Pretty much depends on their actions during covid, particularly how they addressed the rollout in the later years and around teenagers and exercise.
Depends on the video, some doctors make videos because they realize that they don’t have the impact on world health that they would have working in emergency medicine in a rural town
Like the rest of us all GP’s are different. My GP friend, who had recently retired, used to put his overweight patients on a 1000 Kcal diet. When I asked him if he’d heard of the Minnesota experiment, he hadn’t a clue. Hus wife who was also a GP had to go to Slimming World to try to lose weight. Most doctors with one or two notable exceptions here in the UK haven’t a clue about nutrition and just parrot what the government guidelines are.
Most MDs I know really do not bother reading into it. They see a news story about some epidemiological study published in a big journal like the Lancet or NEJM and think okay it got published in those journals so it’s probably a good study…
Because it’s not their job. There are literally nutritionists to do that. It’s fun to bash MDs on here for not knowing about nutrition but it’s a doctor’s job to heal sick people, not necessarily keep people healthy. Which sounds counterintuitive but that’s what they teach in medical school. You could argue that this should change and doctors should be focusing on preventive medicine more, which there is a whole field of, but for now, doctors fix and heal disease. They don’t really deal with diets to prevent disease. And I know a lot of doctors who would love to focus more on the preventative side but they just don’t have the time, energy, or resources. You have somebody who works 60, 70, 80 hours a week seeing hundreds of patients for 30 minutes because they’re overbooked, they don’t have the time to sit down and go into small details of every patients’ life and diet. It’s sad but the reality of medicine in America right now. You have a doctor who says, “why don’t I only book 5 patients today and then I can give them each 1-2 hours of my focus and really help them?” And their employer says no, you’re going to see 20 patients so we can bill 20 patients and make more money. And the doc is like, well maybe I’ll go work over here instead and they find out that it’s the same everywhere. Unless you can front millions to open your own practice only to realize that you won’t make any money seeing 5 patients a day.
Or the other case is that you get so specialized that you only focus on one specific thing. You’re a pathologist, you don’t deal with nutrition, you look at tissue under a microscope. Or a radiologist who reads X-rays all day. Or an Ortho surgeon, “where is bone? Is this bone? Sugar not bone” (if you know you know). So it then is pass the buck time because that’s out of your scope.
All of this is to say I wouldn’t expect most MDs to know a huge amount about nutrition because it’s not their scope of practice and aren’t taught it. It’s like going to a bike mechanic with a car and saying, it’s got wheels and gears, can’t you fix it?
I think it will take a shift in focus on what doctors do for them to know about nutrition. In the US, the focus is on healing the sick, fixing the problem, not preventing it.
What are the ‘good’ studies you are referring to that say much more than the standard advice to eat a balanced diet, including lots of fresh vegetables and not too much sugary, fatty or processed food?
“Good study” in that context seems to refer to a vetted, peer reviewed study that’s thus been published in one of the journals that’s considered reputable. Studies are being performed all the time, in all aspects of physiology and medicine, and a lot of them offer fine-tuning of the general “eat a balanced diet”, because science will never be 100% settled.
Same here in the UK. I’m 69, very fit and to be honest my pre diabetes is pretty low on my doctor’s priorities considering all the sh*t he has to put up with day in day out. I’m lucky though I’ve got the means and the interest to look into things myself. The majority just listen to what the GP/Practice Nurse says and takes the pills.
Ok
Retired General Surgeon here. Everything you point out is true, not just for GPs and primary care physicians, but for all specialties. The death knell for private practice in the US was Obama care with it’s requirement for electronic medical record keeping. Small private practices in all disciplines were unable to afford the EMR, and this forced the American medical work force to move to the employment model with your bosses more interested in the bottom line than the needs of any individual patient. The last 14 yrs of my career was in the employment model, and I disliked every minute of it and was often in conflict with my superiors because I wanted to do certain procedures in a different way than they required, or I was not operating fast enough. Glad I’m out of the game, and enjoying being retired.
