Meet a doctor who thinks for herself and wants you to as well

Editorial Introduction

If you are a regular reader, you’re likely to be what might be called a grown up patient, no longer dutifully following official healthy eating guidelines and obediently swallowing pills but putting together a health package that works for you.  Unfortunately grown up doctors seem harder to find. There are still too many tales of GP’s who dismiss or downplay side-effects, slavishly follow blood test results and show little or no interest is reports of how disorders such as diabetes or arthritis were greatly improved with diet and other non-drug options.

So it was heartening to receive this account from Dr Joanne McCormack, a very grown up GP with an energetic web presence, who describes how she went on a journey of discovery that sounds very similar to the ones undertaken by many patients – being radicalised by reading works of other maverick doctors such as Malcolm Kendrick (statins and cholesterol) or David Perlmutter (microbiome and brain) and regarding the internet as a valuable source of information rather than as dangerously uncontrolled region filled with crackpot ideas.

Commercial confidentially to trump patients’ rights

Even though an increasing number of both doctors and patients are moving towards whole body approach to medicine, which regards our organs as interconnected rather than isolated specialities, there is little room for complacency. Only this morning I got an email about a recent vote in the EU parliament to turn health data into a trade secret. It proposes to strengthen the rules of commercial confidentially for drug companies, placing them above the need for transparency and patient safety http://www.eubusiness.com/Members/epha/trade-secrets-2 .  

The kind of grown up medicine that Dr McCormack is practising is going to be far harder in a climate where commercial advantage trumps patient benefit so we very much welcome comments about ways that a grown up medical approach has improved your life.


 

Confessions of a renegade doctor

By Joanne McCormack

Until fairly recently I was a pretty conventional medic. I graduated from Manchester University as a doctor in 1986 and became a GP in 1990. Back then nutrition was very much a minority topic and certainly eccentric interest, while drugs and the pharmaceutical industry occupied the high ground of medicine. Now as far as I’m concerned when it comes to chronic disease, which is what I spend most of my times dealing with, the positions are pretty much reversed. 

Inevitably I learnt very little about nutrition in medical school and didn’t come across the Eat Well Plate until I was already in practice. Back then I just accepted it, but now I can see that much of it doesn’t make sense.

For instance, even in my limited nutrition classes I learnt that there were essential fatty acids and essential amino acids but no essential carbohydrates (that is starches and sugars).  And yet the Eat Well Plate advises us to fill up with carbs. It is what shapes menus in our schools and hospitals, precisely where you need protein and fats to build new bodies and repair older ones. Watching Public Health England execs still trying to justify the EWP would be funny if it wasn’t so tragic and harmful. Shockingly I’ve even been told that they are aware that they’ve got it wrong but claim they can’t do anything about it.

My conversion to a more nutritionally orientated approach to treating patients was triggered a couple of years ago when I was talking with a group of doctors about what they ate. I’d never believed calorie controlled diets worked well – they certainly didn’t for me – and while I parroted the mantra about “eat less, move more” I’d already found that it didn’t begin to tackle the problem for seriously  overweight patients unless they also greatly altered their diet.

Avoiding sugar is a great way to start

So what should we be eating? A couple of the doctors said their health had improved a lot when they went on dairy and wheat free diets. The reason they helped, suggested one, was that they inevitably meant you ate a lot less sugar.

That made sense to me. If you avoided those foods and didn’t go for the processed substitutes, such as non-dairy yoghurt, gluten free bread and cake, which were usually packed with sugar, you had to eat real food, which had to be better for you.

This set me off on a trail of reading widely about diets and real food for a couple of years. The only healthy diet I’d been told about was the standard low fat one but I soon found plausible alternatives that stood this advice on its head such as the low carb high fat diet and the London AS diet (low starch which can help with a rheumatic disorder called ankylosing spondylitis).

My experience exploring diets then lead me to question the benefit of automatically treating every disorder with drugs. When two of my patients cured their arthritis with the London AS diet, this approach seemed a valuable alternative to the monitoring, frequent specialist appointments and unpleasant side effects that are all part of the multiple drug regime that is needed to achieve the same effect.

