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Why is making a good diet so hard?

I'm trying to create a good diet for myself but finding it incredibly hard. I just want to know what to eat every day. I'm disciplined enough to do it. The question is, why is it so hard to find out what the best foods to eat are? How can humanity not have come up with a common meal plan that people can follow? I don't understand why it has to be so difficult to find out what to eat. All I'm looking for are specific meals laid out over the course of a week.

PCB content, purines, oxalates etc. All rule out a lot of foods. Why hasn't a good diet been laid out? I should be able to open a book and get a list of good foods/meals that are low in toxins but it seems like humanity is too retarded to do this.

In conclusion, has anyone got any good ideas/foods that I can look into more. At the moment my diet consists of

rice, broccoli, kidney beans, spinach, cauliflower
egg whites, salmon, mackerel, chicken, beef, turkey

Basically i just make meals around those food groups even though I've read some bad stuff on some of them. I just want a good food plan. Like I said, I have the discipline to stick to any diet, I would really just like to get a day by day meal plan mapped out so I can forget about food and free my mind up and know that my diet is handled.

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  1. I don't think the goal of a "foodie" site is ever to "get a day by day meal plan mapped out so I can forget about food and free my mind up". Why post here, to chowhound? Maybe nutrition sites would have more information for you.

    There are several smoothie products and soylent products that take care of nutritional needs for folks like you that don't want to think about food, cooking, or flavors.

    6 Replies
    1. re: sedimental

      Thanks for your reply sedimental.

      I understand i probably have different goals/outlook than most here in that I don't particularly look to food as an enjoyment, more of a necessity to ensure optimal health. I do have one "cheat meal" per week though, which I enjoy. I just prefer to have my meals/food completely organised and not having to think about it.

      I just make a big batch of food every 3 days, which contains most of the foods I mentioned above. The problem is, I've known that some of them are bad due to Pcb, oxalate, purine etc levels but I just can't find an optimum solution, which is extremely frustrating.

      I appreciate your ideas though and I will look into them. Perhaps you can give me a link or point me in the right direction as to where I can find out more about those smoothie/soylent products?

      Thanks again.

      1. re: paulk2

        I like whey protein shakes, hemp powder, and vegan protein shake powder for breakfast smoothies. Otherwise, I eat a huge variety of foods in my diet and don't worry about it. However, I love cooking and the taste of food.

        You might look into a primal diet or paleo diet (more ancestral by design) for eliminating processed foods. I use this site for a guide to more natural human eating guidelines:
        http://www.marksdailyapple.com/#axzz3...

        1. re: sedimental

          Thanks again for the information. Read up on Soylent as well as that was the first time I heard of it. What a beautiful idea! The creater of Soylent is a genius! The problem is, society hasn't latched onto it. Something like that should already have been created. A product that contains everything you need. The main problem I have is that it hasn't been through clinical trials and is not scientifically tested, which is a huge problem. I really like the idea though.

          Vegan protein shake powder is also interesting. I will look into that. Thanks again for your help.

        2. re: paulk2

          " I've known that some of them are bad due to Pcb, oxalate, purine etc levels but I just can't find an optimum solution, which is extremely frustrating."
          You might live another 70 or 100 years (or not) living and eating like this. And when you are 125 years old you will ask yourself," why?"
          Live in moderation, enjoy life, don't sweat the details.

        3. re: sedimental

          I had completely forgotten about Soylent Green. It's perfect, and people.

          1. re: jpc8015

            but people are never perfect.

            paulK2 - think about it this way, if you found one additive free food and ate nothing but that over and over, sooner or later you'd be deficient in something. I would suggest make what you like in a balanced manner, rotating things in and out, evaluating more on the positives than the negatives. sure you don't want some weird chemical building up deposits in your system, but a little this week, less next etc. gives you a variety of other nutrients that soylent alone can't do, besides, you're the one carting around that kidney and liver, make 'em earn their rent and do their job ("he's not heavy he's my liver"?) point being the ingestion of a few less-than-desirable elements are an acceptable trade-off for excellent sources of fiber/vitamins/minerals etc.

