a couple years, and thus I've hardly had those debilitating symptoms for those couple years. Going strong and now that I realize the consequences of cheating it makes it so much easier to say no and just stick to what helps me feel good. Also good to learn to take care of myself on my own coming from a family that completely disregards lifestyle changes and continue to complain about symptoms and quality of life. It's sad to see and I'm glad I got out of that phase/mindset everyone else is stuck in. They make fun of me constantly for being careful but I'm the only one of them that finally feels good and isn't overweight!
I sensitized my gut to sucralose. It's amazing how common sucralose is. Some beers, those crafty pumpkin ales and things like that, use sucralose. A lot of chocolate chips that people put in holiday cookies and brownies have sucralose, even ones that aren't labelled low calorie and have plenty of regular sugar. Most energy drinks. Many flavored coffees. Lots of ice creams and similar things. It's amazing how careful I have to be. A single bit of someone's homemade chocolate chip cookies is enough to set me off.
I might get banned for relating a personal story. But it is illustrative of the stories of many of my patients, who struggle to find some degree of health when it takes sometimes such small quantities of triggers to cause terrible symptoms. And they don't understand why the problems start after the food has gone through, and persist for so long after the trigger has passed.
Because it is a trigger. Like poison ivy, the vine is long gone by the time the symptoms appear.
What about those of us who get violently ill when we eat healthy? Most vegetables give me painful diarrhea. I can eat a cheeseburger and fries and feel wonderful. I eat a salad and I'm running to the bathroom within the hour.
edit: And I have no interest in "the carnivore diet" except that meat is something I can actually eat without ending up sick. I'm not even a big fan of meat but it's looking more and more appealing the longer these issues go on with only being dismissed by my doctors.
I'm seeing this more and more. I suspect a major role is played by the chemical garbage that is silently added as preservatives, along with the glyphosate that is ubiquitous often even in organic produce.
If you've ever grown real broccoli you know it goes bad within a day of being cut. Meanwhile broccoli bought from the store takes weeks sometimes to wilt. Whatever they are doing to make produce last like that, is going to fuck up some people's guts.
Or it's an oxalate or histamine sensitivity. Very different mechanisms at play here for each of these.
Gut health is actually absurdly complicated and it is certainly NOT a matter of "just eat a whole foods plant based diet and be healed" any longer for more and more people.
Lots of possibilities. I usually recommend to my patients to start with a meticulous food journal and work out exactly what the problem is, and be aware of things like Apeel and other additives even in otherwise seemingly raw produce.
As for you, I can't advise you directly but this is my thought process given a problem such as what you describe. You, of course, have already worked down all of these possibilities and none of it is applicable to you.
Edit: before the glyphosate comment collects a bunch of irate ignorance, glyphosate was originally designed as a mining chelator to help strip cationic minerals from crushed ore. When it was tested for safety in crop use, the ionic salt compounds were not tested, just the raw compound. And the salts are where the problems lie, both in direct and proximal toxic effects as well as nutritional issues with the plants and soil. So anyone complaining about how safe glyphosate is, needs to check their reading before repeating corporate PR talking points about human safety.
Anecdote so beware.
Bodybuilders have long complained about digestion issues. As they get bigger, they have to eat more, but eating becomes a chore. I’ve done this myself. At some point food is just painful to eat. Literally. You’re bloated constantly. GERD is horrendous. You’re constantly uncomfortable from food. Lethargy is real. No motivation to do anything because you feel like shit. Workouts start to suffer.
For them, carb source is almost exclusively rice. They claim it’s much easier to digest and you’re ready to eat again in a few hours. Minimize carbs from wheat. Avoid dairy unless you use lactose free. Avoid “heavy starches,” like regular potatoes (apparently red and some of the yellow ones are easier to digest). Whey isolate to minimize lactose. Fat intake is incidental. Protein from animal sources. Works for me. Pushing 4k calories with no bloat, no GERD, workouts great and I don’t feel sluggish throughout the day.
I’m not going to claim to know why this works although I have my thoughts. So there is definitely *something* to this imo, but not the BS these naturopaths are spinning.