Patients who are heavily drugged with little benefit

Then I began to notice that our reliance on drugs didn’t always seem in the patient’s interests. I watched elderly, frail bed-bound Alzheimer’s patients in nursing homes being kept on an increasing number of drugs that did little to benefit them on a day-to-day basis. It seemed a total waste of time when they had such a poor quality of life. The only ones who improved were those who were cantankerous enough to refuse them.

It was only a decade or so ago that doctors were warning about the perils of getting medical advice from Internet sites, but now it is where you should turn if you have a questioning mind. It is a place where the international, free speaking, medical and scientific world cam freely debate scientific papers, guidelines and dogma. A place where we can swap notes on the Key Opinion Leaders, (paid for by drug companies) who run our conferences or the (sometimes) dubious Department of Health target.

Most GPs would acknowledge that their patients are prescribed too much medication, and that it may often cause more harm than good. I’ve only recently realized that there are no trials and so no scientific evidence base for the multiple drugs schedules followed by large numbers of those over sixty.

Unfortunately as GPs our freedom of action is partially limited by the guidelines and incentives we work under. Most important are the QOF (Quality and Outcome Framework) points that GP practices get for hitting various targets every year (not all GPs get the payments though).

The invisible third party in the consulting room

So when you have a consultation, especially towards the end of the financial year, the QOF points system is likely to be a silent third party in the room – encouraging the GP to test and prescribe in order to hit targets which may not be aligned with your goals or needs. These include taking your blood pressure and running various blood tests. Failing to do them make doctors feel they are failing as well reducing their pay.

And the results of these tests are far more likely to lead to drug prescriptions than to dietary or other holistic advice. If you want to know what your doctor’s normally hidden agenda is, you can ask him or her to show you what is “missing” on your QOF file.

Luckily, there are many fewer targets than there used to be. Interestingly many of those that have been dropped involve cholesterol – silently removed without explanation. The official line is still that raised cholesterol is an important marker for a raised risk of heart disease and there is even a new and very expensive drug called Rapatha on the way which can drop cholesterol levels even more effectively than statins, but does not reduce deaths.

So I’m concerned about the advice patients are getting and I’ve spoken about it to public health directors and consultants about it. While some of them are open-minded enough to admit the government have got it wrong, they seem unable to translate that into practice. The times are changing however and doctors and industry can and will adapt. I’ve had more mental flexibility from key workers on the ground – nurses, doctors and school meals managers – than from the higher echelons of health service management.

Public health managers need to change

Listen up Public Health management – your hands are not as tied as you think! Individualized care and low GI diets are now options, while QOF cholesterol targets are vanishing. These changes allow you to be much more flexible. Train yourselves in nutrition too. The last Public Health Doctor I met told me and a group of diabetes docs and nurses that low fat didn’t work and that healthy fat was fine. So she is certainly more up to date than the EWP.

So when I find the official recommendations for my patients haven’t worked, such as a low fat diet for diabetes, I’m happy to suggest a range of other options and that is fine because government guidelines all say we must take individualised approach and I agree with that. We are each unique after all.

It is not so much unconventional as the beginning of a global movement of doctors and scientists who treat chronic diseases in a non-interventionist way based ultimately on the very simple idea that if a food has been eaten for millions of years, it must be safe, and that non drug methods may have less side effects and be more effective.

I’m also is my own small way trying to encourage a more informed approach to nutrition in schools and by official bodies. Last week I saw an 11 year old child with non-alcoholic fatty liver disease. It had nothing to do with fat intake or alcohol; It was entirely due to carbohydrate in the diet. So I’m working with the local school meals service in the hope I can persuade them to provide more nutrient dense food and avoid junk carbohydrate foods like chips, pasta, pies and cakes, which can cause weight gain, fatty liver, and diabetes.

I’ve been taught to follow evidence based medicine but the clinical trials, the supposed “gold standard” of the system, clearly has a massive problem with unfavourable results going unpublished. Let’s face it: a lot of our medical evidence base has been distorted or hidden, which can make informed decisions impossible. So what do I do?

I aim to give people unbiased information where possible and to encourage them to make active choices of drug and non-drug treatments. To help them I trawl the Internet and highlight the most useful sites and books, and link to them on my websites.

