This blog originated out of my frustration with the state of nutrition in the inpatient (hospital) setting.  There were (and continue to be) far too many times that I have walked into a room of a patient with diabetes (usually Type 2) who had a giant Belgian waffle doused in regular syrup and usually accompanied by a bowl of fruit and orange juice, in front of them.  While they enjoyed their near-100% carbohydrate meal with the satisfaction that they were following the nutrition guidelines told to them by their dietitian/doctor/diabetic educator/nurse, etc., I spent the rest of the day chasing their glucoses, trying to keep them under control with sliding-scale insulin.  But, their next meal would also be loaded with carbs, and the chase after glycemic control would be never-ending.

Time and again, this scenario drove me to beat my head against a wall and question, “How can this be allowed?!?”  With the most basic understanding of physiology, it is obvious that eating carbohydrates raises glucose.  Very simple: carbs = glucose.  And yet, my patient with a glucose over 300 mg/dL is indulging in a giant waffle given to them by the institution that was entrusted with his/her healthcare.

When physicians order “diabetic diets” for their diabetic patients, they have confidence that the hospital will provide a diet that is effective at controlling the patients’ glucoses.  Physicians have enough to worry about with the complex medical care of their patients, and most don’t know any more about nutrition than the average college student.  Ask the average physician what a “healthy” diet looks like, and the vast majority of them will regurgitate the US dietary guidelines but have no idea what the science is behind them.

I was one of them at one time . . . but no longer.  [Although I would argue that I knew quite a bit more about nutrition than the average doc, because I once did a presentation on the physical exam findings of nutritional deficiencies in medical school.  Also, shortly after residency, I decided to clean up my health and lose the weight that crept on from stress-eating and a relatively sedentary lifestyle during my training, a venture that led me to do a lot of reading on nutrition].  But still, I was convinced until 2014 that dietary fat must be bad.  In fact, I recall having said a number of times to inquiries about the Atkins Diet, “Any diet that advocates bacon over an apple is ridiculous.”  My sincere apologies to Dr. Atkins . . .

To me, the hospital is the setting where we should be setting an example, providing quality, evidence-based care to patients, not only to provide the best medical care possible so that they may return to their previous functional status or improve their quality of life, but also to protect them from their destructive behavior that led them to become ill in the first place.  Allowing diabetic patients to eat whatever they want is not quality care; rather, it is downright irresponsible.

Unfortunately, many of them just don’t know that carbohydrates raise their blood glucoses, because nobody has ever told them!  I recently saw a young woman with Type 2 Diabetes diagnosed 3-4 years ago who was dumbfounded when I told her that her food choices (pancakes) were poor in regards to managing her glucoses.  She had met with a diabetic educator in the past, yet no one had ever told her of the link between dietary carbohydrates and blood glucose.

My goal with this blog is to provide education on nutrition as it relates to health.  I would argue that metabolic syndrome, and its associated diseases (i.e. diabetes, hypertension, cardiovascular disease, etc.), is by far the most pressing issue facing healthcare, particularly among the developed countries.  Thus, much of my attention will be focused on this area.  There are great things to come . . .

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