Conventional MDs: A thorn in our collective sides

This post is by my mother, a private practice RD in Randolph, New Jersey. You can find out more about her nutrition counseling by visiting her website: Reinvent Your Diet.

I will apologize in advance if you are one of the MDs who study the science before they dispense nutrition advice to their patients.  But this morning I was mad, really mad.  Mad enough to feel like giving up on my mission to reach the mainstream adults and their children who desperately need better nutrition advice.

In my state’s health care system, an MD can pull rank on an RD on just about anything – and that includes being an “authority” on nutrition.  This is somewhat common, despite their lack of training beyond a few hours of nutrition that most medical students receive.  Compare that to my several thousands of hours spent in undergraduate and graduate level classes, a 10-month internship, multiple conferences, seminars, webinars, regular reading of articles and books, conversations with peers, and conversations with experts in the ever-evolving field of nutritional science, medicine, and practice.  But then, I am just a lowly RD, so what could I really know?

Do not arouse the wrath of the great and powerful Oz!

Case in point: today I received an email from the mother of a 6 year old girl who I am seeing for chronic constipation.  The mother’s goal is to wean her daughter off Miralax which she has been dependent on since the age of 2; even though the child’s gastroenterologist feels this is not a concern.  My recommendations included a higher fat,  more adequate protein diet, emphasizing natural fats and including some dairy fat.  (Mother had already tried a dairy-free diet without results, but we may have to try this again).  I also asked the mother to restrict all wheat products for 4 weeks until our next session, substituting potatoes, sweet potatoes, and some rice/rice pasta for the grain group.  This is without knowing if this young girl had been tested for celiac disease or not.  Note – the young girl is very thin for her age and I suspect some sort of malabsorption or gut dysfunction.  I also gave her a good probiotic.

Anyway, the mother spoke with the MD after our initial session, and confirmed that her daughter had tested negative for celiac.  Furthermore, the MD did not think it was necessary to restrict gluten/grains/wheat, and besides, the mother noticed no difference in daughter after one week on wheat-free diet.  She added lightheartedly that they “missed pizza” and was “glad not to have to do this anymore.”  As expected, the MD also disagreed with my higher fat diet recommendations, but the mother was okay with a higher fat diet.  In fact, she purchased a Nourishing Traditions Cookbook per my advice and had already visited our local artisanal cheese shop to find good full-fat cheese.

“Get the f*#% out of my office!”

So in the wisdom of Robb Wolf, should I fire this client?

My daughter Laura (this blog owner) said I should just tell her that I can’t work them anymore if the mother does not want to follow my advice.  This is just one of numerous examples of MDs telling their patients that I am not giving them accurate advice, often despite obvious improvements in their health, weight, and lab results.  I have had a few clients leave my practice because their MDs advised them to do so.

I am not sure if it is worth the aggravation any more.  I had great plans to really make a difference – and I know that for the majority of my clients I do make a difference.  But my hope was to work with children, young women, and pregnant women pretty much exclusively in the future, and this is not the first pediatrician/MD that discouraged my clients from following my advice.  My head knows that I should hang in there, as I remember learning the broader nutritional truth when my kids were in their young teens - I was both mad and grateful at the same time.  But the fact is, I don’t know if I care as much anymore. Maybe we can only really reach the people who are truly seeking this information, and clearly not everyone is ready for this. For me even taking insurance is a big hassle.  I am so back and forth on this as I know many young families rely on insurance benefits to pay for healthcare services, and many would not come to me if I did not take insurance.  Sorry to whine, but I am somewhat discouraged that a practice model like mine is an unrealistic goal in our current healthcare system.

Does anyone else have a story like this to share? Any words of encouragement for my mom?

  • Tara

    No words of wisdom other than I would sign up with her and follow her advice if I lived anywhere near there!

  • Allison

    This is such a difficult situation, but if the client wants to choose the MD’s “advice” over yours’, then there is not much point in continuing. She may return later, so it would be best to leave the door open somehow but advise that she needs to make a decision about whose advice to take and then try it. It’s really sad that this lady can’t get beyond the “inconvenience” of going without wheat products for one lousy week. That’s really sad.

    I’m training to be a nutritionist myself and am already steeling myself for these difficult situations where the practitioner has to learn to let go to some extent. All you can do is live truthfully and be honest with clients, if they choose to follow your advice that’s great, but ultimately, everyone has their own autonomy and is responsible for their own choices. It’s a tough realisation to make. If people really cared about their health and that of their loved ones, would they really be so concerned about going without wheat for a week? That’s what it comes down to – motivation. How motivated people are to safeguard their health or fix a significant existing problem. I am highly motivated myself and have learnt to separate my emotions about comfort foods from the task at hand of fixing my health – unfortunately other people are still stuck in that emotive grip of food.

    • http://www.reinventyourdiet.com Pam Schoenfeld

      I agree that motivation is important, but belief must precede motivation. If the MD had supported my recommendation, I think the mother would have gone along with it for at least enough time to really see if wheat and grain avoidance made a difference. Thanks for your insights.

  • http://www.balancedbites.com Diane @ Balanced Bites

    Pam-

    I am lucky that most of my clients are truly seeking the advice I give them when they come to me- perhaps it’s a benefit of not taking insurance and not being an RD. To a degree, I don’t face the same issues, but then again, of course we ALL to in some way.