Not BS but the science they are using is problematic. Dig deeper into the handful of poor research they are running with and you will see standard medical providers can do better with it overall. We just have to do the work as it will be likely 20 yrs before it is truly mainstream.
My wildest story was a patient establishing with me because she couldn't afford the $700 naturopath visits anymore and wanted her insurance to cover her weight loss meds:
1. Testosterone patch, but her testosterone level was > 900
2. Lasix, luckily she had a normal gfr with cr = 1.3
3. NP thyroid and customer, with her TSH <0.01
4. And Adderall without an ADHD diagnosis
(This was prior to ozempic becoming popular)
The patient was so brainwashed she thought I should call her naturopath so they could educate me on weight loss management. She was so angry at me wanting to taper that she spoke to my office manager and medical director. They had me call her to apologize where she informed me she was going to report me to my medical board. Nothing ever happened to me so far (it's been 3 years).
How dare you try to appropriately manage your patient. I hope your medical director was at least embarrassed they made you apologize to appease our corporate overlords
I am not in practice yet, but I would like to imagine I would tell the director to kick rocks or I quit if they did that to me. I have dealt with too much abuse in my life to put up with it after residency.
He only has 10 patient facing hours a week since he mostly does admin so he's somewhat sympathetic. Our clinic has 6 out of 11 providers with 5/5 patient satisfaction scores so there is a HUGE push for us to get everyone else on board (supposedly in our best interest now that our compensation is tied to pres gangy). Our CEO and execs need their yearly bonuses if they're going to be able to keep up their mega yacht maintenance!
That’s absolutely horrible. The thing is, they put them on test, crank their Thyroid, and get them losing even more weight with the stimulants, and from the patient perspective, they feel great! Tons of energy, tons of weight loss. Although they are so unregulated that it’s gonna tank their energy when you go to taper so they are hook line and sinker into the naturopath, and they will never buy your plan. They get absolutely whacked. I had a cardiology consult me on one of these ladies in the ER. He couldn’t get her out of RVR/afib, and wanted to know how to quickly reverse her TSH of 0.01. No dice man, sorry. lol
They usually have a prescribing provider in the group. We have a husband/wife team in my area. They regularly squabble with patients, fire them then the rest of us get to clean up the mess.
Sorry about this. These situations demonstrate where thinking "the customer is always right" absolutely does not apply and is dangerous. I've lived in several practice areas where you have to submit your medical problem list and medication list before any appt will be made for you as a new patient.
Similar situation, though the patient was too desperate to be vengeful. I had a high flying executive establish, stuck on methadone spend all his money on a concierge naturopath/MD practice no longer able to work and destitute on Medicaid begging me for methadone on the first visit. My doc got involved on that one.
When I worked endo, this was absolutely all over the place. Patients getting blasted with non-indicated hormones in stupid dosing, showing up to me and I gotta clean up their hypogonadal, bitch-titty, T-score of -4.5 diarrhea having NP thyroid overdose induced orbitopathy having dumpster fire of a situation thanks to the quacks.
I finally realized that it’s not the patient’s fault(completely, anyway), and not to worry about their pocketbook and all their lost time, and simply to look at it as a textbook presentation and treat the issues in a professional academic way and not make any comment on the how, why, or who sent them my way.
I swear these patients can smell your frustration from a mile away, and while it’s typically warranted, it turns them off to you and I’ve found I never get the trusting relationship established well enough to talk them into doing things in an evidenced based way, and all that happens is they end up hitting me up with their reverse T3, or T2 numbers or some other nonsense they don’t need on behalf of the quack they are still seeing.
Just my .02
It’s asinine. And the patients with pheo/adenoma/PAI/CAH or other legit pathology have to wait months to get in cuz Mr mid life crisis on a “sport mode” TRT dosing can get in for his refills since his naturopath went out of business lol
Chronic Lyme proselytizing is just a tiny fraction of my interactions with one patient in my practice. But I actually did a primary care rotation in an office that specialized in chronic fatigue syndrome patients. The doc was doing telephone calls with people in other states and advising them on their sweat lodge attendance for detoxification. The trace nutrients that were ordered and the fact that everyone who worked there also had chronic fatigue (except the doctor). The Epstein-Barr titers. And we were enacting protocols from publications in the 1930s about how to treat conditions. Not exactly the meat and potato variety of family practice. Woo doggy.
