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DoctorTro

@DoctorTro

Dec 17

There are 5 types of hunger that ideally should be taught to all patients with obesity

Without cultivating an awareness of appetite, hunger and cravings, a patient with obesity will not know what they are fighting against

So Let’s start!

We are going to start with some easy ones…

The Cephalic phase response aka food cues - this is hunger stimulated when in presence of food.

These signals are deeply ingrained and can be conditioned

Think of Pavlov & commercials - these aren’t going away quickly or ever

Second up is appetite triggered by Social cues to eat

our social lives, whether they are business meetings, family dinners or birthdays

Unless you are going monk mode - this cue to eat is also not going away & requires attention to manage

Read 21 tweets

DoctorTro

@DoctorTro

Dec 8

The Crisis in Medicine Part 1/3🧵

“I want to paint a picture of how corrupt our medical system is.”

Doctors, the traditional gatekeepers of health and wellness, have abandoned their role as advocates for patients in favor of compliance with a system that rewards volume over value. This shift has eroded the foundations of trust, compassion, and accountability that once defined the doctor-patient relationship. Over the past several decades, the profession has devolved into a series of disconnected, transactional encounters, leaving patients sicker and doctors disillusioned.

The tragedy is that this decline wasn’t inevitable. It is a failure born of choices… choices made by physicians, healthcare administrators, and policymakers who prioritized financial gain over human well-being. Doctors, rather than rising above the constraints imposed by insurance companies and dogmatic guidelines, have allowed themselves to be reduced to cogs in a profit-driven machine.

The results speak for themselves: skyrocketing rates of chronic disease, polypharmacy as the default treatment, and a complete abandonment of empathy and rapport as tools for healing.

The Shackles of Insurance and Dogma

Accepted insurance contracts have transformed healthcare into an assembly line, where the primary objective is to maximize RVUs rather than optimize patient outcomes. Physicians are incentivized to see as many patients as possible within an eight-hour day, often spending less than 15 minutes with each person. In this time, they must review charts, check boxes, and meet pre-approved insurance guidelines—leaving little room for meaningful conversations or root-cause analysis.

Motivational interviewing, a cornerstone of behavioral change, is nearly nonexistent in this environment. Listening to a patient’s story… truly hearing their struggles, fears, and goals… has been replaced with a perfunctory review of symptoms and a prescription pad. When the system demands efficiency above all else, the doctor’s role shifts from healer to bureaucrat.

But this isn’t just about time constraints. The deeper issue is the abdication of intellectual curiosity. Doctors have become so entrenched in dogmatic guidelines that they no longer question whether those guidelines are effective. Lifelong learning, once a hallmark of the medical profession, has been reduced to obligatory continuing medical education (CME) credits, which often reinforce the very guidelines that perpetuate the problem. The result? A workforce of physicians who are well-versed in polypharmacy but blind to the tenets of metabolic health.

The Forgotten Tenets of Metabolic Health

Metabolic health is the foundation of human health, yet it remains one of the most neglected aspects of modern medicine. Simple, evidence-based strategies like reducing ultra-processed foods, improving sleep, managing stress, and encouraging movement are rarely discussed in primary care settings. Instead, doctors reach for sleeping pills, antidepressants, and, most recently, anorexic injections like GLP1s.

The medical system’s reliance on pharmaceuticals as a first-line solution reflects a broader failure to address root causes. It is easier to prescribe a pill than to engage in the hard, messy work of behavior change. But this convenience comes at a cost. Patients remain trapped in a cycle of dependency, their symptoms managed but their underlying conditions ignored.

The neglect of metabolic health is not just a failure of individual doctors; it is a systemic failure. Medical schools dedicate minimal time to nutrition education, and residency programs prioritize acute care over preventative strategies. The result is a generation of physicians ill-equipped to address the chronic diseases that now dominate their practices.

The Crisis in Medicine - Part 3/3 🧵

Accountability in Medicine: A Missing Standard

One of the most glaring deficiencies in modern medicine is the absence of accountability. Unlike other high-stakes professions, doctors are rarely held to measurable standards of success. There is no quarterly or annual evaluation of patient outcomes, no system to reward exceptional care or address poor performance. The only metrics that matter are RVUs and salary, both of which incentivize quantity over quality.

This lack of accountability is particularly striking when compared to other fields. If airplanes were falling out of the sky, we would hold pilots, maintenance crews, and engineers accountable. We would investigate every failure, implement corrective measures, and ensure that it never happened again. Yet in medicine, where the stakes are equally high, there is no such culture of responsibility. Doctors who consistently produce poor outcomes face little consequence, and those who achieve exceptional results receive no recognition.

Without accountability, there is no incentive for improvement. Physicians have no reason to question their practices, explore new approaches, or challenge the status quo. They become complacent, and patients suffer the consequences.

The Erosion of Empathy and Community Leadership

Perhaps the most tragic aspect of modern medicine is the loss of empathy and human connection. The role of the doctor as a community leader, a neighbor, and a trusted confidant has been replaced by a faceless bureaucracy. Patients are no longer seen as individuals with unique stories and struggles; they are cases to be managed, codes to be billed, and data points to be entered into an electronic medical record.