    I think that the best you can do is explain to the client why you’ve recommended what you have, remind her about how well the MDs advice has (not) worked in the past, and then let her know you are/will be available for her if she decides to come back in the future. An open door for help later without any hard feelings is always helpful. Often they’re just NOT READY for what you have to say, but eventually they almost always realize what they’re doing isn’t working, and that you were probably right.

    I’ve had people come back who I didn’t expect would, but I always handle them with kindness and grace. Remember that not everyone is ready for your vast wealth of knowledge, but the ones who are will be helped a ton.

    Keep trucking.
    Diane

    • http://www.reinventyourdiet.com Pam Schoenfeld

      You have worked hard to create a reputation that brings people to you Diane, insurance accepted or not. That is a great thing. I am glad to some extent to take insurance, as I do see many young families who I doubt really can afford to self-pay. It is a hassle, but it has helped me grow my business and provide a service that the rest of the insurance/medical system rarely offers.

      I think this mother really did want my advice, but when it came down to putting it into practice, it became somewhat more difficult as we often experience. I will see her and her daughter again, as I think there is still more I can offer. I think reminding the mother of the lack of success up to this point following the doctor’s advice is a really good idea. Being non-judgmental is super important too.

      Thanks for taking the time to give me your input, it was most appreciated!!

  • Roz

    I could only hope to have encountered your mother on my journey to health.

    In Dec 2010 I went to see my PCP because I’d been feeling light headed and mentally off-kilter. I thought it was most likely stress related (having to administer CPR on one’s husband until paramedics arrive does tend to have quite the negative impact, but that’s a whole other story). She did some bloodwork and my h1AC was borderline at 5.8 and I was quite anemic. She referred me to a nutritionist.

    The nutritionist? Yeah, poster child for conventional wisdom. Low-fat, low-calorie, eat 30-45 carbs with every meal, and 15-30 per snack twice a day. I asked about low-glycemic foods, and she said there was no real evidence supporting it. She never made any distinction between rice, sugar, wheat products, sweet potatoes, carrots, peas, milk, yogurt. She also tried to explain my insulin resistance was caused by fat blocking my insulin receptors. Even the most cursory study on diabetes and pre-diabetes via Google had given me enough info to want to slap her silly. I listened very politely, took her hand-outs, and never went back. I hadn’t yet heard of Paleo, but I already knew from the low fat craze of the 90s that decreasing fat consumption makes me gain weight and go hormonally bat-shit crazy. There had to be a better way.

    Enter lots of research. I’d hit upon a couple of books the theme of which was some variant on curing diabetes with a low-starch diet. Only most were heavy on franken-foods to make substitutions (vanilla whey powder for flour in pancakes? EWWWW). I kept on looking. By Feb 2011 I had watched Sugar: The Bitter Truth. Lustig threw out this little gem that Paleo cures diabetes. More research. I was scared to make the switch — it was a whole different approach to meal planning; the SAD seems to revolve around a centerpiece of nutrient poor starch and I felt ill-equipped to make the shift to meats and vegetables only. I don’t even like most vegetables, particularly greens. But I had already convinced myself if I didn’t do something I would wind up going blind, giving myself shots, having a foot amputated and dying of a heart attack (those books on diabetes were TERRIFYING).

    6 months after taking the Paleo plunge, my h1ac was under 5 and I was pronounced ‘cured’ by my doctor. Cured would imply I could go back to my old ways, but I know I can’t. On the other hand, carb restriction came close to wrecking my thyroid — I was always cold and lethargic after having been Paleo for 9 months. I’m still trying to find out what works for me, but unfortunately while my PCP tried to hook me up with a nutritionist, it was a complete flop for me. Which ties back into my first sentence: I could only have hoped to have encountered your mother, or someone like her. It would have saved me a lot of frustration.

    • http://www.reinventyourdiet.com Pam Schoenfeld

      Good for you to keep searching for answers that worked. I was quite interested to hear about your experience with very low carbing – this is a problem I have seen in a few people in my practice. Not easy to handle this situation – how to add back in carbs without negatively affecting blood sugar control. Chris Masterjohn’s talk at the AHS 2012 did show that humans are generally carb-adapted, but with the SAD things do go awry, and I am not sure when they do that we can ever reverse the metabolic problems completely. I feel for you as I was lucky enough to learn about my misled eating habits over a dozen years ago. That was thanks to the Weston A Price Foundation, and I shall always be grateful for that.

  • Michelle M

    It is a shame when a highly paid professional such as a doctor cannot admit they don’t know enough about nutrition to give useful advise to their patients, and will in fact contradict information and advice from someone who does. To push medication on a child for a gastro-intestinal problem and not properly address the child’s diet is just not right. My sympathies to Mom, I can see how frustrating this must be for her!

  • http://www.mytruehealthrd.com Andrea

    Thank you for posting this. I am a private practice RD in Omaha, NE and face the same struggles, butting heads with MDs or being told my advice is wrong. I battle the same question of only being open to those who are on the same page and seeking answers or trying to stand strong to convince “mainstream” doctors to trust my advice. Unfortunately, it’s not that easy and like you said with only a couple hours of nutrition, many just aren’t open to what has been revealed in nutrition research. This is my first year with my own business, so as of now, I really don’t work with many doctors, but, like you, I would love to have a large impact and make a difference. I am open to suggestions or ideas of what other RDs or nutrition professionals have done to fight this uphill battle with MD’s.