          1. re: chartreauxx

            I don't have much faith in dieticians but I may do it just to see what is said. along with a blood test to see where I am vitamin and mineral wise.

          2. You may want to skim this thread: http://chowhound.chow.com/topics/976051

            On CH, you will get more advice about the subtleties of quality of flavour than the recommended nutritional value of a daily diet.

            However, there is a Special Diets Board you could check, too. http://chowhound.chow.com/boards/90

            1 Reply
            1. re: Kris in Beijing

              Thanks for the thread and information. Very helpful!

            2. It isn't that hard. If you want to structure your approach, you could use the Food Guide Pyramid as a planning tool.

              http://www.cnpp.usda.gov/publications...

              I'm not saying the FGP is ideal, only that it's a useful guideline as a start.

              9 Replies
              1. re: GH1618

                Yeah, for turning waht used to be called adult onset diabetes into a pediatric disease in just one generation.

                1. re: mcf

                  You are assuming that the Pyramid had a significant effect on American eating habits. I haven't seen evidence of that.

                  1. re: paulj

                    I have. I don't make statements based on assumptions, as you just have.

                  2. re: mcf

                    I don't believe there is anything in the current USDA recommendations which encourages eating practices that lead to diabetes. They recommend against added sugars and refined starches.

                    I don't understand what the OP's problem is. He hasn't identified any specific need that is hard to meet. He just want's a healthy diet, isn't that right? Easy. Eliminate added sugar, or nearly so. Also excessive refined carbs. Include fiber. Eat your vegetables. Don't overeat. How hard is that? People who eat a balanced diet and don't overeat do well enough without the help of a dietician, don't they?

                        1. re: mcf

                          j/k of course...I just had to approach this thread with a closed mouth because but I knew what we were both thinking

                    1. re: GH1618

                      To be fair to the USDA - they've replaced the Pyramid with "My Plate" http://www.choosemyplate.gov/food-gro...

                    2. Welcome to chowhound. Can I respectively ask that you don't use the word "retarded" in that context? It is highly offensive.

                      Every human body requires different fuel to run efficiently. Genetics, daily habits, where you live, etc all contribute to what your diet needs to maintain a healthy body and lifestyle. A pro athlete has different needs than a sedentary person with a desk job. People living in the arctic have different dietary needs than those that live at the equator. A teenager has different needs than a senior citizen.

                      There is no perfect "meal plan" that would work for 100% of the population.

                      80 Replies
                      1. re: foodieX2

                        like i said above: hire a professional. OP is requesting medical advice in a way i think inappropriate, and is allegedly adhering to an extremely orthorexic, restrictive diet as is. furthermore, i second your complaint about the use of the word "retarded". i believe OP needs a medical professional, not a thread on an internet forum.

                        1. re: chartreauxx

                          Again, I have reservations about a dietician. Just because they have a medical background doesn't mean they know it all. I'm quite well versed on what each vitamin and mineral does and why it's necessary in the body and what foods you can get it from. I've got a science degree and studied food biotechnology. I understand a dietician would have a lot of knowledge on the subject but I would question whether I would take the dieticians word as gospel. Maybe it's something to try though. I'll think about it. It may be good to get more input from a professional.

                            1. re: paulk2

                              If you have reservations about a dietician - it's hard to understand why you'd find the internet reliable.

                              If you do go the dietician way, there's no reason to think you have to just schedule an appointment and show up. It's fair to say on the phone call, I'm looking for xyz specifically and want to discuss a meal plan under those guidelines. That way you can save yourself time/money by going to a professional who will be inappropriate for you.

                              1. re: paulk2

                                They have no medical nor metabolism and valid nutrition background. But they get lots of clinical guidelines from grain, sugar and beverage lobbies. https://www.google.com/webhp?sourceid...

                                1. re: mcf

                                  This is an incorrect correlation between the ADA as an organization and what individual dieticians (vs nutritionists) practice.

                                  As I mentioned before - research the dietician you seek out. Where were they educated, what is their specialty, what is their philosophy, etc. It's more similar to choosing a mental health professional than choosing a dentist where you can assume that most approaches for basic care will be the same.