Often an individual and I decide together what the best course of action is, looking at the evidence of what works for him or her, and what does not, rather than blindly following guidelines that may be inappropriate. Beyond the consultation I direct my patients to my websites www.fatismyfriend.co.uk and www.healthylivingsite.me. So have a look and tell me what you think.

 

Joanne McCormack

Joanne McCormack

Joanne McCormack , GP for 25 years& Named GP for Safeguarding children in Warrington & Halton, Cheshire is one of 12 founder members of the new charity PHCuk which campaigns for better nutritional advice in the UK. In 2015 she started a website www.healthylivingsite.me and became an expert advisor to www.iquitsugar.com , and in 2016 started www.fatismyfriend.co.uk to show how eating real food could help health.
Joanne McCormack

Latest posts by Joanne McCormack (see all)

18 Comments

  • Jerome fantastic news that some GPs are thinking more about nutrition and personalised medicine. My own GP is fine with my refusal to take medicines and in fact offered some of her grandfather’s ayurvedic wisdom on how to take Turmeric for my back pain. It worked too!

    I only hope this awakening extends to digging further into how Thyroid Function Tests are based on poor quality evidence. A bad workman uses bad tools!

  • “Shockingly I’ve even been told that they are aware that they’ve got it wrong but claim they can’t do anything about it”.

    Welcome to the world of politics! What they really mean is that they are not willing to admit having been wrong, no matter how muchy harm is caused by that refusal. Put another way, their “reputation” is more important than our lives.

    But the fact that you find it shocking speaks well of your honesty.

  • “Shockingly I’ve even been told that they are aware that they’ve got it wrong but claim they can’t do anything about it”.

    I suspect it is much more complex than politics or loss of face.
    A quick walk round a supermarket will give you an idea of what proportion of our GDP is bound up with processed food – of which a fair chunk is low fat rubbish. An abrupt change of recommendations on diet could wreck the economy as fast as the banking crisis.

    Any changes will come gradually. It’s very frustrating. I have friends who follow the official guidelines to the letter. Their health would be much better if they didn’t but they listen to the NHS and not to me – which is understandable.

    Excellent article.

  • What a breath of fresh air from Dr McCormack. How lucky her patients are to have her as their doctor. The part about QoF and what’s missing on our file is interesting and useful. It was good to hear that cholesterol is being downgraded as a concern and for QoF. It will be small steps away from the public health disaster that is the low-fat diet.

    I read today that one in five children starting school is obese. We need a revolution, but it’s coming slowly from the bottom and not from those paid to lead. I wonder if they care what their reputations will be when this is fully exposed? If they care, they have to be brave. The public forgives those who do the right thing, but not those who cling on when they know it’s wrong.

  • Our unhealthy eating regimes have been ingrained into us from the end of rationing after the last world war. Supermarkets appeared to the detriment of small local grocers etc. Were swamped with carbs /sugar for breakfast lunch ,evening meal & supper,it’s as though we’ve been drugged or hypnotised .garages & stores have whole walls of sweets,cakes,breads ,processed meals & like robots we pile our trolleys high.,,toxifying ourselves. I am just like everyone else but I know my health issues have been a result of an unhealthy lifestyle but I’m learning….& when I try to share what I’m learning I’m met with doubt & put downs.

  • Hi Joanne

    Great to hear someone in UK is thinking for themselves. I like your idea that you can tell the Guidelines promoter that you are taking an individualised approach, to get round the possibility of being arraigned for not following the guidelines.
    I no longer talk to any of the drug reps, because although they are perfectly nice people, the drivel they spout is based on what their companies tell them to say. As anyone can find out, any trial in which a drug company is involved will be worse than useless, as the results will be twisted to show what the companies want told. So far in Australia, I’ve had no problem with saying things like low carb, high fat will help diabetes far more than the daft high carb low fat peddled by the dietitians and endocrinologists. The logic of the approach is appreciated by the patients I tell it to. Unfortunately, because of the addictive qualities of sugar, it is less easy to stick to the regime. Similarly, when I mention to them that no less an authority than the BMJ state that taking your statin for 5 years will help you to live from -9 to +120 DAYS longer, a lot of them are more than happy to come off it.
    More power to your arm, and I have noted your name on posts on Malcolm Kendrick’s blog. Keep up the good work. There are some GPs out there who are in full agreement with you.