    • http://www.reinventyourdiet.com Pam Schoenfeld

      One thing I do for my adult patients is provide links to really good science directed to the layperson. I have also used the movie Fathead to get people to begin to question the current USDA paradigm, it is really entertaining and gets the point across. Peter Attia has a great presentation – check out the Ancestral Health Weight Loss registry or his website which I think is http://www.theeatingacademy.com. There are also great articles like the Hoenselar article published I think last year in the journal Nutrition. The editor of Nutrition, Michael Meguid MD PhD, supports the work of those who are challanging the mainstream thinking. I also point them to great books like The Perfect Health Diet by Paul Jaminet. Finally, articles by Chris Masterjohn at the WAPF website are great as well. I love the one he wrote on Vitamins for Fetal Development. Good luck with your practice. If you do what is right, you will be successful. Just don’t cast your pearls before swine.

  • Dr. Shauna Young

    You just described my day to day life! A “lowly RD”? Try being a lowly Naturopath! I do nothing but study how natural substances work in the body, and I have a PhD in Natural Sciences, but one word out of an MD’s mouth (especially the Great and Powerful Oz) and BOOM!! I have a diet that has been reversing Autism for SEVEN YEARS and because I’m not an MD….

    All I can say to your Mom is, it’s okay if some days you just want to throw in the towel and quit. Don’t worry… you won’t!

    • http://www.reinventyourdiet.com Pam Schoenfeld

      You right – I am not ready to retire yet. Hang in there yourself!

  • Josh

    In answer to the big question (Should I fire my client?):

    It depends on the initial expectations that were voiced during your first meeting. You can never assume just because you are the authority as a specialist, that your client will follow your advice. If you set the expectation that you do not work with people that ignore your advice, then fire her. If you didn’t then give her a stern warning that she is on thin ice.

    I would try this with future clients:
    1) Make sure that they understand that you are the specialist, and that in order to have a healthy working relationship, they must respect your authority on the subject. A generalist such as an MD cannot pull rank on you due to your concentration. If your prospective client isn’t okay with that, then part ways before anything even begins.
    2) Encourage your clients to ask questions. Encourage them to learn. Discourage them to question your correctness because “I heard it on the news” etc. Your client has come to you because you are the specialist. They have to accept that your knowledge is what they pay you for. If they don’t want to partake in what you’re willing to share, then they can go waste somebody else’s time.
    3) Explain everything. Your role is not only that of a problem solver, but that of a teacher, as well. The goal of any RD, nutrition consultant, personal trainer, etc. should be to create independent clients. You should always seek to teach people to fish, not to give them fish.
    4) Watch them thrive

    • http://www.reinventyourdiet.com Pam Schoenfeld

      All good advice, and I think I do most of these things, or at least try to. Doesn’t hurt getting a refresher course though!

  • http://lauraoliva-writinginthenight.blogspot.com Laura

    Take heart, Mom! As someone who started investigating Primal/Paleo/WAP nutrition when I was pregnant, and now as a new mom who is raising my son on those principals, I WISH there were more “lowly RD”s out there who had the balls to give me the information I need, rather than the tired, recycled lines that are passed off as “conventional wisdom”.

    I can only imagine how frustrating it must be to be in your position, since this is obviously something very close to you. But people need to know this stuff! And it’s precisely because of nutritional renegades like you that I was able to educate myself and take my family down a (not conventional-medically supported) road to vibrant health.

    I may not be one of your clients, but I have benefited from people like you, as have my husband and my baby son. Thank you for doing what you do, even when it seems like a thankless, futile job!

    • http://www.reinventyourdiet.com Pam Schoenfeld

      You know, I just had a young family in my office today and the mom was pregnant with her second child. Both parents were really appreciative of my advice just like you were when you learned from your renegades. There is absolutely nothing more gratifying than this and stories like yours. Thank you for taking the time to respond.

  • http://mary-sews.blogspot.com/ Mary in FL

    Some people are stuck in a rut. In this case it was the “doctor knows best” rut. I agree with Diane to use kindness and grace with this un-client.

    I knew of someone who only did what the doctor said, while many people offered to pay for her to go to alternative practitioners who – I’m fairly certain – could have helped her greatly. It’s very sad to see people who are stuck in that rut.

  • Mike F

    Something that helps me keep things in perspective is the old saying “When the student is ready the teacher will appear.”

  • Rick G

    I live right around the corner from your office. We must meet!!

    • http://www.reinventyourdiet.com Pam Schoenfeld

      Where do you live – what town? What do you do? Love to hear.

      • Rick G

        Ironia. I’ll contact you soon.

  • http://amandamodeen.blogspot.com Amanda

    I really hope you do not give up! I really feel that what you are doing will make a difference. Making yourself accessible to that population is how you will make that difference. I have no idea how difficult your situation is but it is really an inspiration to someone that is in school studying dietetics. Good luck and I hope things work out!

    • http://www.reinventyourdiet.com Pam Schoenfeld

      Thank you and good luck with your studies. I only finished my dietetic internship in 2009 and already I have a fairly profitable private practice. Just need to forge more relationships with like-minded ediatricians – many of them are very wary of our type of nutrition. But my goal is to work with children and I think with everyone’s encouragement, I will persevere. Thanks to everyone for your support!!!!

