I believe 100% in lifestyle changes for people who are facing preventable diseases such as diabetes, hypertension, coronary artery disease, inflammatory diseases (inflammation is the cornerstone behind almost all chronic diseases), rashes, fatty liver disease, etc.

My first-line treatment regimen is a low-carbohydrate lifestyle. If patients are not currently being medicated and their current situation warrants not needing medication at the time of their visit, this is a great opportunity to get them on board with this plan. But sometimes patients need pharmacotherapy as a bridge to wellness. And some patients insist on being on a medication, but I still emphasize that drugs should be regarded as a short-term approach in mitigating and alleviating their symptoms. Depending on the patient, I always start slowly and stress that this has to become a lifestyle. This is not going to change overnight, nor are results an instant download. In our current environment of instant gratification and all things available on an App, I try to reorient my patients’ thoughts so that they see their current deteriorated health situation is the byproduct of years of miseducation on food and living, and they have to re-educate themselves and eschew the antiquated dogma of the food pyramid way of thinking. I use scholarship work from titans in the field, such as Gary Taubes, William Davies, Sally Fallon, Mary Enig, Stephen D. Phinney, Jeff Volek, and Ronald M. Krauss, to name a few, and I recommend the Atkins diet if they are not as literate, mainly because most people have heard of the Atkins diet and it is familiar and user-friendly.

If they have a higher level of sophistication, I include with the Atkins diet a reduced grain/grain-free approach. I try my best to get them to see the benefits of grass-fed meats and pasture/free-range poultry. But I also understand the financial constraints that this may have. I refer many of my patients with diabetes type 1 and 2 to Richard K. Bernstein, the diabetologist who has done fantastic work with successful outcomes in this patent population.

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I mention these people because it is important that we all support each other in this battle against mainstream practices that are failing and/or exacerbating the problem. And I feel it is my duty to get the word out that the low-carbohydrate lifestyle is not a fad/new phenomenon; it is an excellent alternative to medication. And more so, the low-carbohydrate lifestyle is corroborated by well-educated and thoroughly researched individuals. I tell my patients that this research and guidance are readily available in many forms and outlets for them to access. 

It would be great if as a collective, farmers of grass-fed/free-range animal stock could work with communities to help make their meats more accessible to people on limited incomes. I think most people either do not know that there are grain-free options available to them or they feel it is out of their economic reach. I do what I can to help provide my patients with local and/or online free-range/grass-fed resources, but it remains difficult. If anyone has any suggestions and or recommendations, please share. 

There are many more scholars and practitioners whom I wanted to mention who are doing great work in the low-carbohydrate world, but due to time and space constraints, I limited them to a few. — Cheriee Slobodsky, MPH, PA-C, Stamford, Conn.

These are letters from practitioners around the country who want to share their clinical problems and successes, observations and pearls with their colleagues. We invite you to participate. If you have a clinical pearl, submit it here.