  • Sorry, -9 to +10 days, I would hate to make people think statins actually did you some good

  • Glad to see you are getting away with it. I am currently being investigated by the medical board for allegedly promoting “inappropriate” treatment in my blog. Despite being 56 and having long standing type1 diabetes and Addison’s disease, I recently ran a half marathon in under 95 minutes, and 5k in 20:20, my fastest time since I was 19. But doctors have now threatened legal action against me, claiming that I cannot comment on diabetes treatment because I am “not an endocrinologist” Look me up on Google Plus

  • Hello Joanne,
    Great to hear words of wisdom from another GP who has noticed the big holes in our NHS treatment protocols.
    I have started studying with Institute for Functional Medicine and it has been life changing and now Locum as a GP 2 days and work in integrated Medicine another 2. If you want more support they are the best providers of a structured education programme for Medics.
    All the Best
    Sarah

  • Hi Nick,

    I thought it incredible that anyone wants to sue you for “not being and endocrinologist” when clearly a long-term history of managing type 1 diabetes should give you more than enough insight into this area.
    But then I looked at your blog and saw you were based in Australia – a light came on. You have the misfortune to be practicing in a place dominated by an antediluvian dietetic establishment that guards is fiefdom as fiercely as ever the Painters and Dockers union guarded theirs.
    e.g.

    http://www.babyboomersandbellies.com/blog/2015/09/local-health-district-says-no-to-low-carb-diets-for-diabetes/

    http://www.babyboomersandbellies.com/blog/2015/10/snsw-lhd-keeps-saying-no-to-low-carb-diets/

    I suggest you get in touch (if you haven’t already) with Troy Stapleton and Gary Fettke who have assembled a kind of united front to deal with the scientific aspects of such challenges in Australia.

  • Hi Joanne,

    Yes, it has all been one big fat mistake over the last few decades, hasn’t it? Speaking as someone who has lived with Type 2 for 22 years and rheumatoid arthritis more recently, I agree with much of what both you and your editorial intro say. However, I do feel the need to put in a word for those of us living with chronic disease. For example, when I was first diagnosed, having followed health guidance to the letter all my life in the awareness that I was high risk, I followed the guidance I was given and then took the medicine, because that was what you did to take care of yourself right? I had not taken any science qualifications, and thought it was really strange that I had to eat a lot of the stuff that my body couldn’t cope with and really bizarre that I was supposed to stop eating really tasty fat and eat horrible plasticky stuff on bread instead of the butter I had enjoyed as a child, but that was what all the experts said…

    At that point I had not understood properly how a bit of power, prestige or money (and sad to say education?) could turn people’s heads and enable them to believe ideas that are clearly preposterous when you look at them clearly. So I followed the guidelines and did the whole getting fatter and sicker thing. Until the internet came along, thank heavens! A friend pointed me in the direction of something she had seen and my life was changed for so much the better. As you would expect, I am now well controlled, medication and largely pain free, with high levels of energy and activity; angry that I had to spend so many years tired, hungry and in pain. I am doing what I can to help others reach the same better place.

    A word in support of people who have not reached this position. It is reasonable to go to the doctor and expect that the advice they give you is the best. It is only fair to think that huge amounts of public money are spent to spread sensible public health advice. It is hard to accept that there are highly educated people who spend their time producing useless studies and giving harmful advice. There are a lot of people who should be truly, madly, deeply ashamed of themselves and their behaviour and it is not the patients.

    So I will be at the Public Health Collaboration conference next month, and I am looking forward to hearing some fresh ideas and developing new ways to reach people.

  • I have been on the low carb high fat diet for a while now and find that I am quite satisfied, don’t feel hungry and steadily losing weight. For me it is not a diet, more a way of life and I am really enjoying good fresh food in a variety of different ways

  • Joanne McCormack

    Laura S
    I agree that a patient should be able to trust a doctor’s advice. However, doctors are subject to the same prejudices and biases as everyone else. What has happened demonstrates that. We are also subject to the public health and QOF frameworks which direct our thinking. Once we all accept these facts we can mitigate against them.
    As you pointed out the Internet saved you from a life of further sickness. It also saved me and thousands of other people. By spreading the word we will gradually unpick the harm that has been done, but we will need to be continually aware of the risk of misinformation.
    Thank you so much for the frankness if your comments and I hope to meet you on the 11th June.
    Joanne McCormack

  • Hi Joanne,

    I totally accept that Doctors have to work within their framework, it is the people who set the frameworks and allow the science to be subverted for profit who should be ashamed, although perhaps frameworks may have changed if they had been questioned more? Please do not mistake frankness for aggression that requires defence.