  • http://paleoosteo.com Dr Josh Lamaro

    hey there
    this is a real shame, but something I, as an osteopath, encounter almost weekly; a disagreement between doctor (MD) and our holistic approach.
    in my experience the best thing to do is state what your opinion on these issues is, state your experience with the matters at hand, and leave the rest up to the client.
    It is not worth banging your head against the wall to find the solutions THEY want to hear.
    Health is a choice for some, and if they choose to try and emulate it through medicating then I feel bad for them. Better health is only a footstep away but at the end of the day they need to be held responsible.
    My colleague Mark would say “perhaps they havent suffered enough yet”

    • http://www.reinventyourdiet.com Pam Schoenfeld

      Experience is really helpful to build confidence in one’s recommendations. Unfortunately, I have just recently started working with more children and therefore am often relying on what I have learned from other professionals and publications I read. Not that this is bad, but my level of confidence is not quite where I would like it to be as of yet. But one thing I do know is that the pediatric RDs I trained with were stuck in the 1980s, as are many of my patient’s pediatricians who believe low-fat diets are appropriate for children. So I feel I am a resource that is sorely needed in our community. Thanks for your feedback.

  • http://www.my-food-coach.com Daphne

    I have some of the same issues as an RD in a private practice. I will often preface the “I will run this by my doctor before I make any changes” by telling them that their doctor will often not agree with my advice because they are trained to treat ailments and illnesses with medication, not nutrition. In the end, I agree with Mike F, when she is ready you can be available to her.

    • http://www.reinventyourdiet.com Pam Schoenfeld

      Thanks for sharing your experience. I often say something similar to my clients, such as your doctor may not agree but I am giving you the most up-to-date information we have. Nice to have a forum to share these experiences, I don’t feel so alone anymore.

  • Kris

    In my job, I work with a number of new moms. It never ceases to amaze me the things pediatricians will say to them, including non-medical advice for which they have no more training than the random parent on the street. If you want to really get frustrated, be a breastfeeding advocate and talk to folks about what their peds have told them. I’ve heard everything from, “Stop breastfeeding when they can ask for it,” (um, they come out asking for it … that’s how the species survived!) to “well, my wife used formula and she got over it” (now, that’s evidence-based!)

    I am blessed to have to ped who will clarify whether she is giving medical advice or parenting advice, and she understands that her training is in the former, not the latter. (She is a mom, so I listen to her parenting advice like I would that of a friend.)

    But I’ve given a lot of thought as to why moms will take what their MDs say so seriously, even when it flies in the face of their intuition or, in your case, the advice of another more qualified professional. I think it’s fear. Parenting is scary and we feel like if we just do what the “doctor” says, our kids will be fine. It’s a false sense of security and it’s an attitude that I think has caused more harm than good, but I do think it persists. The only way I know to counter it is to train docs to know what their limitations are … to understand the scope of their practice. And that’s not going to happen overnight, if ever.

    • http://www.reinventyourdiet.com Pam Schoenfeld

      Fear is probably one of the most powerful of emotions, and I don’t fault the mom for wanting to feel secure in her decisions. Doctors are probably trained to speak as authorities on whatever they say, so I guess I should just learn to deal with it. I probably care too much and I need to learn to keep a little more distance.

  • Wendy

    How did the client come to you, Pam? Did she find you on her own (perhaps on the recommendation of a friend?), or did her doctor refer her to you by name? Did her doctor even know the woman was bringing her daughter to see you? Most GP’s and pediatricians have patients who explore things other than conventional medicine in their pursuit of resolution of health problems, and it’s simply not possible for physicians to know everything about everything out there, or even for them to know enough about some things to recognize how much they don’t know.

    Do you know this woman’s daughter’s doctor? If not, could you forge a professional relationship with him/her, to achieve a mutual understanding and greater benefits to the patients you both see? Perhaps not one-on-one, but through your respective professional associations, colleges, etc. I work in Primary Care, and continuing and supported GP education is something we do a lot of, in the interest of improved physician practice efficiency for physicians and medical office assistants, and improved access and service for patients. It’s made a huge difference, especially to our patients with chronic diseases. (Though, full disclosure, very few people are yet teaching anything other than low-fat, high-fiber, healthy-whole-grains in terms of nutrition.)

    I totally get your frustration. I’d understand if you gave up, but I hope you don’t.

    • http://www.reinventyourdiet.com Pam Schoenfeld

      Great advice. My overall plan is to visit the pediatricians of my patients as I begin to see good outcomes. I have had good outcomes with my teenage patients, but still a bit early to tell about my toddlers and grade-school patients. I think once I have more experience, it will be time to work on forging relationships. I just need few more successful cases under my belt.

  • Lin in PA

    Vibrancy oozes from the photo accompanying this blog post and gives evidence of great success in nutritional density.

    I applaud your dedication to making a difference in the lives of others. So it was painful to read at the end of your article,”I am somewhat discouraged that a practice model like mine is an unrealistic goal in our current healthcare system.” But please remember that even amongst MDs themselves, this undermining of fellow professionals is commonplace.

    Example, my esteemed surgeon of 10 years suggested that I get a second opinion from an ‘expert’ at Johns Hopkins to see if she had any better ideas than he did. She recommended a drastic (draconian, in my opinion) procedure. She wanted to dissect my trachea. His response was, NO WAY! Which, of course, resonated with me! I was relieved not to argue with him about it because I had already decided against it.

    My point… please be encouraged that MDs (even within the same discipline) disagree among themselves and are not hesitant to tell patients this. It is business-as-usual, in my experience.

