Op-Med is a collection of original articles contributed by Doximity members.
Here's the typical story we come across every day:
Jack was overweight and had a terrible cardio-metabolic profile. Jack changed his diet: he eliminated X, Y, Z and added more A, B, and C. He's now lost 30 pounds and feels fantastic. His numbers are also perfect: his HDL is through the roof, his LDL is undetectable, and his A1c is smack in the normal range.
Todd was overweight and had a terrible metabolic profile. Todd changed his diet but he did not eliminate X, Y, or Z. In fact, he did the opposite. He increased his intake of X, Y, and Z but eliminated A, B, and C. He's now lost 30 pounds and feels fantastic. His numbers are also perfect: his HDL is through the roof, his LDL is undetectable, and his A1c is smack in the normal range.
Jack swears by this diet and encourages everyone to follow suit. The diet makes sense because X, Y, and Z can promote a really harmful metabolic pathway, whereas A, B, and C can do the opposite. There are numerous studies that show this.
Todd swears by this diet and encourages everyone to follow suit. The diet makes sense because A, B, and C can promote a really harmful metabolic pathway, whereas X, Y, and Z can do the opposite. There are numerous studies that show this.
Jack and Todd both have followers who have experienced what they have experienced. Now Jack and his followers argue endlessly with Todd and his followers. Each group accuses the other of disregarding the evidence, of being disingenuous, of being unhealthy, of making things up.
But there's something wrong with this picture because both Jack and Todd are credible individuals, and so are most of their followers. Most of those who have followed Jack's diet have experienced benefit, and most of those who have followed Todd's diet have experienced benefit. So, who's right?
Both sides are right. And therefore, both sides are wrong.
When Jack and Todd changed their diet, they changed something first. They changed themselves. For human beings, a diet is not just a list of foods and ingredients. For humans, a diet is also behavior. When a diet is changed, a behavior is changed first.
What you become doesn't follow what you eat. What you eat follows what you've become.
Michel Accad, MD, practices cardiology and internal medicine in San Francisco. He is a father, husband, author, philosophy teacher, blogger (AlertAndOriented.com), and co-host of The Accad & Koka Report podcast.