AHS12 as a Practicing Clinical Physician

This past weekend I had the terrific opportunity to attend the Ancestral Health Symposium 2012, and also speak to a much larger audience than I could have anticipated.  I'd been to the original symposium in LA last year, and got a real sense of how much the interest in ancestral health lifestyle has grown in such a short period of time.  I'll probably gossip a little more in a later post, but for now I wanted to give some of my personal ideas inspired by the excellent post of Paleolithic MD, a Physician Manifesto.

Last year, I was thrilled when two physicians came up to me and we were able to talk a bit of ancestral health shop.  Sometimes being a Western physician interested in ancestral health principles can feel incredibly lonely, exhilarating, and even frightening.  In March I went to PaleoFx and met a core group of family medicine and physical rehabilitation physicians from Utah who wanted to organize a physician's forum.  We bonded immediately, because we have such similar experiences and goals that are not exactly shared by anyone who has not tried to juggle the practice of clinical medicine and evolutionary medicine principles.  Doctors have particular needs, obligations, regulations, and a widely varying patient base, ranging from those who are very ready to make healthy diet and lifestyle changes and those who will continue to smoke while dragging around an oxygen bottle.  

Everyone comes to see a psychiatrist from a different place in life.  I might not talk too much about diet for months or years of working with someone because we are working on keeping someone employed, brainstorming about how to keep from being homeless, or working on how to keep from self-injuring, drinking, or suicide.  Sometimes folks embrace dietary and lifestyle changes as a part of a solution to these enormous problems, but sometimes they cannot or will not… and some may come to me years later and begin to ask about nutrition or sleep, but many, many folks never will.  With very few exceptions, I do not kick people out of treatment just because they don't follow my advice.  Nor can I judge when someone with particular temperament, education, family situation, and stress is not prepared to make major lifestyle changes.  I don't live in anyone's shoes but my own.

After PaleoFx, the Utah docs and I began the embryonic stage of a forum for MDs, DOs, and medical students, and at AHS12, put out a call for other physician attendees to come and talk about joining forces for support, education, and other practical considerations.  Rick Henriksen, MD, on faculty at an academic medical center in Salt Lake City, has done a great job putting together statements of basic principles and ideas.  While AHS11 had a great introductory and research focus that was expanded into AHS12 to include even more anthropology, different angles on the science, and some of the old tired arguments about whether glucose will kill you or not.

We were all surprised when 30-40 people, mostly physicians, showed up, interested to network and learn.  Of course one travels to a conference to network and learn, but I hadn't realized there were quite so many physicians in the "fold," as it were, and if there are this many physically attending the conference, how many are now out there in the community or academia?

Doctors for the most part do not want to burn down the academic medical center.  We want to integrate the best sensible practices of Western medicine and ancestral health principles.  While everyone (including me) can bemoan the number of C-sections and the (lifelong?) alterations in microflora that might involve for the infant, I was seated between two very amazing doctors, both born by C-section, who might very well have perished along with their mothers at birth without the intervention.  I've seen midwifes claim rates as low as 2% C-section, and the near 30% rate in the US is no doubt too high, I don't know that anyone who cares for women and babies who would say the C-section rate should be 0%.

The clinical medicine place where allopathic and ancestral health principles meet is in proper nutrition, preparation, and education to help a mother be as healthy as she can be prior to conception and pregnancy and to avoid some of the complications that may increase risk of C-section (such as obesity, gestational diabetes, or hypertension).  But again, some women won't or can't make the changes that could ameliorate these complications, and sometimes the changes simply aren't enough.  Then the key is to be educated and experienced in childbirth to minimize unnecessary intervention, and to know when to act decisively if a vaginal delivery is not possible.

Often antibiotics are overused, but sometimes, if you don't take antibiotics, you will hasten your death or end up with a disfiguring surgical wound infection.

Physicians must navigate the evidence, plausible biologic mechanisms, unknowns, and various corrupting or biasing influences.  There is the industry money from pharmaceutical companies or supplement companies or shoe companies or traditional entrenched methods that may have no basis, personal pride or narcissism that might make the doctor recommending pig thyroid for everyone seem like a convincing plan, but ultimately the harms may outweigh the good.  There is a mountain of information to negotiate and the motivations of the presenters of the information to consider.

And sometimes there are health problems that can't be changed, but only borne.  Supporting someone in coping can be the physician's most valuable skill.  It is perhaps the oldest one.

As far as the practical implications for ancestral health in the western medicine paradigm today and in the future, I'm most excited about the potential for widespread support of a whole foods, anti-inflammatory, processed-foods restricted diet, and the end of academic dietitian and nutritional support of micro nutrient-poor and then enriched processed foods as "health food."  I'm also interested in the possibilities of immune modulators such as helminths and pseudocommensials for autoimmune disease, and learning more about how technology use affects sleep and mental health.  Other things, such as being on the lookout for iron overload and encouraging regular blood donation, particularly for men, and learning how to avoid toxic imbalances of nutritional supplements while using them judiciously to replete deficiencies will continue to be practical yet tricky.

With all the tinkering, in Western medicine and in ancestral health, we don't want to lose sight of the basics.  Now matter how healthy I make today, I can't undo the sleep-deprivation of the past weekend.  No matter how many times I quantify hormone levels with lab tests, I can't get your hypothalamus and testicles or ovaries or adrenals to work together if you don't help them out by eating and sleeping and laughing enough.    

I'm excited about the future collaboration of evolutionary-minded doctors.  Now, getting doctors to agree on much of anything can be like herding cats, and establishing some maverick (but very sound!) principles in the age of increasing pressure for evidenced-based medicine to be cookie cutter medicine delivered from a manual can seem daunting.  As doctors, however, the first thing we must remember is to meet the patient where he is.  If we start there, it is much harder to fail.  Our job is to exemplify, as best we can, good principles of healthy living and to deliver support and healing.  We will do a much better job integrating the best science of modern medicine and the sensible, proven traditions and experiences of our human past.