    I do not think however that it does any harm to express strong feelings in this matter; suffering the consequences of Type 2 when it can be avoided is a big deal. People do have strong feelings about it and my hope it that it may help people to know that is ok to be angry- it helps people move on from the guilt of being stereotyped and take action.

    Laura

  • Joanne McCormack

    Thanks for your comments Laura. I agree.

  • How very timely. I was composing a comment beneath your post Dr McCormack when something entered my inbox.

    http://www.thegrocer.co.uk/buying-and-supplying/health/eatwell-guide-branded-timebomb-by-doctors-alliance/536538.article?utm_source=Newsletter&utm_medium=email&utm_campaign=7129932_Gro%20daily%2023%2F05%2F16&dm_i=131K,48THO,5DVQVN,FHNUM,1

    The above is open access to speak of but the mere headline is intriguing enough. But the internet is a marvellous place and the story has been more openly reported elsewhere. See link:

    https://ca.finance.yahoo.com/news/advice-nations-diet-sparks-health-row-015225136.html

    Not only is the Eatwell Plate a bastion of establishment thinking it is also so useless in the face of the lesser-known facts as to ranks as total bollocks. Thankfully it has been taking hits from attacks directed at it. The earlier ones I know of date back around eight years to a time when the Food Standards Agency had a Chief Scientist and a remit to promote healthy eating advice (off the back of the Eatwell Plate). The attacks are now falling far closer to the target. The Eatwell Plate should not survive.

    The lipid hypothesis for cardiovascular disease (CVD) is a nonsense. Saturated fat does nor contribute to the process via which CVD advances. Likewise the cholesterol hypothesis for CVD which forms an alliance with the lipid hypothesis to amount to the diet-heart idea is a nonsense too. Underpinning the the cholesterol hypothesis is a notion that cholesterol could be a concentration dependent atherogen. But this notion emerged out of the work of Dr Ancel Keys in a time when much less was known about cholesterol than is the case now.

    Science now makes available more about the complexities of cholesterol and its peculiar significance to the realms of biology and biochemistry as the zoo-sterol of natures own choice. More is known and available about the lability of cholesterol and how it is the precursor substance from which the steroidal hormones are made. And if a person would take the trouble to read ‘The Biological Effects of Cholesterol Oxides’ they could become alerted to the number of cholesterol oxides and the variation in the scope of their individual properties. The book indicates that certain cholesterol oxides could be infinitely more atherogenic that is cholesterol itself because at no time since the ease with which cholesterol could become oxidised became better appreciated has any experiment indicated cholesterol to have any atherogenic effect at all.

    The diet-heart idea and its components, establishment thinking, aspects of NICE guidelines, unquestioning faith in the lipid profile test, and the bias within medical practice that is rooted in QOF, is not truly promotional of improved health outcomes at all. Indeed it is the reverse.

    I have just emailed a person who has campaigned hard over the years. On occasions this person has sought my opinion upon whether I consider minds and times are changing. I have always replied to the effect that despite the gains no significant cognitive watershed has been traversed. Now I think we are so close all that is needed is a big push. Here’s how I communicated my take on things to this individual.

    ” [...] I would hope endocrinologists, medical professors at teaching hospitals etc, and general practitioners could begin to perceive that obesity can only arise under conditions of chronic hyperinsulinemia and that saturated fats in the diet do not provoke hyperinsulinelia to the extent that highly glycemic carbohydrates do.

    My understanding has trended to perceive that endocrine disruption can leverage the extent of oxidative stress as resides in a bodys biochemistry. Together endocrine disruption and oxidative stress are the main channel (internal to the body) through which causality is conveyed. Hence external risk factors and influence have effects over biochemical, cytological, tissue, and organ, degeneration may result through external affairs that bring on endocrine disruption and/or add to the levels of oxidative stress running in the background.