                                  I wouldn't rely on the ADA as a lobbying entity at all. But there are a lot of lobbying entities related to the medical field that have been tainted by accepted donations. That doesn't mean all practitioners have "no background".

                                  1. re: cresyd

                                    Not in my experience, though there are isolated exceptions in every field.

                                    Those who do the vast majority of damage are those working with diabetics, in hospitals and nursing homes, where the dastardly guidelines have them bringing cereal, juice, toast and syrup to diabetics with amputations or kidney failure, Hospitals, niursing homes and assisted living facilities house a huge and growing segment of the vulnerable population.

                                    I don't care where a dietitian was educated, the guidelines are as crappy at prestigious schools as lesser ones. I care what they've read outside their training, like the few good ones I know.

                                    1. re: mcf

                                      Should you have had bad experience with dieticians related to diabetes and those guidelines - then that is one set of concerns. My experiences with the dietetics community have been different.

                                      Related to meal planning around weight loss/healthy living there aren't such rigid restrictions. If someone has blood test results of low iron, there aren't strict guidelines on what to recommend to increase iron levels. Similarly if one sees a dietician about how to lose weight, there's not one way on how to do it. That being said, most dieticians will have preferences/expertise in certain methods/diets/lifestyle changes. So it's definitely worth asking questions before booking an appointment with anyone.

                                      1. re: cresyd

                                        "If someone has blood test results of low iron, there aren't strict guidelines on what to recommend to increase iron levels."

                                        Hmm, that's interesting...

                                        1. re: fldhkybnva

                                          My point is just that if you show up with low iron or high cholesterol - there may are different ways to approach recommended treatment from a dietetics standpoint. Similarly from a physicians standpoint. Ideally it's a mix of working with the patient to best determine what best works.

                                          With something like "give me a meal plan" - in a vacuum a dietician can write something on paper, but without taking into consideration an individual's life, it's meaningless. What income level does a person/family have to spend on food? What hours is a person working and how does that impact cooking/meals? What is a person's skill level of cooking/access to a kitchen? What foods does someone refuse to eat? Etc.

                                          The OP clearly has a strong idea of what is wanted as part of a "good diet" and clearly has a strong personal diet philosophy. Finding a like minded dietician could be very beneficial. The key idea being "liked minded".

                                          1. re: cresyd

                                            Yes, I agree with you that each plan is individualized. If OP has the knowledge of what he does and doesn't want to eat it would seem that a meal plan would follow naturally without a dietician though.

                                            1. re: fldhkybnva

                                              The OP has a list of foods to be excluded and a limited list of foods that are included. A dietician may be able to think of more foods that are able to add to that list while still fitting within that idea or may have thoughts/ideas on how to access recipes or apply "recipe rehab" to recipes that are currently excluded.

                                              1. re: cresyd

                                                Actually, the OP does not have a list of foods to be excluded. He just seems to have a general fear of toxins. I expect that most of his fear is unwarranted. If the difficulty of finding something healthy to eat is due to a phobia rather than a paucity of healthy foods, the problem is within.

                                                1. re: GH1618

                                                  The inclusion of oxalates in that list of worries is good evidence of what you describe. If a person has a history of kidney stones (and a few other medical conditions) then a low oxalate diet is worth considering. But most people don't need to worry about eating spinach and rhubarb.

                                                  1. re: paulj

                                                    Even if one has a specific problem with oxalates, diagnosed by a medical doctor, the dietary adjustments advised don't seem difficult:

                                                    http://my.clevelandclinic.org/urology...

                                          2. re: fldhkybnva

                                            My husband's hemogloblin was low. It took three months to convince a medical professional to test his iron level. That was also low. They had no recommendation to fix this.

                                            I have researched and begun giving him something that will hopefully help.

                                            Next comes begging for the test to see if he is improving.

                                            The system is even more broken than it was a few years ago when I last tried to get medical treatment.

                                            1. re: sandylc

                                              «Next comes begging for the test to see if he is improving.»

                                              www.mymedlab.com

                                              No begging required.