Because, of course, as a manager or insurance company it’s important to force surgeons to rush when doing delicate procedures. Maybe could bill the patient for longer anesthesia if the procedure goes long as well.
It is a sad state.
Joe
Connecticut insurers tried the opposite 
“Hmmm, that’s some weird anatomy right there. Hey, where are we on the time limit? Only 10 minutes left? Yeah we’re never gonna fix this in 10 minutes, it’d take at least an hour. Just close him up and tell ICU he’s on the way and critical”
Joe
In a classic HMO, the anesthesiologists are also salaried, so they can’t bill based on time.
Thanks for all the MDs chiming in on this topic. And also to Lionel for highlighting his current situation after a lifetime of poor practice. I had Philip Prins on my podcast the other day, who lead the most recent study showing that only 10g/h of carbs was enough to enhance performance (by 22%) in triathletes adapted for 6 weeks to both low and high carb diets. Dr Prins was also the one who showed that, just like Lionel’s situation, up to 30% of the athletes that enter these studies are pre-diabetic. Lionel’s case is not an isolated one. You can appear fit and healthy on the outside, but…
Is this new? I thought that this was fairly well known for lower intensity. I mean, it’s great for long distance stuff that you’re maintaining lower intensity pretty evenly, but for pretty much any road or MTB discipline it doesn’t really provide much insight. 70% VO2 isn’t very high intensity at all. Even gravel will have big surges over that rather than steady power.
It would be interesting to see this same study but performed at more realistic intensities for road or MTB races.
From Table 1: Power output at 70% V̇o2max = 248.8 ± 34.9W. Time to exhaustion (RPE=6/10, between hard & very hard) at that power ranged from 90 min to 2 h. Granted these participants are a bit fitter than old me, but its likely just under critical power (FTP); Zone 3b. Probably not far off where you’d ride a hard gravel/MTB race of that duration (minus the stochastic nature).
In the past we’d have thought mechanistically that sort of performance (90min-2 h to exhaustion) would be muscle glycogen dependent. Their data suggests otherwise.
What would happen though if the ride WAS a lot more stochastic though?
Does Dr Prins really not know where the other half of the carbohydrates go when 120 g/hr is being ingested? Does he know that the 120 is typically about half fructose?
Does fructose not get processed through the liver, and therefore take significantly longer to get to the bloodstream? I asked here or another forum, one time, how long it takes the liver to take ingested fructose get it into the bloodstream and the answer I got (no idea how correct it might be) was that it takes about 2 hours. I think I probably did a google/AI search and got some confirmation on that. Well, that would lead me to believe that adding the fructose to my bottle for a 2-3 hour (or less) ride will maybe not provide significant benefit for my performance on that ride, though it may have some benefit for recovery, or maybe there is a potential negative effect due to the timing relating to the liver shutting off or turning on it’s flow of glycogen into the bloodstream after it’s been fed 120g of fructose over a period of 2 hours. Yes, due to my age, weight, and family history, I have particular concerns about how much carbohydrate I ask my liver to process.
If there’s anything to my line of thinking, then the outcome may be different over longer rides for endurance athletes (which is what the thread is about). I’m not one of the 90+ g/hr folks (30-60 is what I aim for depending on ride length and intensity), and seem to do fine for what I’m trying do accomplish in my 8-11 hrs every week, and do my <2 hr zone 2 rides on just the light sugar that’s in my coffee.
In the study the HCLF group used 380 g carbs, and the average weight of the participants was 84 kg. That’s roughly 4.5 g/kg. I’ve found sports nutritionists recommending WAY over that. Upwards of 8-10 g/kg on training days. Maybe 380 g is still too low to show performance & recovery gains? I personally only eat that few carbs on recovery days. Standard 2500 kj training days are double that.
Edit: What’s “healthier”, a diet of 50g carbs, 120g protein, 425g fat to meet 4500 kj worth of energy expenditure, or 50g fat, 120 protein and 900g carbs?