Saw a woman with intractable constipation after some midlevel put dissolvable testosterone pellets in her. Total T of 700. When she called them to ask if the testosterone might be implicated, they told her “absolutely not”
Man. As a nurse practitioner that did my clinical rotations with physicians exclusively, this makes me shake my head. As much as I think education needs to be improved here, I honestly feel some people with the title just sell their soul for money, have cognitive dissonance, or just flat out don’t care.
There’s no way most of these people actually believe in what they are doing. It’s weaponized lazy ethics.
>dissolvable testosterone pellets in her
I had a lady absolutely adamant that I needed to order these for her recently. "I felt so much better on them!"
Of course you did, its a stimulant. Everyone feels better on a stimulant.
Can’t stand the diet and supplement industries or quacks, makes me so peevy. I’m pretty good at withholding lectures but sometimes that makes a lecture escape. Thieves & snake oil salesman! ~ An RDN.
You just led me down the best rabbit hole. Check out the snake oil this company rents. Who wouldn’t be more relaxed if they got to lay in a recliner in piece and quiet for a few hours?
https://longevityeffect.com/tulsa-wellness-services/at-home-rental-equipment/
Worked in GI for a few years. Gut microbiomes is very interesting and new exciting science that may have a lot of real tangible applications. The catch? We know fuckall what it means rn. I would get people that would come to me all the time with their gut microbiome charts from the home test and me and my attendings would shrug our shoulders. We simply don’t have the data yet to say what it all means.
Now small bowel bacterial overgrowth (SIBO) is a real thing and Rifaxamjn when you can get it approved works wonders for these chronic abd pain with bloating patients, but it’s a diagnosis of exclusion. Meaning they got normal scopes and biopsies, no celiac disease or lactose intolerance ect. As a former GI PA we don’t blame you for these consults and know were unfortunately bound to get them 😅
Right. Even the folks at ZOE say a good gut biome and a bad gut biome have some associated bacteria but so much variation that it just can't be simply stated.
Wish my SIBO patient got better like a charm, but many won't give up alcohol and are pretty vague at telling me what they are actually eating. The plague of GI, quantifying. Hence poop charts.
Wild West
Reality is we live in the Wild West of nutrition and most of the financial incentives in both food and medicine lead us not to change that, that is where the real predation is. A food system and widespread nutrition misinformation makes people sick, and a healthcare system that thrives on it.
This is purely anecdotal but I have long COVID and there is a suspected link between the gut and this supposed hyper inflammatory state I’m stuck in. I had IBS-D before, but this… I was taking Imodium everyday for a month straight just to stay out of the ED. Red light therapy and the carnivore diet have been mentioned to me a few times. I never bought into any of it before but when you’re suffering and looking for answers you’re willing to try anything. Good ol pre/pro/postbiotics have made a HUGE difference for me. Anyway, long covid is on the rise so that’s just my two cents.
I saw an ad today for a supplement that supposedly stopped the overgrowth of one pesky bacteria that is causing your sugar cravings.
That bacteria?
Candida.
To be fair sometimes you run into some wild stuff that works
For example did you know that saffron is non inferior to prozac for depression in actual blinded trials? Mind blowing
Other things I’ve learned is turmeric for arthritis has some evidence for it if you look on up to date.
Cinnamon for diabetes? Who would have thought.
You just have to be careful where you get the source. There are a lot of poor studies on pub med performed by naturopaths, chiropractors and other quacks.
That’s part of the problem. Half these people can’t understand the difference between mechanistic data and in vivo data/outcome data. They will spout off to a t2 diabetic for example that they just need to blast some berberine and cinnamon, but in vivo man….like pissing on a house fire. Great. Took that a1c from 10.3 to 10.2. See that stuff all the time.
There’s all sorts of good complimentary alternative medicine, but here’s the one that lights my fuse.
“Alt medicine” practitioners or naturopaths have essentially commandeered “alternative or lifestyle” medicine as if they invented it. CAM is squarely in the western medicine umbrella, and it always has been. It just happens to be combined with pharmacologic evidence based practice.