                                              1. re: sandylc

                                                One doctor is not "the system." A primary care physician should be able to diagnose and treat iron-deficiency anemia. If his couldn't, perhaps another doctor could.

                                                1. re: GH1618

                                                  Mayo clinic doesn't think this is something to self diagnose and treat.
                                                  http://www.mayoclinic.org/diseases-co...

                                                  1. re: paulj

                                                    I agree. I'm opposed to self-diagnosis generally. No need to convince me.

                                                  2. re: GH1618

                                                    There were three separate medical practices involved. None were willing to take the lead.

                                                    I at least got email approval for the supplement I chose.

                                                    1. re: sandylc

                                                      If I had not diagnosed my own diabetes (I'd had kidney damage for many years and developed severe peripheral neuropathies), I'd be dead or limbless and on dialysis.

                                                      Decades later, I still have never had a diagnostic fasting glucose test, and my HbA1c at that time was still considered normal.

                                                      I reversed all that damage and maintain low normal glucose with diet alone, had to learn to give up my low fat, high carb diet for low carb, which was not my preference but it's saved my life with no meds for 16 years of nothing but improvements diabetes wise.

                                                      Everyone should self diagnose if they're suffering and not getting answers, and then do the research and networking it takes to find a doctor who will be interested in partnership, not dictatorship and drive by appts.

                                                      1. re: mcf

                                                        This is too long a story for this board (told it on Special Diets), but my H's Type2 diabetes was diagnosed while he was in the hospital for a stroke. In his forties. Not kidding. If I told you ( you in general, not you mcf) what he was served for breakfast while in bed, with the docs trying to control his BG...you would freakout. We both (H and I) learned the hard way

                                                        Unfortunately (or fortunately), he's been able to get off of insulin and and 2 other meds, and to have recently reduced dosages of 2 more (per the doc) because of his disciplined eating and the tips we learn on the SpecDiet board...not via consultation with any dietary specialist.

                                                        For me, the best resource was people who were living with the same condition as my H and NOT getting worse, but staying stable or getting better. That was inspiring. Then, it was a matter of "trust, but verify"...and the proof was in his meter and in his bloodwork.

                                                        Anyway, to the OPs point...
                                                        food choices should be a joy, not a burden. One of the great joys of changing our diet was experimenting with new, colorful, delicious veggies, fishes, etc. But on Chowhound, we tend to be more of a "live to eat" than "eat to live" bunch.

                                        2. re: mcf

                                          I went to one, eons back, and she cut a hunk of hair and then diagnosed I was low in so and so vitamins. I was having a lot of stomach problems then. I remember one biggie involved copper and while I followed her advice for awhile, I sort of healed myself instead, eventually.

                                        3. re: paulk2

                                          "Just because they have a medical background doesn't mean they know it all."

                                          they know more than this band of know-it-alls...

                                          1. re: hill food

                                            Most do not. All that's required is curiosity, reading and critical thinking skills to understand 100X better than most dietitians.

                                            OTOH, one of the brightest young people I've met earned the degree but eschews all the guidelines, since he reads real science and not sugar company handouts. He eats low carb, high fat.

                                            1. re: mcf

                                              this kind of dietitian is the *only* kind i worked with in eating disorder treatment. believe me, those people are not hawking lobby interests - they are actually saving lives, and i found the approach to generally be "moderation in everything". they also have to work more scientifically than your garden variety nutritionist because they're literally charged with balancing and tapering a diet to bring the human body out of starvation without causing life-threatening imbalances or triggering dangerous psychological episodes. i found all the dietitians i worked with (in the ED field, which is the only kind i know) to be excellent, very scientific, and very well-educated and thoughtful.

                                              1. re: chartreauxx

                                                Dieticians for eating disorders are different than for general diet counseling-different goals, different set of issues.

                                                1. re: fldhkybnva

                                                  agree, but it's the same degree. it's all in how a given practitioner applies it. there's no special training for ED dietitians, they are RDs like any other RD. many of them take outpatients, or move out of the specific field into general practice. i believe OP, especially since his current food list and list of concerns sound to me orthorexic (a type of eating disorder), might benefit in the extreme from such counseling.