    Patients who discourage you also choose the path of least resistance in many areas of their lives, not only in their pursuit of health. It’s in their DNA to take the easy, comfortable route and not to think too assertively on their own. The good news – DNA can be changed. The bad news – it’s a long process. We who are on that path need to be surrounded by good philosophies like yours! Please be patient with us while we process. Please don’t give up! Many of us will get there with your help.

    • http://www.reinventyourdiet.com Pam Schoenfeld

      Interesting about the MDs disagreeing amongst themselves which I kind of knew anyway. I must admit, I sometimes wish I was an MD, but in reality, I think what I am doing is really the best match for me. I don’t have the powers to diagnose, test, or prescribe like an MD, which sometimes hinders my effectiveness. But I am paid by my time, so I really get to know patients and it is interesting how one can figure out a lot just by asking patients questions. But that takes time and MDs are generally paid by procedure, not time. So in that way I have a distinct advantage and am grateful for that.

  • Dara

    I will echo “don’t give up”! One of the keys is to work with people who are fed up with MDs telling them to do things that don’t work. Until they get to this point, most people aren’t ready to break with the institutional/conventional authority figures. Unfortunately, many people will never believe their MDs aren’t gods and don’t know everything – and these people will remain unnecessarily sick. I dare say this category of patients is not your target audience (I’m a marketing professional so often speak like this).

    Since this approach is outside the mainstream, some targeting will be needed to connect with people who are ripe for what you have to offer.

    I just found your blog tonight (from the Weston A Price FB feed) so don’t know much about you yet, but if you can get referrals from a more unconventional/alternative type doctor, more open minded people can find you and you can make a real difference with people who are ready to try a new approach. Gyms or intense training programs could be another place to find people who are willing to try nutrient-dense eating. Or, you might contact local farms who sell direct to consumers, and give your info to them to pass onto their customers.

    This is how I found my incredible nutritionist who is a proponent of nutrient-dense eating and now has me off all grains, dairy, soy and sugar (well, almost!). I am one of the sick ones who has tried just about everything to heal my crazed immune system.

    Please don’t stress over the people who choose to listen to their MDs instead of you. Your energy is better spent finding the ones you can help.

    • http://www.reinventyourdiet.com Pam Schoenfeld

      Good advice about networking with alternative MDs and other practitioners. Unfortunately, I have tried to do so with the very few MDs in my area that practice this way – actually there are only a couple that I know of. One is very supportive of me and wants me to work in her practice, but is somewhat disorganized and we can’t seem to get it together. Another is an ND who may view me as competition. Why there are so few alternative MDs in central Jersey is a mystery to me. I do have a couple of regular adult MDs who send their patients to me. I don’t know if they really understand what I do, but they seem to like the results. Just got to work on some pediatricians.

  • Ross

    I understand your frustrations. I am not an RD but I have been studying nutrition and medicine for over ten years now. I don’t feel like a lot of things really made sense to me until I lived in Argentina and saw everything from a different viewpoint. I always try to educate people about traditional foods and have many times met with success, with the information often having to be tailored to the person’s level of understanding. There are people who, despite what you tell them, want to continue living the same, even if it could be the cause of their ailments. If this is the case, don’t loose heart, you are doing your best and that is all you can do. I am glad you have created a blog to help spread information about traditional food; I will be reading it and contributing when possible.

    • http://www.reinventyourdiet.com Pam Schoenfeld

      You said it in a nutshell – do your best and that is all you can do.

      Thanks for reading this blog. My daughter is a great writer and I think she blends solid information and real life problems very well. Life is so much more than food, but we need good food to live well, and playing a role in that is very satisfying. Looking forward to your comments!

  • http://www.inkyblack.net Maire

    It sounds like you need to sit down with your client and just have an honest heart-to-heart about what your qualifications are, and what goals she wants to reach with her daughter’s health. If I were in her shoes, I would want to know why I should be listening to the RD rather than the MD. We’ve all be told to “trust your Doctor” (thank you, BBC!), but maybe she is unaware of how your training and his are so radically different?

    Also, you may want to discuss in detail *why* you want to try a diet that the MD brushes aside. Yes, the client wants the go-ahead to eat gluteny-starchy-carby meals! She doesn’t want to give up *her* sandwiches, muffins, cupcakes, pasta and pizza because she’s being supportive. If her family is missing pizza after only a week, then you have to wonder what percentage of their weekly intake is made up of that particular foodstuff. Maybe let her know that a lot of subtle allergies and insensitivities can be pinpointed with a corrective diet, and that adding things back slowly, over the course of months, can help determine whether food is a problem, and what foods are triggers.

    I’d also ask if they could keep a food journal for a week or two so you can see just what is being eaten in the family, and what the child has access to.

    If, after all that, they’re still unwilling to work with you, then you’ll probably want to gently remind them that if they can’t do so, then they might be better served looking elsewhere for assistance. Your job is to work with them as an expert on diet and how it affects their physical well-being. If you’re doing your job, but they aren’t….like any relationship, it has to end.

    (Now, bear in mind that I’m not a medical professional, but I *did* teach piano for a couple of years and it teaches you to vette your client. Particularly when Mom wants her child to learn to play for all the wrong reasons. Nothing is worse than having to tell a hopeful mother that Baby Prodigy has absolutely no interest in working with you.)