Empathy, once the cornerstone of medical practice, has been sacrificed on the altar of efficiency. Doctors no longer have time to listen, let alone build rapport. Motivational interviewing—a simple yet powerful tool for fostering behavior change—is rarely practiced. Instead, patients are met with a litany of prescriptions and referrals, each one a tacit acknowledgment of the doctor’s inability (or unwillingness) to engage on a deeper level.

This loss of empathy is not just a personal failing; it is a systemic issue. The medical system actively discourages doctors from forming meaningful connections with their patients. Time spent listening and understanding is time that cannot be billed. And so, doctors learn to suppress their humanity in order to meet the demands of the system.

Should Doctors Be to Blame?

Absolutely. While the system bears much of the responsibility, doctors themselves must also be held accountable. They have allowed their profession to be co-opted by insurance companies, pharmaceutical giants, and hospital administrators. They have accepted the constraints of RVUs and dogmatic guidelines without protest. And in doing so, they have failed their patients.

It is tempting to absolve doctors of blame, to view them as victims of a broken system. But this perspective ignores the agency that every physician possesses. Doctors have the power to question, to challenge, and to change. They have the power to demand better for their patients and for themselves. But too many choose the path of least resistance, prioritizing financial gain and professional convenience over the hard work of advocacy and reform.

If doctors don’t take ownership of their failures, why should patients? If physicians are not willing to rise above the system, to challenge its shortcomings and demand accountability, then they are complicit in the harm it causes.

The Crisis in Medicine - Part 2/3 🧵

The Path Forward: Reclaiming the Role of the Doctor

The path forward begins with a fundamental redefinition of what it means to be a doctor. Physicians must reclaim their role as healers, advocates, and community leaders. They must rise above the constraints of insurance and dogma to prioritize what truly matters: the health and well-being of their patients.

This requires a commitment to lifelong learning, intellectual curiosity, and accountability. Doctors must be willing to question the guidelines they follow, to explore alternative approaches, and to measure their success not by RVUs but by patient outcomes. They must embrace empathy, rapport, and motivational interviewing as essential tools of their trade.

Above all, doctors must take ownership of their failures. They must acknowledge the harm caused by their complacency and commit to doing better. Only then can they begin to rebuild the trust and respect that have been lost.

The time for excuses is over. The medical system is broken, but it is not beyond repair. Doctors have the power to lead the way, to demand change, and to redefine what it means to practice medicine. The question is whether they will rise to the challenge… or continue to fall short.

Read 4 tweets

DoctorTro

@DoctorTro

Dec 1

1/ 🚨 Big news for #Type1Diabetes: The Society of Metabolic Health Practitioners @TheSMHP has published its position on Therapeutic Carbohydrate Reduction (TCR) as a viable, evidence-based option for improving glycemic control.

Here's why this matters... 🧵doi.org/10.4102/jmh.v7…

2/ Despite advances like hybrid closed-loop insulin systems & CGMs, T1DM outcomes remain suboptimal. Only 21% of adults w/ T1D achieve an A1C <7%, & complications like insulin resistance & "double diabetes" are rising. We need better solutions. Enter TCR.

3/ TCR focuses on reducing dietary carbs to stabilize blood sugar, lower insulin doses, & reduce glycemic variability. Unlike high-carb diets, TCR aligns insulin needs w/ intake, minimizing the wild swings in blood glucose that burden T1D patients daily.

Read 15 tweets

DoctorTro

@DoctorTro

Nov 26

THREAD: 🧵

CGMs - continuous glucose monitors

Having looked at 10,000+ CGMs let me tell you what you will learn...

1/9

Lesson 1: Hidden carbs are everywhere
- you will find hidden sugar & carbs everywhere.

You didnt know you could find carbs/sugar but you will:
hotdogs, sausage, beef jerky, spices, condiments, sauces, soups, broths, basically everywhere you didnt look.

2/9

Lesson 2: consider avoiding seed oils, vegetables oils, especially from restaurants.

Patients who switch to olive oil and avocado oil & hoke cooking seem to have improvement not otherwise explainable on CGMs

3/9

Read 9 tweets

DoctorTro

@DoctorTro

Nov 5

🚨 THREAD ON WEIGHT LOSS & EXERCISE 🚨

Many patients ask me about exercise for weight loss, and getting toned.

We are often advised to exercise, however, if we are severely overweight this can be quite challenging.

I typically advise patients to focus on fixing the diet first and forgo exercise for the first 6-8 weeks of any weight loss plan. if your diet isn’t in order & your appetite isn’t controlled, exercise will increase appetite and likely stall weight loss.

While it is true that over a long enough time, patients may experience changes in body composition (ie getting toned) they won’t see the scale move and the process will be slow and this can be discouraging to patients.

Read 14 tweets

DoctorTro

@DoctorTro

Sep 17

After helping thousands of patients lose weight, here’s my advice for those looking for lifelong, sustainable life changes. These are the “5 MUSTS” anyone trying to lose weight lifelong NEEDS to do.

🧵/Thread

Before you understand my “5 musts”, simply ask yourself -what are the side effects of your prior weight loss attempts- NOT your reasons, NOT what you want to happen, what went wrong, what made you stop?

The 5 Musts: #1 HUNGER
Most people quit diets because they feel low energy, tired & hungry. Your weight loss attempt will need to manage HUNGER. Are food choices making you full, or are they leaving you craving more a couple of hours later? Stick to:: 🐠🥩🍳🍗🍖🍤🫑🥑🥬🥦

Read 10 tweets

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