                                                  1. re: chartreauxx

                                                    Same initial degree, but not likely given clinical responsibility for ED anyplace worthwhile without post grad training.

                                                    In any case, I'm glad you got what you needed, but sad that it is not what diabetics, heart patients or the general public are getting from consensus setting organizations or most dietitians.

                                                    1. re: mcf

                                                      i admit i find it extremely offensive that food lobbies are involved in sponsoring dietitians' conferences.

                                                      there's nothing stopping this individual from hiring one of the ED dietitians who takes outpatients. at a bare minimum, most do an intake evaluation to determine if they think you're a fit for their services.

                                                      1. re: mcf

                                                        I'm sorry that your experience with the dietetics profession has been poor. I'm not going to challenge that experience. I can counter with alternative positive experiences that I have had and those I know how have had. But that won't change someone else's bad experience.

                                                        But honestly, this perspective to me sounds no different than someone saying "I've had bad experiences with dermatologists/psychiatrists/dentists" - and then writing off the entire profession.

                                                        1. re: cresyd

                                                          You haven't read carefully; I have never put myself at the mercy of the food industry by seeing a dietitian.

                                                          I have read all their guidelines and literature and the related science for decades, nearly, though, and communicated with probably hundreds of those, many obese, most diabetics, who've been given terrible advice. I know what they insist on feeding institutionalized patients, including diabetics; all carbs, plenty of sugar and starch.

                                                          Not good policy.

                                                          1. re: mcf

                                                            Then with all due respect, I wonder if you actually know how the profession practices.

                                                            1. re: cresyd

                                                              Yes, I do. I also know what their training is (one relative, a few friends are RDs) and how they implement food policy is implemented institutionally.

                                                              And I read voraciously all the relevent scientific lit.

                                                              I think you have no idea, however, except for a very limited, specialty perspective.

                                                              1. re: mcf

                                                                I too have a relative who's an RD. I used to work as part of a hospital-based outpatient childhood obesity program (not as an RD). I have friends who are RDs with failure to thrive populations, those who undergo lap-band surgery, and eating disorders. The field of dietetics is wide - and I do consider myself to have an extremely limited perspective.

                                                                There are people who have read extensively about psychiatry and feel that field of practice is harmful. It's not a perspective I share.

                                                                However, whenever a professional association accepts money from entities that have a perceived conflict of interest (as the ADA has done in spades) - it is unfortunate and contributes to well-deserved public mistrust.

                                                                1. re: cresyd

                                                                  Especially when you see them serving juice, cereal, muffins and syrup to hospitalized diabetics, the only foods that raise glucose and that humans do not need. And when you find that when sugar was found to be no worse for diabetics than grains and their sponsors went into a tizzy at the news, they promoted inclusion of sugars (as no worse than grains!) instead of restriction of starches.

                                                                  Thw question is no whether dietetics or psychiatry is harmful, it's whether it's being taught and practiced to promote health or corporate profits.

                                                            2. re: mcf

                                                              A Certified Diabetes Educator would never advocate such a diet.

                                                                1. re: mcf

                                                                  Exactly, unfortunately.

                                                                  Last year, I was at a workshop for managing chronic illnesses, run by the local hospital. I do not have diabetes (at least at the moment) but a good part of the discussions were on that, and on nutrition and healthy eating, there was a lot of focus and encouragement on the low fat, low sugar, high carb approach to eating, even by the facilitators who are nurses.

                                                                  I felt like a minority there, and did not feel comfortable speaking up about my disagreement. I wish I had the credentials to be able to tell them to try a different kind of diet to see if it helps them, but alas, I don't.

                                                                  1. re: vil

                                                                    " there was a lot of focus and encouragement on the low fat, low sugar, high carb approach to eating, even by the facilitators who are nurses."

                                                                    I am not into paleo or adkins I have no problems with wheat or gluten or any other food type but the low-fat high-carb diet has to be laid to rest - unfortunately it has been so deeply ingrained and institutionalized it will be hard to get rid of - it is a terrible diet, terrible for health and worse for taste - sad for the people who's lives have been spent eating snackwells, lean cuisines and cheerios.