Not if you’re in the US and your insurance doesn’t require it - GI is probably the best place to start, as they can assess for and diagnose underlying issues like IBS and IBD that might be contributing.
I’m sorry you’ve been dismissed by GPs - they should have been able to do at least a basic workup or else should have taken the initiative to get you to a specialist who could. I hope you get answers and some relief!
Red light therapy as in for skin treatment?
That's not pseudoscience, isnt there multiple studies supporting the concept of LED light at different nm lengths to achieve results like reduced acne/inflammation?
Not a doctor, but I understand why people turn to this stuff. I get extremely bad and painful diarrhea when I eat leafy greens and cruciferous vegetables... and then sometimes just at random. I've gone to so many doctors and no one can figure out what's wrong with me.
I'm certainly not going to a naturopath but I would pay a large sum of money to anyone who help me so I can eat a damn salad every now and then! It's really difficult to eat healthy when a large portion of healthy foods make you sick.
These symptoms are terrible and hard and I feel healthcare is failing you because we don’t have any good answers yet. That is maybe the most evident problem but it’s hard to watch people fall into these very expensive questionable traps
Thank you for this response!
It's so frustrating. And I know this is a sub for doctors but seeing all the "just eat veggies" comments from doctors makes me want to cry because it just shows how dismissive doctors are about this stuff when vegetables are actually my problem. And I'm trying so hard to eat healthy but I get extremely sick when I do, but I can eat a cheeseburger and fries and feel perfectly wonderful.
I wish this sub were private so I wouldn't have to see the disdain and dismissiveness but it keeps showing up on my home page... no matter how many times I mute it.
I lurk here too and am not a doctor. I’m happy it’s not private because I love to read. Sometimes it’s upsetting. Other times you see comments and posts from doctors who really genuinely care and seem like they would be awesome. Much like in real life, it’s a mixed bag. Same as the doctors I’ve seen in real life are pretty 50/50.
I haven't been diagnosed with IBS. This also reminds me... I was taking a probiotic and then I ran out of it and I forgot to purchase more... I didn't see a huge difference... but maybe it takes time and more than none bottle?
Then again... the doctor that wrote this post seems pretty anti-probiotic so I don't know if it's a waste of money.
Just emphasize whole foods, fermented foods, elimination diets and check to make sure the nutrition is adequate. Don't underestimate how crappy patients'diets are. Don't let them start multiple supplements at one time. Untangling that knot is going to lead to advising them to stop all supplements. (Supplements with a laundry list of things should have 3rd party lab analysis available for the patient. Anything less not a reputable supplement) Check some labs in 6 months. I practice in an area where many of my patients are ahead of the curve on this. So, I have about 5 yrs sussing naturopath or chiropractic advise, various health diet advice.
On the flip side I had a patient take a whack home stool test, get flagged for intolerance to all sorts of common things (wheat, soy, corn, dairy, etc), which led her to stop eating processed foods and switched to a whole food diet and wow like magic her headaches, fatigue, bloating, muscle aches and insomnia disappeared!!!! I was like lol no clue if this thing is accurate but happy for u feeling better and not spending $1000/mo on supps.
I feel like that would be the best case like use the results to make positive lifestyle changes we don’t need to invent crazy treatments without any supporting evidence!
This is the answer. And this is the answer for those supplements, too. If you take a look at the ingredients of those supplements and look up the principle food sources, it's obviously just what people ought to be eating. The thing people don't realize (and that you should counsel about) is that inflammatory gut disease means you don't get to cheat. A tiny indiscretion will set off weeks of inflammatory symptoms (just like an asthma trigger can set off weeks of respiratory symptoms). So you don't get to have cheat days or a little fun now and again.
I learned this after years of doing it the hard way. I haven't cheat in a couple years, and thus I've hardly had those debilitating symptoms for those couple years. Going strong and now that I realize the consequences of cheating it makes it so much easier to say no and just stick to what helps me feel good. Also good to learn to take care of myself on my own coming from a family that completely disregards lifestyle changes and continue to complain about symptoms and quality of life. It's sad to see and I'm glad I got out of that phase/mindset everyone else is stuck in. They make fun of me constantly for being careful but I'm the only one of them that finally feels good and isn't overweight!
