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At the start of my residency, the Affordable Care Act (ACA) was passed and all doctors had to get up to speed on the Merit-Based Incentive Payment System (MIPS), a new program under the Quality Payment Program (QPP), where a physician would now receive substantial adjustments to payments from Medicare if they met specific quality-of-care criteria. One would think that “quality” and “merit” in medicine would mean that the patient was actually getting better. But when I dug deep through the MIPS website to find the specific quality metrics for each specialty, I was shocked to see that these quality criteria were primarily based on whether doctors prescribed drugs regularly or did more interventions. Yes, a government incentive program focused less on actual patient outcomes (i.e., Did the patient get healthier?) and more on whether doctors prescribed long-term pharmaceuticals.
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which their previous doctors have chalked up to “normal.” These symptoms often include neck pain, seasonal sinus infections or recurrent colds, eczema, itchy ear canals, lower-back pain, acne, headaches, bloating, reflux, chronic cough, a little anxiety, trouble falling asleep, low energy, and PMS symptoms like cramps and moodiness. None of this is normal. You can and should feel incredible — mentally and physically — most of the time.
Doctors have twice the rate of suicide as the general population. Based on my own experience with depression as a young surgeon, I think a contributor to this phenomenon is an insidious spiritual crisis about the efficacy of our work and a sense of being trapped in a system that is not working but seems too big to change or escape.
Another way to practice mindfulness at any moment is to close your eyes and scan every sensation in your body: your heartbeat, your butt on the chair, any areas of warmth or cold, your toes on the ground, the air moving into your nose and lungs. Because this body scan forces you into the present moment, it takes you away from mental states of anxiety or stress.
Triglyceride-to-HDL Ratio After assessing each of these five biomarkers, there is one more step: calculate your triglyceride-to-HDL ratio to better understand insulin sensitivity. Simply divide your triglycerides by your HDL. Interestingly, studies have shown that this value correlates well with underlying insulin resistance. So even if you are unable to access a fasting insulin test, the triglyceride-to-HDL ratio can give you a general sense of where you’re at. According to Dr. Mark Hyman, “the triglyceride-to-HDL ratio is the best way to check for insulin resistance other than the insulin response test. According to a paper published in Circulation, the most powerful test to predict your risk of a heart attack is the ratio of your triglycerides to HDL. If the ratio is high, your risk for a heart attack increases sixteen-fold — or 1,600 percent! This is because triglycerides go up and HDL (or ‘good cholesterol’) goes down with diabesity.” Dr. Robert Lustig agrees: “The triglyceride-to-HDL ratio is the best biomarker of cardiovascular disease and the best surrogate marker of insulin resistance and metabolic syndrome.” In children, higher triglyceride-to-HDL is significantly correlated with mean insulin, waist circumferences, and insulin resistance. In adults, the ratio has shown a positive association with insulin resistance across normal weight and overweight people and significantly tracks with insulin levels, insulin sensitivity, and prediabetes. Perplexingly, the triglyceride-to-HDL ratio is not a metric used in standard clinical practice. If you remember one thing from this chapter, remember this: you need to know your insulin sensitivity. It can give you lifesaving clues about early dysfunction and Bad Energy brewing in your body, and is best assessed by a fasting insulin test, discussed below. Right now, this is not a standard test offered to you at your annual physical. I implore you to find a way to get a fasting insulin test or to calculate your triglyceri
I deeply respect doctors, but I want to be very clear on something: at every hospital in the United States, many doctors are doing the wrong things, pushing pills and interventions when an ultra-aggressive stance on diet and behavior would do far more for the patient in front of them. Suicide and burnout rates are astronomical in health care, with approximately four hundred doctors per year killing themselves. (That’s equivalent to about four medical school graduating classes just dropping dead every year by their own hand.) Doctors have twice the rate of suicide as the general population. Based on my own experience with depression as a young surgeon, I think a contributor to this phenomenon is an insidious spiritual crisis about the efficacy of our work and a sense of being trapped in a system
nonalcoholic fatty liver disease has become the most common chronic liver disease in the world, increasing from 25 percent of the global population in 1990 to close to 40 percent by 2019. NAFLD is full-blown metabolic dysfunction in kids and adults, representing liver cells filling with fat, which worsens insulin resistance. Key contributors are processed foods, refined sugars, refined grains, sweet beverages, high-fructose corn syrup, fast food, low fiber and phytochemical intake, habitual eating close to bedtime, sedentary behavior, and oxidative stress. Liver transplants have gone up close to 50 percent in the past fifteen years, and while alcohol and hepatitis C used to be the leading causes, now NAFLD is taking the lead in women as the cause of liver failure and is a top cause for men. Fatty liver disease is now the most common cause of liver transplant in young adults in the United States. We are failing our children.
By simply noting the thought, you get off the “train of thought” and back to the present moment. In doing this, you solidify the understanding that your identity is separate from the rush of stressful thoughts running through your brain. Most of us spend the entirety of our life jumping from thought to thought, never getting off the “train,” thinking that this is “reality” or “you.
HDL is often referred to as “good” because it helps remove cholesterol from the blood vessels and carries it back to the liver for processing and elimination from the body. This process of reverse cholesterol transport can help prevent the buildup of plaque in the arteries and reduce the risk of heart disease and stroke. Therefore, high levels of HDL in the bloodstream are considered beneficial for cardiovascular health. Meanwhile, LDL (low-density lipoprotein) is often referred to as “bad” cholesterol because it can deposit cholesterol in the walls of the arteries, leading to the formation of plaque. This process, known as atherosclerosis, can narrow the arteries and increase the risk of heart disease and stroke.