                                                                    1. re: JTPhilly

                                                                      I think even sadder for those suffering blindness, amputations and dialysis for diabetic complications easily avoided by doing the opposite.

                                                                    2. re: vil

                                                                      45 grams of carbs per meal is their baseline.

                                                          2. re: chartreauxx

                                                            Actually the iaedp does offer certified eating disorder specialist credentialing (including CEDRD), but I think only one RD I've ever worked with for an ED had that special certification.

                                                      2. re: mcf

                                                        MCF: perhaps, but a lot of us on CH are just dilettantes with highly verbal opinions.

                                                        like - are you REALLY going to wear those socks today? oh we have opinions, just not always backed up by empirical data,

                                                        1. re: hill food

                                                          I certainly don't recommend that anyone follow advice they find on the internet from me or from a doctor, either, before doing their own due diligence and researh, at least as much as you would before buying a car or fridge.

                                                          Much of the worst damage and negligence I've encountered medically has come at the hands of dept chiefs in very prestigious academic facilities.

                                                          I think everyone should research assiduously before following any prescriptive advice in order to avoid medical injury. Those who don't won't even know when it's happening to them otherwise.

                                                          1. re: mcf

                                                            There's a huge difference between a medical doctor and a car salesman. If your experience with doctors has been so bad that you can't tell the difference, you can't have shopped around much.

                                                            Being informed is a good thing, but the inclination of many to delve into self-diagnosis and self-treatment is the bane of the medical profession today.

                                                            1. re: GH1618

                                                              Not my personal experience alone. I spent many years working in the human services field, developing and operating med and psych case management programs.

                                                              if you want to be blissfully less informed of how things work, cling to it.

                                                              Every doctor I know socially or by family ties will tell you what a Harvard research and numerous med journal publishers have opined: drug companies own medicine.

                                                              In the same way junk food companies own dietetics and the pyramid.

                                                              1. re: mcf

                                                                You'd probably like our latest dietician. She recommends buttered coffee--coffee, butter and coconut oil. Big proponent of grass fed beef. I've yet to meet her but just read her blog. Interesting change.

                                                                1. re: chowser

                                                                  Bulletproof coffee, stuff of gods!

                                                                  1. re: fldhkybnva

                                                                    I have to say the thought turns my stomach but I don't even like cream in my coffee, just milk. Maybe add some rum...

                                                                    1. re: chowser

                                                                      I don't actually drink it, SO does. I've tasted it and it's fine but I like coffee black. I save the butter and coconut oil for food :)

                                                                  2. re: chowser

                                                                    Not MY coffee, LOL. :-) But I only buy grass fed beef, heritage pork and I use some coconut oil, but I love dairy too much to be paleo.

                                                                2. re: GH1618

                                                                  I have been permanently damaged by every encounter I've had with "specialists". They have been uninterested in encouraging health and often not interested in a diagnosis. They have had no interest in my diet, even when my problems were digestive. They only wanted to "try this drug". They were all top physicians in my area.

                                                                  Yes, they are clearly owned by the drug companies, and additionally are not allowed to act outside of the "here, try this drug" arena.

                                                                  1. re: sandylc

                                                                    http://www.nytimes.com/2009/03/03/bus...

                                                                    http://www.bostonmagazine.com/2009/10...

                                                                    http://www.jsonline.com/news/health/d...

                                                                    "At the end of the day, the drug companies own medicine," said Eric Campbell, an associate professor at Harvard Medical School who has researched conflicts of interest in treatment guidelines. "We've created a system that allows this."

                                                                    1. re: sandylc

                                                                      It’s not just the drug companies which have had an impact on patient care.

                                                                      Many physicians are afraid to vary from what the 'standard of care' is in their area, from fears of a malpractice suit. So they follow treatment protocols, many of them developed by HMOs to ration care.

                                                                      The days when doctors looked for an alternate way to investigate or treat a patient's illness is long gone for most, I’m afraid.

                                                                      1. re: RelishPDX

                                                                        The very idea of making a patient healthy is not allowed in our current system.