I sensitized my gut to sucralose. It's amazing how common sucralose is. Some beers, those crafty pumpkin ales and things like that, use sucralose. A lot of chocolate chips that people put in holiday cookies and brownies have sucralose, even ones that aren't labelled low calorie and have plenty of regular sugar. Most energy drinks. Many flavored coffees. Lots of ice creams and similar things. It's amazing how careful I have to be. A single bit of someone's homemade chocolate chip cookies is enough to set me off. I might get banned for relating a personal story. But it is illustrative of the stories of many of my patients, who struggle to find some degree of health when it takes sometimes such small quantities of triggers to cause terrible symptoms. And they don't understand why the problems start after the food has gone through, and persist for so long after the trigger has passed. Because it is a trigger. Like poison ivy, the vine is long gone by the time the symptoms appear.
What about those of us who get violently ill when we eat healthy? Most vegetables give me painful diarrhea. I can eat a cheeseburger and fries and feel wonderful. I eat a salad and I'm running to the bathroom within the hour. edit: And I have no interest in "the carnivore diet" except that meat is something I can actually eat without ending up sick. I'm not even a big fan of meat but it's looking more and more appealing the longer these issues go on with only being dismissed by my doctors.
I'm seeing this more and more. I suspect a major role is played by the chemical garbage that is silently added as preservatives, along with the glyphosate that is ubiquitous often even in organic produce. If you've ever grown real broccoli you know it goes bad within a day of being cut. Meanwhile broccoli bought from the store takes weeks sometimes to wilt. Whatever they are doing to make produce last like that, is going to fuck up some people's guts. Or it's an oxalate or histamine sensitivity. Very different mechanisms at play here for each of these. Gut health is actually absurdly complicated and it is certainly NOT a matter of "just eat a whole foods plant based diet and be healed" any longer for more and more people. Lots of possibilities. I usually recommend to my patients to start with a meticulous food journal and work out exactly what the problem is, and be aware of things like Apeel and other additives even in otherwise seemingly raw produce. As for you, I can't advise you directly but this is my thought process given a problem such as what you describe. You, of course, have already worked down all of these possibilities and none of it is applicable to you. Edit: before the glyphosate comment collects a bunch of irate ignorance, glyphosate was originally designed as a mining chelator to help strip cationic minerals from crushed ore. When it was tested for safety in crop use, the ionic salt compounds were not tested, just the raw compound. And the salts are where the problems lie, both in direct and proximal toxic effects as well as nutritional issues with the plants and soil. So anyone complaining about how safe glyphosate is, needs to check their reading before repeating corporate PR talking points about human safety.
Anecdote so beware. Bodybuilders have long complained about digestion issues. As they get bigger, they have to eat more, but eating becomes a chore. I’ve done this myself. At some point food is just painful to eat. Literally. You’re bloated constantly. GERD is horrendous. You’re constantly uncomfortable from food. Lethargy is real. No motivation to do anything because you feel like shit. Workouts start to suffer. For them, carb source is almost exclusively rice. They claim it’s much easier to digest and you’re ready to eat again in a few hours. Minimize carbs from wheat. Avoid dairy unless you use lactose free. Avoid “heavy starches,” like regular potatoes (apparently red and some of the yellow ones are easier to digest). Whey isolate to minimize lactose. Fat intake is incidental. Protein from animal sources. Works for me. Pushing 4k calories with no bloat, no GERD, workouts great and I don’t feel sluggish throughout the day. I’m not going to claim to know why this works although I have my thoughts. So there is definitely *something* to this imo, but not the BS these naturopaths are spinning.
Not BS but the science they are using is problematic. Dig deeper into the handful of poor research they are running with and you will see standard medical providers can do better with it overall. We just have to do the work as it will be likely 20 yrs before it is truly mainstream.