    Good luck and keep your chin up :D

  • http://www.gopaleo.com Wendy Schwartz

    Is there any possibility. of speaking to the MD or educating him via a tactful lettervthat includes. supporting documentation?

    OR AM I PIPE DREAMING?

  • Tanya

    As a mom I can’t understand why someone would want to keep their child on any kind of long term medication. If she sought your help then she should give it more than a week. I agree with your daughter and I would tell her that you can’t work with her if she isn’t willing to follow the advice. Thankfully, in Swizterland there is a large focus on natural foods and staying away from unnecessary medication. I grew up in Morristown and would definately go to you if I were still in the area! Best of luck!

  • http://primalnorth.com Danny J Albers

    Don’t feel bad.

    You will win over the mainstream crowd once paleo and WAPF can afford to send doctors on a free cruise every year as part of their educational requirements the way big pharma does.

    Until then you are just fighting the good fight and we are in the age where people are not truly ready to accept just how badly the establishment is failing us on health matters.

  • Ron

    I’ve been at this diet thing a long time. Lost 100 pounds in 2002. Attended the WAPF Conference in 2003. All life changing events.

    Doctors are doing the best they can with the information that they have. Most of them, anyway. They are trying to help. They trust the system in which they learned and that provides them with patients. I think most of them are good guys trying to get it right.

    Yet, as you correctly mention in your post, they know little about nutrition. They have little personal experience with it. Yet it is their job to guide their patients nutritionally as best they can. When they encounter ideas like yours they are _obligated_ to ask their patients to stop following them.

    That makes you and your job even more necessary. It will take years for the current revolution in nutrition to have a proufound effect on the American diet. In fact, it may never happen. There are too many interests in place with real power who are opposed for financial reasons. Dr. Price wrote in the 1930′s and 40′s. He is still considered to be a fringe character in the modern nutritional pantheon and most people have never heard of him.

    You, however, are changing that. One person at a time. If you quit how many people will never have the opportunity to heal and get healthy? How many people will be unable to choose between your guidance and their doctor’s because they will not know that there is another way?

    Don’t give up.

    Ron

    • http://www.reinventyourdiet.com Pam Schoenfeld

      Thanks to everyone for this amazing support. This community is so great and I will continue to work alongside of each of you to spread the word. Our next generation deserves this information!!!!!

      Thanks, thanks, and thanks again.

  • Christina

    Pam,

    I am currently going back to school to pursue Registered Dietetics, and I hope to promote WAPF in my future practice. I am trying to remind myself that I will be learning a lot of information contrary to what I believe and know to be good nutritional advice. Please do not give up hope! As I learned from reading Laura’s blog, we need more RD’s within the ADA who are dispensing WAPF/traditional food advice, and not the ‘conventional wisdom’ that is rarely questioned in our society. Also, I am contemplating not taking insurance, since it seems to be a huge hassle and rarely benefits the patient or practitioner. Perhaps you could run a “Karma clinic”/practice in which your clients pay what they can afford (you can even suggest prices for service, but ultimately, it’s up to them). I also urge you to read Tim Ryan’s article: “My Experience Going Third Party Free”. This helped shape my perspective on insurance-free clinics/practices. I hope these may help you!

  • jess jk

    Hang in there, I know it is difficult. My suggestion would be to reassess your situation in a few months. Maybe a higher power is calling you to rethink how you offer your skills. You never know, and of course we all know that it is hard to think of anything positive in the face of such discouragement. Keep it up, I know your daughter is proud of you, and I know you have reached other clients before, so think of them when your spirits are low.

    • http://www.reinventyourdiet.com Pam Schoenfeld

      You may be right – there is a small chance we may be moving in which case I will rethink everything. And most of my clients have been great, despite the occasional non-compliant one. Thanks for the pep-talk.

  • shadia

    I hope you don’t quit your work, or take offense to what an MD might say about your nutritional advice. I’m an MD, and certainly no other conventional wisdom MD is listening to me either! I have three siblings who are all MDs and none of them listen to me about this lifestyle.

    I’ve begun a wellness coaching program that has taught me that people do best with positive health changes when they find the answers themselves. On some level, patients struggling with health issues aren’t happy with conventional medical care that mainly focuses on suppressing symptoms (and here I would defend MDs–this is how we are trained, and to not alleviate a patient’s symptoms is considered a failure. There is no time in medical school to sleep let alone learn anything different). Empathy is huge, and I use it even among my family when I can clearly see them making bad food choices for themselves and their children. I try to see them for where they are, and I’ve found empathy actually opens the doors for them and they begin to ask me more questions about how I eat and why. If I try to tell them on my own, that door slams shut. A patient being told contradictory information by two professionals needs empathy and understanding, and if they are motivated they will hopefully begin to find what is right for them.

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  • http://hussygetshealthy.blogspot.com Michelle

    I’m also embarking on the nutritionist path, and I already dread these situations! I’m a bit (well, more than a bit) angry with this mom for putting the convenience of grabbing a pizza above her child’s health.

    Since you’ve worked with her, you’ll know in your heart what is best.

    Is she the kind of person that appealing to reason will work on? If so reminding her that your bajillions of hours of schooling, continuing education, as well as passion for nutrition should trump the few (being generous) dozen hours of nutrition that most MD’s get waaaaaay back in med school.

    Or is she the kind of mother that laying on the guilt would be enough? “Your daughter is sick and we need to try all the options!”