                                                                        Yes, the health insurance companies dictate care and they hold the purse strings.

                                                                        Doctors can't win, really. And patients pay for it.

                                                                        1. re: sandylc

                                                                          That's one reason why I posted the name of a third-party lab in another post, where you can order your own diagnostic tests.

                                                                          For instance, my doctor relies on TSH to Rx thyroid meds. But TSH doesn't measure how much thyroid is actually circulating in my bloodstream, it's a pituitary gland hormone.

                                                                          So I go to a lab independently to order my own suite of tests which does measure what my actual thyroid levels are, so I'm a more fully aware and informed patient when it comes time to talk about adjusting my meds.

                                                                          There's a danger in that though, doctors will often bring up trust issues if you tell them you've done that, asking why you don't trust in their ability to diagnose and treat you. So I keep that information close to my chest.

                                                                          It's all a delicate balancing act. Sometimes I've had to pay for tests twice, once at the third-party lab, then a second time when I gently ask the doctor if it might be a good idea to check whatever, so he can see an abnormal reading come back from his own lab.

                                                                          1. re: RelishPDX

                                                                            If your doctor measures thyroid conditions by TSH, you *should* have trust issues!

                                                                            1. re: mcf

                                                                              Most doctors don't look at it that way, though. They are taught that TSH is the gold standard test, and nothing else is necessary.

                                                                              It goes back to not deviating from the 'standard of care'. If that's what everyone else is doing, and what the protocols say to do, then that's what they'll do.

                                                                              1. re: RelishPDX

                                                                                I don't do this much, but as a doctor I'd like to just clarify that at least at the med school I went to we were not taught that "TSH is the gold standard test and nothing else is necessary."

                                                                                I usually sit back and watch these discussions because I'd rather not be involved but I have to say something when a statement is just false.

                                                                                1. re: fldhkybnva

                                                                                  «I have to say something when a statement is just false.»

                                                                                  I can only tell you what I've been told and observed as a patient. The first endocrinologist I was finally referred to, and saw for over a year and a half, who lectures at the teaching university here, never once took anything other than TSH, B-12, and adrenal function tests.

                                                                                  Anything else he dismissed as a waste of medical resources, and claimed would only confuse the issue.

                                                                                  I've also never had any other doctor—GP, internist, or specialist—order anything else other than TSH, unless I've backed them into a corner over how I've reacted to their dosing of thyroid meds.

                                                                                  1. re: RelishPDX

                                                                                    No I understand that and I'm definitely not challenging your own personal experience. I cringe at these stories including the one above about a doctor failing to check iron in a patient with anemia. I can only say that this level of inadequate care is not the norm at least where I work and fortunately many of you have empowered yourselves to get better care.

                                                                                  2. re: fldhkybnva

                                                                                    It's what pretty much every general practice doc relies on, though. They learned it somewhere, because most of them are doing it.

                                                                                    1. re: mcf

                                                                                      There is a lot of apathy and failure to continue educating oneself in the medical field, I suspect.

                                                                                      1. re: sandylc

                                                                                        No billing code for it. And censure from peers and insurers if you don't fall in line.

                                                                                    2. re: fldhkybnva

                                                                                      So, as a doctor, do you consider yourself to be on the problem side or the solution side? Or do you not see the problem? Just curious...

                                                                                      1. re: sandylc

                                                                                        Excuse me. I'd like to not be on the problem side of anything. As a pathologist, I'm not really in the game as much as other doctors but I also spend most of my free time reading the literature about many different specialties which is more than I can say for most doctors I know. I see the problem which is why even with my own health I don't trust my own doctor. I wouldn't trust even my own colleagues. I present new information to them and they turn away because they don't care to learn or synthesize new information. I read the literature and make my own decisions. I wouldn't trust a dietician with anything regarding my health without reading about it myself. I don't trust my own doctor to check my lab results. I check them and then I inform her. Most of the time she's shocked as she completely forgot about it and then forgets to tell me what to do about any abnormal results. I had to read the literature and figure out the best treatment regimen for vitamin D deficiency because she dropped the ball. I see the problem in medicine, I see the problem in food and it all frustrates me and why I spend so much time reading and educating myself. We all deserve better and unfortunately decisions of the past few decades have put us in this situation we now face. Others are OK to deal with it and live in the current infrastructure, I'm hoping for it to change and would love to be a part of that change.

