What Has a Family Doctor Learned From 25,000 Patients? 

Can you see chronic disease coming before it's diagnosed?

Yes. If you know which labs to check, most chronic disease is visible years before the patient actually develops it, in many cases up to a decade.

Take type 2 diabetes. If a doctor only checks fasting blood sugar or A1C, they may catch prediabetes two or three years ahead. But if the doctor checks a fasting insulin and it's above 15, that's almost a look into the future: this person is going to have type 2 diabetes in 5, 10 or 15 years if they don't cut the carbs. The same goes for fatty liver, hypertension, metabolic syndrome and obesity. In my view, most patients and many doctors don't know this.

Why does hunger always beat willpower?

Every adult at some point decides to go on a diet and get healthy. They throw all their willpower at it. But if the diet isn't a proper human diet, at some point their hunger, for the amount of food their body wants or for the nutrition in it, will trump their willpower, and they'll quit.

Hunger is a built-in biological drive. Willpower is just something you think. Breathing is a biological drive too. If I put my hand over your mouth, when your body gets hungry enough for oxygen, you're going to take my hand off your mouth. The same principle applies to eating.

Hunger isn't the enemy. A proper human diet gives you enough healthy animal fat and animal protein to turn on your satiety hormones, the hormones that tell you you're full. Then you're not hungry anymore, and willpower is out of the equation. In my opinion, plant-based, vegan, Mediterranean and "eat less, move more" diets are destined to fail because your hunger is going to win.

Why don't patients follow their doctor's diet advice?

The average patient will listen to their doctor about diet if the advice actually makes sense. Most doctors tell patients to eat less and move more. In my view, that's stupid advice. Exercise stimulates your appetite, so now you're hungrier, and you're supposed to eat less.

If a doctor recommends a plant-based, vegan or vegetarian diet without enough animal fat and protein, you'll be hungry all the time and develop nutrient deficiencies. You'll either eat constantly or take a handful of supplements. That advice is unfollowable. It's not the patient's fault they couldn't stick to it. Only when someone eats enough healthy animal fat and animal protein is the diet sustainable.

Is the bathroom scale the best way to track progress?

Very often, no. Many people, especially older women, have been trained all their life to treat the scale as the true test. But your body measurements often start to shrink well before the scale says what you want. Buy a tailor's tape.

Also check your labs regularly, most importantly fasting insulin. If your fasting insulin is 40, that's terrible. For most people, it has to get down to 10 or lower before you can burn the stored fat on your body. If you've lowered it from 40 to 30, that's an improvement, but you probably won't lose weight until it gets closer to 10.

Those numbers give you something black and white to hang your hat on. The scale hasn't moved, but your fasting insulin came down 10 points and you lost 3 or 4 inches. That's the motivation boost you need to keep going until the scale starts talking nice to you too.

Why does simple beat complicated?

Before, you ate three meals a day with snacks, ate the rainbow and chased variety, because that's what you were taught. In my view, that kind of variety can push you to overeat.

Say you eat nothing but beef, butter, bacon and eggs, and you eat ground beef and boiled eggs until you can't take another bite. Then I bring out a bottle of ketchup, which is full of sugar and designed for you to overeat it. You'd magically be able to eat two or three more patties and two or three more eggs, because I broke up the monotony.

So for many people, especially if you're severely obese, severely type 2 diabetic or have severe hypertension, I think your diet needs to be monotonous and boring for at least 90 days. You can add some salt, some pepper and a little spice, but don't soup it up until you've lowered your insulin and inflammation, lowered your triglycerides, raised your HDL and gotten your blood sugar back to normal. Then you can start to experiment. You're an adult. You can do anything for 30, 60 or 90 days.

The goal is to retrain you that food is nutrition, fuel and building material, not pleasure, happiness or love. The most important thing is fixing your metabolic health, because that's what will kill you if you don't take charge of it.