I’m watching medicine undergo a transformation as we reach an explosion of new understandings. Unfortunately it’s later than it could have been because of the diligent and dogged attachment to evidence based medicine with all its inherent delays. Unfortunately this is costing lives. Here are some of the things I believe we could have acted on some years ago. Prove me wrong.
- BMI is a horribly crude risk indicator and should have been replaced by indices of central adiposity (unhealthy obese vs healthy. TOFI vs healthy thin) years ago. Fat that is overwhelmed with energy stores gets sick and leaks toxins causing disease (see next point). We need to store and use. Cyclical feast and famine is our only hope even if the “famine” is your weekly fast, or extended overnight fast.
- Type 2 diabetes, coronary heart disease, pcos (and its subclinical partner – the majority of female infertility), dementia, a lot of depression, and a lot of autoimmune disease are probably caused by a caloric overload, dysfunctional microbiome and immune dysregulation. Serum glucose is only a surrogate marker. It’s the inflamed fat that causes most of the damage, and few medications alter that (but metformin fortunately does)
- Your brain needs healthy saturated fat, because that’s what comprises it. Starve it of that and instead feed yourself manufactured oils and you will get membrane changes that aren’t so good.
- If we eat “empty calories” (pure energy sources- sugar, refined carbs, modern nutrient depleted wheat) and your body will crave vitamins and minerals. You will probably overconsume causing energy storage overload, leading to chronic disease. We should avoid processed foods.
- Most of the conclusions about unhealthy fats, serum cholesterol were based on simplistic and false assumptions, poor stratification of food groups in comparative trials and many studies were highly influenced by vested interests.
- We’ve only just started to realise the effects of pollution- air, water, food and environment. The effects are huge and the diseases complex and some defy current understandings. Avoid cities. Wash food. Don’t trust many “safe” additives. Recent examples- emulsifiers, additives to sunscreens.
- Randomised trials and well conducted studies can’t save us now. Too many variables. Artificial intelligence using big datasets, associations and algorithms are our main hope.
- A lot of diagnosing relies on pattern recognition. Humans can’t have a big enough dataset to keep ahead of machines (dermatologists, radiologists for example are a threatened species) Google will become a better diagnostician than your GP.
- Machines will never be human enough to do empathy. Humans can enhance the benefits that AI will bring to medicine by providing spirit and connection.
- We waste most of our health budget on monitoring or treating preventable disease. We are poor at motivating people because our culture undereducates us in health literacy and outsources that to “experts”, and we by training blame others or ourselves for our “failures” rather than recognising and growing our agency.
That’s enough for now. More to come. Prove me wrong, or let’s get together to shift the paradigm.