    Or is she the kind of socially brainwashed person that will believe that anyone with an MD after their name had a direct line to the almighty and knows exactly what’s right all the time?

    If she’s either of the former, she may be worth working on. If she’s the latter, drop her like a hot potato but let her know your door is always open!

  • Sonya

    I’m at this moment a PA-C in GI and have been for over 2 and a half years. I came into Ancestral Medicine and “Paleo” about 2 years ago and through my own recovery of wellness have felt the need to share this information with my patients. Alas, I have been “doc-blocked” even by physicians within my own department regarding nutrition recommendations to help with IBS issues as well as a plethora of other vague GI complaints in people who simply do not know better than to continue the SAD lifestyle. I have gotten to the point where I resigned my position, last day Sept 13th, and I expect I may not return to Western Medical practice ever. You can only deal with ignorance for so long until you begin to feel like a crazy person. So I have spent $100K on an education I feel was useless in the role I WANT and feel the ABILITY to provide for patients. I am sorry for your experience. From what I have seen it will take ridiculous momentum to get a doctor to change their out-dated ways of managing patients. It is depressing and frustrating which is why I have felt the need to step back completely for at least some amount of time.
    If I were you I would tell the Mother that she cannot expect significant changes in gut health without AT LEAST 30 days of implementation. And if that is too much to ask then admit there is a difference in practice styles and that yours does not match the doctors nor hers and call it good for now. Definitely leave the door open for the future as I am 100% certain this little girl’s GI issues will continue to blossom once her hormones start pitching in.
    Good luck to you.

  • http://n/a norma hilliard

    I am so happy to finally be on the nutritional track. I am 57. My whole life I have been constipated and have had exema on my hands. I was just tested for celiac disease; i do not have it. But I have given up gluten, started with more calcium and magnesium, and doing probiotics. My hands have cleared up and I no longer have to worry about constipation. THIS WAS SO EASY! Why did I use a cortisone cream every day? Why did I take dulcolax? I wish someone would have told me a long time ago I could be fine with just a few changes to my life.

  • shawn

    You need to post this on your website. Bare your sole and speak to peoples emotions, which will override the “logical” advice of MDs. You ARE a mom and therefore more EXPERT at being a mom than any MD. You’ve personally experienced for yourself that following the conventional wisdom of MDs did not make your daughter healthy. As a matter of fact, it wasn’t until she tried something completely the opposite that her health turned around. Expose the insanity of their doing the same things over and over again and expecting different results with your own personal mom experience. It’s the only way to break through the walls and speak directly to the hearts of those you are trying to reach…for those who are actually ready to make some meaningful change in their lives.

    • shawn

      I meant soul, not sole. LOL

  • http://strengthsaga.com Matthew

    All of my experience in behavior modification and working with people starts with readiness. Your client was looking for the easy out and the MD gave it to her. Focus your efforts on people that are ready to change and just patiently wait on those that aren’t.

    If and when they are sick of being broken, they know where to find you. It is especially disheartening when a solution is available for a younger person, when so much future suffering can be alleviated. Stay the course, regardless.

    • http://www.reinventyourdiet.com Pam Schoenfeld

      Good point – you are right – people listen to the answers they are ready to hear.

      Thanks for the input.

  • http://www.MercyViewMeadow.org Kris Johnson

    I can understand your angst, Pam. As a retired and reformed dietitian, I often wonder what I would have done if I have found WAPF sooner. Thinking of the diabetes clinic I worked in, I think I would have sat down with the doc in charge and talked to him about changing our approach. I think it would have made sense to him and he would have supported me. I’m sure we would have gotten better results. Now I teach classes periodically, always from the point of view of a diet that can produce vibrant health, but I often warn people that what I say is unconventional, and if it makes sense to them they might be careful about what they say to their doc. If often mention the book “Trust Us, We’re Experts – How Industry Manipulates Science and Gambles with Your Future” to illustrate that you can’t always trust ‘experts.’ I provide good information, and they can do with it what they will. Fortunately I don’t have to make a living doing this.

    I’m sure it’s helpful to be ‘up front’ with new clients, tell them your story and how you’ve come to change your approach, give them some helpful information, and let them decide if they want to follow that path. They may need to start with some simple steps. I was struck by the approach of a black doctor I questioned at an obesity meeting here recently, who sees many obese teenagers. He advises them to make one simple change, such as avoiding sugary drinks, and come back in 3 months. Often by then they have had some measurable success, are proud of that, and are willing to take the next step, like cutting down on bread – and he said he doesn’t mention fat.

    • http://www.reinventyourdiet.com Pam Schoenfeld

      Thanks Kris. I sometimes think what my life would have been like if I had pursued becoming an RD after I got my BS in nutrition research. Even then, I knew that working in a hospital was not for me. I am so grateful that I have had the luxury of starting my own practice, so that I can speak the truth to the level my patients are ready to hear.

      I am not really mad at this mother, just at a system that creates patients for profit. I will hang in there because I see so much work to be done. Your helping so many people and if I am correct, you don’t even charge for people to attend your presentations. I hope that I can do more philanthropic work in the future if our life situations allow.

  • Tina B

    I can’t imagine seeking out any kind of professional’s advice, paying for it, and not following that advice, at least for some period. Remind the mother that SHE wants to wean her daughter off Miralax, and the doctor’s not concerned. Remind her that nothing else has worked thus far, and encourage her to give your advice a real try. Plus, perhaps give her a more detailed explanation as to why 1 week isn’t long enough to make a difference, how it might be a long process, and the reasons why you have asked her to remove gluten even though Celiac testing was negative.

