你的医生谈论营养吗？我的猜测是不。作为一名医生，我的感觉是大多数医生对营养知之甚少。为什么不？我们处于健康和疾病的整个范围内，正在发生巨大的范式转变。事情发生得如此之慢，大多数医生都没有意识到这一点。在过去的几十年里，医生的道路从“保持健康的人”变成了“给你药物和手术的人。” 让我解释。
医生的工作一直是医治病人，并就如何保持健康提出建议。当然有医学治疗-榨取，清除，和我个人最喜欢的-吃粉末木乃伊。是。阅读你正确几千年来，长期食用 1920x1080人造石膏的尸体被认为是良药。那是他们在古代医学院所教的。对木乃伊的需求是如此之大，以至于有时小商贩只会碾死死亡的乞丐，殃及受害者，并将其卖为木乃伊。
医学史是安慰剂效应的历史。这种木乃伊吃法在十六世纪被淘汰，被其他同样无用的手段所取代，如治疗精神疾病的玻切手术。嘿，让我通过你的眼球推这个冰镐，捣碎你的大脑的一部分，就像我在捣土豆。这个程序的发明者收到了1949年年的诺贝尔医学奖。这是大约在1949年年的医学的前沿。任何对这种脑力战略的批评都可以合理地通过“ 你 赢得诺贝尔奖，哥们吗？
随着抗生素的发展，医学作为半无用和半可怕的职业开始转变 - 从1928年开始使用青霉素。现在，突然之间，我们对传染病进行了有效的治疗，传染病一直是主要的20世纪的医学问题。医生们几乎是第一次有了合理有效的方法来对抗疾病。医生有一些比木乃伊提取物更好的东西，或通过眼球推动尖锐的金属尖头东西。Yaaayyy！
同样，随着现代麻醉和手术技术的到来，我们有效治疗了附件破裂，胆结石等疾病。在此之前，手术是一个可怕的景象。没有有效的抗生素，没有有效的麻醉，术后并发症多。这真的只是一个有锯子的人，准备把你的腿割下来，给你一根绳子咬下来，所以你没有尖叫。你和手术一样可能死于手术。手术是最后的选择，因为治疗与疾病一样致命。你走进理发店，看到那个带着生锈的手术刀的家伙，他刚从脏兮兮的血迹斑斑的盘子上捡起来。很多时候，你从来没有回来过。
到20世纪中叶，这一切都改变了。发现了细菌的概念和防腐剂的重要性。发现了麻醉剂。青霉素等神奇抗生素被发现。公共卫生和卫生得到改善。所以，医患关系改变了。现在，医生们把自己看成是一个固定的人，或者把它固定在女孩身上。你有一种疾病，我给你一个药丸。你会好起来的 或者 - 你有一种疾病，我给你手术。你会好起来的
这从二十世纪四十年代到八十年代非常成功。大部分主要的健康问题都是传染病。从细菌性肺炎到像幽门螺杆菌这样的细菌，像艾滋病毒一样的病毒，到丙型肝炎，人们都变得越来越好。你可以清楚地看到65岁以上人的预期寿命（这消除了儿童死亡和战争等的影响，集中在慢性疾病上）。
在这段时间里，医学院培训反映了医生们看到的新角色。我们想知道药物和手术，以及更多的药物和更多的手术。我知道，肥胖，饮食疾病应该与药物治疗！如果那不行的话，我知道，手术！用锤子给医生，所有的问题都是钉子。
医学院实际上并不存在营养培训。在住院期间（医学院5年的培训）完全不存在。我们没有了解它，所以我们不关心它，我们不关心它。营养不是词汇的一部分。作为一名医生意味着“我不关心营养”，因为医学院教我（和我的医学院的其他人） - 不是公然的，但是我们是男孩和女孩。毒品和手术团伙。不是营养师。这很好，只要主要的健康问题是感染和手术问题。
Things changed by the end of the 20th century. The big problems were no longer infectious diseases. Starting in the late 1970s we had a massive obesity epidemic. Then 10 years later, a massive diabetes epidemic. Our drugs and surgery tools were completely inadequate to deal with this new reality. We tried to apply the 20th century attitude to the new 21st century medical problems, which are largely obesity related and metabolic in nature. We tried – You have type 2 diabetes, let me give you a pill (or insulin). It was a dismal failure. We tried – You have obesity, let me give you surgery. It works, kind of. But there are a lot of complications.
So, we, as doctors, were lost. We were reduced to giving simple, puerile, and utterly ineffective advice like “Eat Less, Move More”, or “Count your calories” or “It’s all about the Calories”. We lacked comprehension of the problem. We didn’t understand obesity and its hormonal nature, and we didn’t know how to treat it. So, most of us gave up. We admitted defeat by trying to pretend that type 2 diabetes is a chronic and progressive disease. We pretended that obesity is a natural consequence of aging even though it had never happened on this scale in human history. Both statements, of course, are completely false. Losing weight often reversed type 2 diabetes, so we told people to lose weight, but we didn’t tell them how to lose weight.
Without any training, we gave the only advice we knew – Eat Less, Move more. This is rather ironic, considering that all available evidence from our studies shows that restricting calories is a completely ineffective method of weight control (see article – The Lack of Evidence for Caloric Restriction). We introduced non-physiologic concepts from physics like calories to try to explain weight loss (see article – The Useless Concept of Calories). We knew that about 99% of the time, this Caloric Reduction as Primary strategy failed, but we didn’t care. It was the best we had, so that’s what we gave.
But there is hope. More and more doctors are starting to recognize that the related conditions of the metabolic syndrome which are all closely related to obesity are treatable, not druggable conditions. This includes obesity, type 2 diabetes, cardiovascular disease, cancer, and Alzheimer’s disease. You can’t treat a dietary disease with drugs. So the weapon of choice for metabolic problems of the 21st century is not a new drug or a new type of surgery, although there are many who try to medicalize a dietary problem. No, the best option is to treat the root cause. Treat the dietary disease with correction of the underlying diet.
The weapon of choice in 21st century medicine will be information. Information far beyond the simplistic notions of calories. Information about the ancient practice of fasting. Information about the dangers of excessive fructose intake. Information about reducing refined foods especially carbohydrates. Information about the hormonal basis of obesity and type 2 diabetes.
而好消息是，这些信息并不局限于医生，而是可以通过任何有互联网连接的人发现。这正是本博客及其相关书籍和相关播客的重点 - 关于肥胖科学，营养科学，2型糖尿病科学的详细讨论。这正是我们的在线强化膳食管理计划的重点。营养作为营养性疾病的治疗选择。那是医学的未来。
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