                                                                                        1. re: fldhkybnva

                                                                                          Wow, your statements are very powerful. Thank you.

                                                                                          1. re: fldhkybnva

                                                                                            Thank you for honestly sharing that, and coming from a medical professional, it speaks volumes.

                                                                                            I notice that some of the doctors that I have a lot of respect for are starting to get involved in teaching, instead of just practising. I tend to think that it is their way of making changes, even just a bit at a time, towards the direction that they envision in the medical system.

                                                                                            I also came across this brain surgeon turned "health educator" who runs this website, sharing his insight and vision about optimal self care. Somewhere he expresses his disagreement with what he had been professionally trained for, and what he thinks makes more sense. It is a commercial website but with tons of free advice (and some radical ideas), including nutrition and food: http://jackkruse.com/

                                                                                            I just thought that the Internet is perhaps a good platform, for now, for health professionals who want to see and make changes, by offering material that can educate others.

                                                                                      2. re: RelishPDX

                                                                                        Yes, I know. I traveled from metro NY to LA to see a genuine, skillful endocrine specialist. TSH is low in folks with pituitary disease no matter what their thyroid is doing, and it can be high no matter what, too, given the right conditions.

                                                                                        1. re: RelishPDX

                                                                                          Between the years 2000 and 2008, I must have come across some 10 or more doctors, some from walk-in clinics, during my on-and-off desperate search for one who would be willing to order the needed tests, to give me a proper diagnosis after a complete thyroid gland removal through RAI. They all only gave me the TSH and maybe the T4 tests, said that I was "fine" despite my self report that something was obviously and terribly wrong. My ex-family doctor, whom I had trusted for years, even told me to simply do more exercise if I didn't find my mind working the same way at all as before.

                                                                                          In 2008, I was finally eligible to see an endocrinologist because I got pregnant. She seemed to be ahead in her field, because she simply ordered the T3 test, then announced to me that my body could not convert the T4 to T3 from the meds.

                                                                              2. re: mcf

                                                                                I agree though this is not always wise advice and assumes a certain level of ability to understand, comprehend and synthesize the information which many are unable to do.

                                                                                1. re: fldhkybnva

                                                                                  That's what the corporations writing health and nutrition guidelines are counting on. :-/ I agree.

                                                                    2. re: foodieX2

                                                                      I'm afraid I'm going to stand by my comment that the idea that humanity hasn't figured out the optimal diet for people is retarded.

                                                                      Yes people have different genetic profiles but lets talk about the western world, America, Europe, the UK. We all need similar nutrients and macros. The fact that a general outline of a meal by meal diet hasn't been optimized is completely retarded. I feel like I should have been given this information at the age of 15, rather than having to trawl around the internet reading studies and trying to figure it all out. Completely retarded.

                                                                      1. re: paulk2

                                                                        We don't have a defined "optimal" diet because people don't want an optimal diet. They want a diet that is varied and tasty, and sufficient for good health (those that care about health, anyway).

                                                                        1. re: paulk2

                                                                          There *is* an optimal diet. But people don't want to change. I already recommended the book Whole (linked above), which talks a lot about why people and the government don't know about this optimal diet, even though science has already found it. I also recommend Rethink Food (http://www.amazon.com/gp/aw/d/0991358...) and The China Study (http://www.amazon.com/gp/aw/d/1932100...).

                                                                          I have nothing to do with any of these books. I'm not trying to sell them or anything. I just think that your question is a lot more complex than can be answered in a few forum posts, and should come from the doctors who research and write books, not random strangers. If you're really interested, read some of these.

                                                                          1. re: paulk2

                                                                            Wow, that's about all I can say. I rarely post on these kinds of threads but I can't help myself. You clearly know nothing about the history of nutrition or nutritional research in this country.