    Also, encourage the mom to talk to her daughter and see if her daughter notices anything after she does or doesn’t eat certain foods. At 6 yrs old, she is old enough to provide some input, and may truly notice things that the mother does not.

    It’s sad that you have to persuade a the mom to follow the advice they came to you seeking, but hopefully a little extra light shed on the subject will be the difference in improving the girl’s overall health.

    • http://www.reinventyourdiet.com Pam Schoenfeld

      Great advice Tina. The daughter was pretty shy at our first session, so we shall see. She seems somewhat oppositional as well, in more of a controlling her own life way rather than a defiant way. I will tread carefully but be sure to try some more education and gentle persuasion.

  • http://www.acneeinstein.com Seppo

    I can see how frustrating that can be. I sometimes run into the same problem with acne patients. Dermatologists still keep insisting that diet has nothing to do with acne – despite several studies now showing otherwise. In my case I, luckily, mostly deal with people who have already realized that dermatologists can’t cure their acne. So they become open to alternative information.

    Change is hard. And until people are forced to abandon their current beliefs it’s not likely to stick. In your case it seems the client was relieved to be able to go back to their old ways. That kinda tells me they weren’t ready for it yet. Let them suffer for a few more years and they’ll come around :)

  • http://www.tuitnutrition.com Amy

    I’m a little late joining the conversation here, but I just wanted to offer Pam some support. I am a *brand new* nutritionist — just finished my master’s degree a few weeks ago. I specifically did not choose the RD path because I didn’t think I’d be able to hold my tongue long enough to make it through the program with my sanity intact. ;-) That said, I know that because I’m *not* an RD, a lot of doors will be closed to me, and I’ve even been considering pursuing an ND. (After winning the lottery to cover the tuition, of course.)

    I haven’t even started my practice yet, but I know I’ll have to tread very carefully in terms of the language I use and the specific recommendations I make for clients. It’s really a minefield these days. It’s getting to the point where you think mothers are going to be arrested for putting home-cooked dinners on the table if they happen to mention that their kids should eat broccoli because it’s good for them. Oh, no! Can’t have that! Can’t have plain ol’ moms out there with no training whatsoever dishing out nutrition and health advice. *Sigh.* I’m a little discouraged and I haven’t even begun.

    It’s very interesting for me to hear from someone like you, who’s been in practice for quite a while and still faces these challenges. Like others have said, I guess you just have to help the people who want be helped (and who will help *themselves,* too) — and that’s where it’s neat that you mentioned Robb Wolf, because he talks about this a lot — not wasting time on people who don’t care enough to save their own skins. You can give people all the information in the world, but ultimately, you can’t do the grocery shopping for them, and you can’t bring the fork to their mouth. At some point they have to take *some* responsibility for their own bodies.

    Don’t give up, Pam. We need people like you out here in CrazyFoodLand! Sounds like you’ve already explored trying to find like-minded MDs in your area. If you haven’t tried these too, check out the Paleo Physicians Network, and there’s also a Low Carb Doctors directory from Jimmy Moore. I know there’s a lot of debate about low carb these days, but I think most of those docs would be on board with WAPF/Paleo principles.

    I’ve hooked up with a Paleo-friendly MD in my area and she might be giving me some office space to start out in. She was looking for a dietician or nutritionist to refer people to and couldn’t find anyone. I don’t know how it’ll work out, but after reading your post, I feel very lucky to have found her and at least have the *potential* for a fruitful collaboration.

    Focus on all the good you’ve done and are doing. Don’t let the disappointment about the few you can’t “save” cloud all the people you’re helping.

  • http://momessentials.net Jenni@NaturalMedicineMom.com

    I’ve encountered this problem too, but I say “Don’t Give Up!” The world is in such desperate need of messages and support for good health. There are so many voices out there, that it’s hard for some people to differentiate what is true. But there are people that change their lives because of our influence. I’ve almost thrown in the towel a few times, especially being married to an ER doc. But PEOPLE ARE SEARCHING and when they find us, it makes it all worth it. Keep up your fantastic work!

    PS-I wonder if you’d be interested in contributing to a collaborative book by influential women on natural medicine? I would love to send you more info if you are!

  • Tyler Geers

    Definitely very late in joining this discussion, so for that, I apologize. However, as a first year medical student that has experienced the atrocity of medical school nutritional education, as well as observed the egos of our future “doctors”, I want to commend you in your efforts. I can only imagine how difficult it is to deal with MDs and their hierarchical self-proclamations, despite the fact that they know so very little in the field of nutrition.

    But I also urge you to press on! You are paving the way for the future; sooner than later (hopefully), everyone will be on board with the same ideology and methodologies. But you have been a forerunner in that fight, and for that, I thank you!

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  • Clare @ fitting it all in

    Just reading this now. I am a pre-med student with a holistic nutrition certification and I want to become an MD BECAUSE OF THIS! I want to be a doctor focused on more functional medicine and nutrition focused care, working with great RDs like you. I’m sorry you are dealign with this, but I hope to be one fo the MDs to change it!

    • Pamela Schoenfeld

      Good for you – that is a great motivation – I wish you the best!

    • Laura

      That’s great Clare! PS – I had a client sign up who told me they were reminded about me from your blog, so thanks for the shout out! :)