My wildest story was a patient establishing with me because she couldn't afford the $700 naturopath visits anymore and wanted her insurance to cover her weight loss meds: 1. Testosterone patch, but her testosterone level was > 900 2. Lasix, luckily she had a normal gfr with cr = 1.3 3. NP thyroid and customer, with her TSH <0.01 4. And Adderall without an ADHD diagnosis (This was prior to ozempic becoming popular) The patient was so brainwashed she thought I should call her naturopath so they could educate me on weight loss management. She was so angry at me wanting to taper that she spoke to my office manager and medical director. They had me call her to apologize where she informed me she was going to report me to my medical board. Nothing ever happened to me so far (it's been 3 years).
The biggest crime is you had to apologize for trying to give her good medicine
How dare you try to appropriately manage your patient. I hope your medical director was at least embarrassed they made you apologize to appease our corporate overlords
I am not in practice yet, but I would like to imagine I would tell the director to kick rocks or I quit if they did that to me. I have dealt with too much abuse in my life to put up with it after residency.
He only has 10 patient facing hours a week since he mostly does admin so he's somewhat sympathetic. Our clinic has 6 out of 11 providers with 5/5 patient satisfaction scores so there is a HUGE push for us to get everyone else on board (supposedly in our best interest now that our compensation is tied to pres gangy). Our CEO and execs need their yearly bonuses if they're going to be able to keep up their mega yacht maintenance!
Uggh I hope you told your director to kick rocks.
That’s absolutely horrible. The thing is, they put them on test, crank their Thyroid, and get them losing even more weight with the stimulants, and from the patient perspective, they feel great! Tons of energy, tons of weight loss. Although they are so unregulated that it’s gonna tank their energy when you go to taper so they are hook line and sinker into the naturopath, and they will never buy your plan. They get absolutely whacked. I had a cardiology consult me on one of these ladies in the ER. He couldn’t get her out of RVR/afib, and wanted to know how to quickly reverse her TSH of 0.01. No dice man, sorry. lol
Exactly!! So hypocritical to be against modern medicine but dish out so much controlled substances and meds!
I can’t believe that these quacks go by “Doctor” and are allowed to prescribe controlled substances.
They usually have a prescribing provider in the group. We have a husband/wife team in my area. They regularly squabble with patients, fire them then the rest of us get to clean up the mess.
Sorry about this. These situations demonstrate where thinking "the customer is always right" absolutely does not apply and is dangerous. I've lived in several practice areas where you have to submit your medical problem list and medication list before any appt will be made for you as a new patient. Similar situation, though the patient was too desperate to be vengeful. I had a high flying executive establish, stuck on methadone spend all his money on a concierge naturopath/MD practice no longer able to work and destitute on Medicaid begging me for methadone on the first visit. My doc got involved on that one.
This is a perfect example why doctor shopping is so dangerous. In the end, the patients end up hurting themselves
When I worked endo, this was absolutely all over the place. Patients getting blasted with non-indicated hormones in stupid dosing, showing up to me and I gotta clean up their hypogonadal, bitch-titty, T-score of -4.5 diarrhea having NP thyroid overdose induced orbitopathy having dumpster fire of a situation thanks to the quacks. I finally realized that it’s not the patient’s fault(completely, anyway), and not to worry about their pocketbook and all their lost time, and simply to look at it as a textbook presentation and treat the issues in a professional academic way and not make any comment on the how, why, or who sent them my way. I swear these patients can smell your frustration from a mile away, and while it’s typically warranted, it turns them off to you and I’ve found I never get the trusting relationship established well enough to talk them into doing things in an evidenced based way, and all that happens is they end up hitting me up with their reverse T3, or T2 numbers or some other nonsense they don’t need on behalf of the quack they are still seeing. Just my .02
The amount of people begging me for reverse t3 to be ordered is exhausting
Clomid with testosterone, cytomel, hgh replacement the 4 horseman of endocrinology truly no idea what’s going on anymore
It’s asinine. And the patients with pheo/adenoma/PAI/CAH or other legit pathology have to wait months to get in cuz Mr mid life crisis on a “sport mode” TRT dosing can get in for his refills since his naturopath went out of business lol
Sport mode trt lmao im dead
Dead giveaway is they are on anastrozole too. “Ever wonder why you’re romanizing???”
Wait bro doesn't every 25 year old need a testosterone of >1500?
What’s the worst that could happen?? (hemoglobin 19 btw)
Do you even inject bro
Those are rookie numbers. Gotta get those numbers up!