    In the present time it is just too radical sounding a thing to direct that the rather ubiquitous use of rubber and plastics in the manufacture of modern footwear could rank as a prominent endocrine disruptor, despite the evidence supports such an outlook. Likewise it is just too radical a thing to suggest that the light-bulb and the rather ubiquitous presence of artificial light is no less disruptive to aspects of the endocrine system than any other less radical sounding influences.

    The LFHC diet is undoubtedly an endocrine disruptor whose evidence is revealed upon any set of scales and BMI calculations (notwithstanding not everything about the computation and interpretation of BMI is sound).

    But if people within and without the medical profession can begin to gain a cognitive sense that hyperinsulinemia is the real driver of weight gain and obesity then that may pave the way forwards to a time in which the extent to which aspects of the modern developed world we most of us live harbours the several man-made affairs capable of bringing on chromic endocrine disruption that can feed oxidative stress and the assimilation of degradation to our ‘inner soup’ that eventually manifests itself as one chronic disease or another.

    In addition to the above Barry Groves indicated that autocrine disruption allied to LFHC diet nay be implicated in the etiology of several diseases too.

    ‘They’d’ better start swimming or else they may sink like a stone.

    At last I do sense the times they are a changing.

    I do not no who may have had the most influence to have the members of the herd begin to think about things differently. I really do think the blogosphere and debate in comments beneath blogs has done a lot to convince think patients and consumers. It is why I so revere and regard so highly those who have sacrificed so much time and effort to host blogs that have been the arena of open and transparent debate. [...]“

    Do not take criticism from conservative colleagues who direct you are ‘killing patients’ (as Dr Malcolm Kendrick might put it) or being unprofessional. Since the box is so full of nonsense you do well and can serve your patients better if you do grant yourself the freedoms to ‘think out of the box’ where it seems the far more appropriate thing to do.

    I do highly recommend that you explore the theory of Earthing via Ober, Sinatra, and Zuckers book on the topic. Likewise the extent to which we are sensitive to light, and to the dark, and to the natural cycles of light and of dark is worthy of any GPs contemplation. I have some reservations about aspects of its approach but as an introduction to the subject ‘Lights Out’ authored by Wiley and Formby is a book worth reading. Then if you really wish to expand your minds horizons then curiosity for aspects of biochemistry, and a willingness to read Gerald Pollack upon the Forth Phase of Water will help foster regard for protonation and deprotonation as being the very spark that is life itself, and that may provoke you to wonder, as I do, if oxidative stress, which frequently manifests itself at a molecular and biochemical level, can also have roots in the quantum dimension. Inflammation is an indication of increased activity associating with electrons, much of it arising in the quantum dimension. Electrons can generate photos, and photons can result in a rise in temperature. It is surprising how much of that which Richard Feynman explained is pertinent to the distinctions between health and ill-health.

    You spend a lot of time in practice offering consultations to patients whose illnesses are essentially man-made. It the same for all GPs. With this in mind it hardly seems decent to ignore the causes and to prescribe dugs that, at best, merely treat symptoms. Well done for gaining a sense of this and for actively being promotional of this, for it can be a professionally risky thing to do within a profession so full conservative thinking fat-heads.

    Stains are the weapon via which rank capitalism wages war on innocent people.

  • Thank you for your considered and detailed reply.
    I hope that this is the start of people considering all the evidence in front of them and deciding what they believe at any moment in time. That may change according to the appearance of new evidence, whether it is a new trial or disclosure of a conflict of interest. We cannot rely on the opinion and the directions of people who have hidden vested interests without considering that of others who may be more free to speak and direct.
    When I was at school we were taught the “facts” of history and had to learn the dates, events and details as if there was only one truth for any historical event. When my daughter was at school in 2010 she was taught to evaluate evidence and make judgements on the likely truth of any event. So should it be with scientific and medical evidence. It is evidence not fact, and evidence will grow and change over time. I welcome people challenging my ideas and saying that I may be wrong. So should we all. It is how we learn and reach a better understanding.

Leave a Reply


WP-Backgrounds by InoPlugs Web Design and Juwelier Schönmann