Tro Profile picture
25 Mar, 9 tweets, 1 min read
Is restricting addictive, unhealthy food the cause of the spiral or our thin idealization, fat shaming, unnecessary weight pressures particularly on our young women... ?

Restricting or limiting harmful things is not the problem.

THREAD 🚨
While dieting in general is associated w/ disordered eating, other psychocial factors like thin idealization & body image seem to be more strongly associated

doi:10.1037/abn0000219
Severe dietary restriction does not induce acutely induce binge eating

doi:10.1111/obr.12295
The only eating disorder prevention programs demonstrating efficacy in high risk patients employs “healthy diet” concepts which encourage eating “whole, real foods” and snacks
doi:10.1007/s11920-014-0453-0
-Healthy Weight program reduces weight gain and eating disorders through sensible dieting, reducing the thin-idealization, improving self-confidence and body image

doi:10.1037/a0026484
Case-series that demonstrates ketogenic diet can decrease binge-eating symptoms

doi:10.1186/s40337-020-0278-7
Describes the relationship of modern hyperpalatable, ultra-processed food and eating disorders

doi:10.1093/nutrit/nuz089
So please actually do some research before you encourage donuts to a diabetic, obese population ESPECIALLY VULNERABLE CHILDREN

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More from @DoctorTro

11 Feb
Two new medical students have started rotating in my practice.

I asked them why they got into medicine, and both said they had an overwhelming desire to help people.

I asked them in their two years of clinicals have they ever truly affected anyone in a primary care rotation.
I asked them have they ever taken a patient off of a blood pressure medication or off of the diabetes medication, did they ever make a diagnosis that changed the life of one of their patients for the better...

They said they have not.
Imagine growing up, dreaming about helping people... Only to find out that it was a big scam.

And well I’m not surprised, what does it say about the mentors that our medical students have, what does it say about a profession that her medical students cannot see real medicine.
Read 5 tweets
31 Jan
THREAD ALERT 🚨🚨

Let's play the game where I call out all the dogma in an editorial against meat consumption from a plant-based proponent

I wish I was joking, but "environment/TMAO" both mentioned in the paper 🤔

doi.org/10.1093/ajcn/n…
DOGMA #1

"The absence of RCTs on this topic is explained by insurmountable challenges"

We have plenty of trials with ketogenic diets, rich in red meat that improve glycemia and metabolic syndrome.
DOGMA #2

"The time frame is daunting due to the nature of chronic diseases that develop over decades before they present as incident cases."

Thankfully we can use CGMs & not dogma to demonstrate that glycaemia in DM2 is immediately ameliorated by adding meat & removing carbs
Read 10 tweets
12 Nov 20
THREAD 🚨

tears roll down my face right now

I just saw a patient who had a gastric bypass 10 years ago, who regained all her weight & the surgeon “upgraded” her to a duodenal switch

1/
She has been re-hospitalized several times after the procedure several months prior with multiple complications

2/
I asked her if anyone had ever talked to her about diet and she said yes the nutritionist told her to count calories and review the myplate

I asked her, given her history of diabetes had anybody mentioned low carb dieting, she said no.

3/
Read 11 tweets
29 Sep 20
Let’s talk about LDL and low carb diets.

🚨 THREAD FOR DOCTORS 🚨

Let’s first address the issues, you have no clue what you are looking at on a lipid panel.

Now since that’s out of the way, let’s let the education begin.
The conventional medical knowledge is that LDL is causative for CVD.

Many models have shown this, namely drug trials, Mendelian randomization, gene defect analyses and population association data
This is aggregated data from primary and secondary prevention trials

It appears that in both primary prevention there is a nominal improvement in CVD with LDL lowering whereas in secondary the benefit seems more robust

Nnt 200-500 in 1*
NNT 100-200 in 2* Image
Read 18 tweets
29 Sep 20
THREAD 🚨

Let’s talk about the headlines about time restriction!

Firstly I want to commend @ethanjweiss and all for a well designed study.

I poured through the data and wanted to share my thoughts.

jamanetwork.com/journals/jamai…
Basically the TRE group had more weight loss and fat loss although it wasn’t statistically significant.

Interesting on DXA it appears that there was a statistically significant reduction in lean mass.

Where did this come from?
Do we think that eating 12-16 hours of the standard diet would lead to significantly more lean mass than 8 hours?

It doesn’t seem likely.

So where did it come from?

The answers may be in the supplemental.
Read 7 tweets
29 Sep 20
Review of the supplemental from @ethanjweiss lead to some interesting findings.

EXERCISE:
The late TRF group had decreased activity, daily movement, METS, steps, high activity, training frequency and training volume

The TRF group exercised less! Much less!

1/4
SLEEP:
They also had worsened sleep timing/efficiency & more awake time

This could be an issue with meal timing close to sleep. eTRF versus lateTRF

2/4
HEAD SCRATCHERS...literally

Interestingly, the HEAD AREA of the TRE group also shrunk (statistical significance) 🤔

Also TRE preferentially decreases right arm lean mass 🤔

I talked with Dr. Weiss to access the data to correlate LBM with BIA, stay tuned

3/4
Read 6 tweets

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