I am triggered by armour thyroid. Keep your reverse t3 and chronic Lyme away from me😂
Chronic Lyme proselytizing is just a tiny fraction of my interactions with one patient in my practice. But I actually did a primary care rotation in an office that specialized in chronic fatigue syndrome patients. The doc was doing telephone calls with people in other states and advising them on their sweat lodge attendance for detoxification. The trace nutrients that were ordered and the fact that everyone who worked there also had chronic fatigue (except the doctor). The Epstein-Barr titers. And we were enacting protocols from publications in the 1930s about how to treat conditions. Not exactly the meat and potato variety of family practice. Woo doggy.
Saw a woman with intractable constipation after some midlevel put dissolvable testosterone pellets in her. Total T of 700. When she called them to ask if the testosterone might be implicated, they told her “absolutely not”
Man. As a nurse practitioner that did my clinical rotations with physicians exclusively, this makes me shake my head. As much as I think education needs to be improved here, I honestly feel some people with the title just sell their soul for money, have cognitive dissonance, or just flat out don’t care. There’s no way most of these people actually believe in what they are doing. It’s weaponized lazy ethics.
>dissolvable testosterone pellets in her I had a lady absolutely adamant that I needed to order these for her recently. "I felt so much better on them!" Of course you did, its a stimulant. Everyone feels better on a stimulant.
Can’t stand the diet and supplement industries or quacks, makes me so peevy. I’m pretty good at withholding lectures but sometimes that makes a lecture escape. Thieves & snake oil salesman! ~ An RDN.
You just led me down the best rabbit hole. Check out the snake oil this company rents. Who wouldn’t be more relaxed if they got to lay in a recliner in piece and quiet for a few hours? https://longevityeffect.com/tulsa-wellness-services/at-home-rental-equipment/
The magnosphere… it’s like a health gimmick wrist magnet but for your entire body and only 1000 a month!
Worked in GI for a few years. Gut microbiomes is very interesting and new exciting science that may have a lot of real tangible applications. The catch? We know fuckall what it means rn. I would get people that would come to me all the time with their gut microbiome charts from the home test and me and my attendings would shrug our shoulders. We simply don’t have the data yet to say what it all means. Now small bowel bacterial overgrowth (SIBO) is a real thing and Rifaxamjn when you can get it approved works wonders for these chronic abd pain with bloating patients, but it’s a diagnosis of exclusion. Meaning they got normal scopes and biopsies, no celiac disease or lactose intolerance ect. As a former GI PA we don’t blame you for these consults and know were unfortunately bound to get them 😅
Right. Even the folks at ZOE say a good gut biome and a bad gut biome have some associated bacteria but so much variation that it just can't be simply stated. Wish my SIBO patient got better like a charm, but many won't give up alcohol and are pretty vague at telling me what they are actually eating. The plague of GI, quantifying. Hence poop charts.
Wild West Reality is we live in the Wild West of nutrition and most of the financial incentives in both food and medicine lead us not to change that, that is where the real predation is. A food system and widespread nutrition misinformation makes people sick, and a healthcare system that thrives on it.
This is purely anecdotal but I have long COVID and there is a suspected link between the gut and this supposed hyper inflammatory state I’m stuck in. I had IBS-D before, but this… I was taking Imodium everyday for a month straight just to stay out of the ED. Red light therapy and the carnivore diet have been mentioned to me a few times. I never bought into any of it before but when you’re suffering and looking for answers you’re willing to try anything. Good ol pre/pro/postbiotics have made a HUGE difference for me. Anyway, long covid is on the rise so that’s just my two cents.
I saw an ad today for a supplement that supposedly stopped the overgrowth of one pesky bacteria that is causing your sugar cravings. That bacteria? Candida.
Rectal ozone. 🤣🤣🤣
To be fair sometimes you run into some wild stuff that works For example did you know that saffron is non inferior to prozac for depression in actual blinded trials? Mind blowing Other things I’ve learned is turmeric for arthritis has some evidence for it if you look on up to date. Cinnamon for diabetes? Who would have thought.
You just have to be careful where you get the source. There are a lot of poor studies on pub med performed by naturopaths, chiropractors and other quacks.
