IMG_20140630_085050Pulling out the roots of metabolic disease requires two major bits of knowledge in addition to the underlying pathophysiology and biochemistry.

1. An understanding of the whole person – physical, emotional, spiritual, social and structural as I mentioned in the last post.

2. An understanding of nutrition, exercise prescription and promotion of behavior change. Unfortunately physicians have been poorly trained in these areas. We therefore tend to give vague or inaccurate diet and exercise advise. “Eat a low fat, low glycemic, low calorie, low salt, low cholesterol diet and just make sure you walk 3 days a week for an hour.” (Yeah right doc and can I put some mustard on that cardboard?)  We give lame advice and rarely provide needed support in the way of training, coaching or tools for success. Then when patients return unchanged or worse, we conclude that behavior change is impossible and vigorously proceed to the next big mistake which is the hallmark of this incredibly expensive and woefully ineffective medical system that we have developed.

More on Wednesday……