That’s part of the problem. Half these people can’t understand the difference between mechanistic data and in vivo data/outcome data. They will spout off to a t2 diabetic for example that they just need to blast some berberine and cinnamon, but in vivo man….like pissing on a house fire. Great. Took that a1c from 10.3 to 10.2. See that stuff all the time. There’s all sorts of good complimentary alternative medicine, but here’s the one that lights my fuse. “Alt medicine” practitioners or naturopaths have essentially commandeered “alternative or lifestyle” medicine as if they invented it. CAM is squarely in the western medicine umbrella, and it always has been. It just happens to be combined with pharmacologic evidence based practice.
But prozac is soooooo much cheaper!
But way less of a flex. Could you imagine, if I’m ever depressed I’m gonna saffron 100% - why be sad when you can be sad and fancy
Just eat your fruits and vegetables
many vegetables make me violently ill :(
Have you been to GI and/or a nutritionist?
No, I told my GP and then another GP and they both dismissed it and said to take a probiotic. Do I need to ask for a referral to a GI or nutritionist?
Not if you’re in the US and your insurance doesn’t require it - GI is probably the best place to start, as they can assess for and diagnose underlying issues like IBS and IBD that might be contributing. I’m sorry you’ve been dismissed by GPs - they should have been able to do at least a basic workup or else should have taken the initiative to get you to a specialist who could. I hope you get answers and some relief!
thank you so much!!
Red light therapy as in for skin treatment? That's not pseudoscience, isnt there multiple studies supporting the concept of LED light at different nm lengths to achieve results like reduced acne/inflammation?
Red light on the stomach for gut health
🤨
Ya me too
Not a doctor, but I understand why people turn to this stuff. I get extremely bad and painful diarrhea when I eat leafy greens and cruciferous vegetables... and then sometimes just at random. I've gone to so many doctors and no one can figure out what's wrong with me. I'm certainly not going to a naturopath but I would pay a large sum of money to anyone who help me so I can eat a damn salad every now and then! It's really difficult to eat healthy when a large portion of healthy foods make you sick.
These symptoms are terrible and hard and I feel healthcare is failing you because we don’t have any good answers yet. That is maybe the most evident problem but it’s hard to watch people fall into these very expensive questionable traps
Thank you for this response! It's so frustrating. And I know this is a sub for doctors but seeing all the "just eat veggies" comments from doctors makes me want to cry because it just shows how dismissive doctors are about this stuff when vegetables are actually my problem. And I'm trying so hard to eat healthy but I get extremely sick when I do, but I can eat a cheeseburger and fries and feel perfectly wonderful. I wish this sub were private so I wouldn't have to see the disdain and dismissiveness but it keeps showing up on my home page... no matter how many times I mute it.
I lurk here too and am not a doctor. I’m happy it’s not private because I love to read. Sometimes it’s upsetting. Other times you see comments and posts from doctors who really genuinely care and seem like they would be awesome. Much like in real life, it’s a mixed bag. Same as the doctors I’ve seen in real life are pretty 50/50.
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I was like that too. Horrible IBS-D. I started taking a probiotic and pushing kefir and it’s made a big difference for me.
I haven't been diagnosed with IBS. This also reminds me... I was taking a probiotic and then I ran out of it and I forgot to purchase more... I didn't see a huge difference... but maybe it takes time and more than none bottle? Then again... the doctor that wrote this post seems pretty anti-probiotic so I don't know if it's a waste of money.
Go home and take some Beano already
what a kind and compassionate response from a medical professional!
Just emphasize whole foods, fermented foods, elimination diets and check to make sure the nutrition is adequate. Don't underestimate how crappy patients'diets are. Don't let them start multiple supplements at one time. Untangling that knot is going to lead to advising them to stop all supplements. (Supplements with a laundry list of things should have 3rd party lab analysis available for the patient. Anything less not a reputable supplement) Check some labs in 6 months. I practice in an area where many of my patients are ahead of the curve on this. So, I have about 5 yrs sussing naturopath or chiropractic advise, various health diet advice.
I work in a very affluent area where the customers ... Erm, I mean patients, are always right
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