T Nation

How Docs Don't Know Dick?


I asked my doctor the other day about a supplement I was considering taking to combat depression-
It's called 5-HTP.
It's been studied since the 70's,and been on health food shop shelves for many,many years,and considered safer than most prescription drugs.
He didn't even know what it was,even when I gave him the bottle,with '5-HTP -5 Hydroxy Tryptophan' on the label.
He was still stumped.
I ended up giving him a lecture on it!!
I wanted to know about possible interactions with other prescription drugs I am taking.
I know doctors probably know more about actual medications,
but this is not the first time I have asked him or other doctors about supplements,and found them clueless.
I know they are not nutritional advisers/therapists or experts in sports nutrition,but he couldn't get back to me? check a website? a reference book?
I had to do it myself.
Fair enough,but almost every supplement or exercise programme has a disclaimer saying 'check with your doctor/physician before trying this'
so you ask them,and they don't know jack!

In another case,my mum was diagnosed with high cholesterol recently.
With no consultation,a 'one size fits all' pre-printed diet plan was issued to her,
by a doctor (NOT a nutritionist/dietitian oranyone in that field) on it was an incredibly simplistic approach-eat less of this,more of that,etc. with a one-week sample menu.
On it was some good common sense,along with outdated advice no doubt the result of a template put together by UK government guidelines probably some 20 years old.
(For instance,2-3 eggs a WEEK,MAXIMUM!) Luckily,I got hold of it,tweaked it a bit,and made some more realistic recommendations (and told my mum eat as many eggs as you want!)
Her cholesterol has now stabilized.

More recently,the UK government (NHS) is realising that prevention is better (i.e. cheaper) than cure,and GP Referrals (The practice of doctors referring patients to gym instructors/personal trainers for a programme,and subsidizing gym membership) are increasing.
My dad was recently classed as obese,and reffered.
As a personal trainer,I commend this,it's an additional revenue stream,and I plan to gain the GP Referral qualification too.
It's still not very common though,and I hope they find more money to fund this in future.

But I am getting sidetracked.
Why don't doctors know more?
You can get an MD and do only a couple of days on nutrition.
How come?
If I am not an expert on say,marathon/triathlon training.
If a client comes into the gym training for this,I will refer them to another trainer who has actually DONE marathons if I can,as there is one in the gym.
If I don't know enough,I will at least do a one day course or weekend seminar/lecture,get a dvd,read a book,research it on the net,etc. so I can advise in the future.
Why don't my doctor(s) have an up-to-date reference book,or website approved by the government for this kind of thing?
Or send them to a few seminars.
I think they would have at least a basic grasp of exercise/nutrition/supplementation.
Can anyone tell me-do doctors have to continually prove their knowledge?
I do,I have to do so many CPD (Continuing Professional Development) or CEC's (Continuing Education Credits) each year to prove I am still learning and keeping up to date...


Why? Because people go to doctors to get prescriptions for pharmaceutical drugs (or to get diagnosed and referred to another doctor, or to get surgery.)


Why do you type like that? Really annoying to read




type like what? using my fingers?
I find it easier than a big clump of words...


What's QFT?


Quite Frankly the Truth? I dunno, just a guess.


Are you serious, you're pissed that your doctor didn't know about one specific supplement? Have you ever looked a PDR (physicians desk reference)? That damn book is around 3000 pages long. Medical school, and the after school requirements aren't enough. Those bottles say check with your doctor so the companies ass is covered, not because they actually expect your doctor to know everything about it.

And the high cholesterol thing, that's what doctors do, follow guidelines and give someone a generic formula for reducing cholesterol that they believe a majority of people will benefit from.

Doctors (nurses too btw) do have continuing education requirements, but the amount of information to chose from to fulfill them is astounding, they can't keep up with the latest of everything that comes there way (or even something that's been around since the 70's and they have never encountered.

I am a nurse and deal with a lot of medication. I know what most of them do, and if I see something i don't know, i look it up, and I know more about meds than i really need to. I don't think it would benefit me to know every drug formulation, indication, contraindications, side effects, etc and every vitamin and supplement in order to effectively do my job (and none of that "doctors are smarter than nurses" bullshit)


When I last visited my doctor, I told them I consume 200-250 grams of protein a day. I got a big lecture about needing to eat more whole wheat and yogurt. I looked at her jelly rolls, laughed inside, nodded my head, and walked out. I was just there to discuss an ingrown toe-nail.

Oh well, she's been a good doctor, but I don't see her for nutritional/supplement advice.


Well,there you go.many supplements have different interactions with prescription drugs.
Isn't it in the interests of them to know these?
Or to know if they work BETTER?
I took anti-depressants for like a month for depression,the pills I was prescribed came with a whole host of fun side-effects-the list is very long but included strokes,heart attacks,increased heart rate,insomnia,bloating,hair loss,etc. etc. that were all worse than the depression! you ready for the punch line? The strongest and most common side effect was......(wait for it) INCREASED DEPRESSION and SUICIDAL THOUGHTS!!
Just what I needed! cheers doc! I was a walking time-bomb,if I owned a handgun/shotgun,it would be so quick & easy to end it,I wouldn't be here now...it was horrible.
I read and tried 5-HTP,after reading about it on T-Nation,incidentally.
I researched it more,and it is recommended for depression,insomnia and weight loss,with a short list of side effects and interactions,WAY less than most anti-depressants.
It raises serotonin naturally.I started taking it and felt better 2 days later.I have now ditched the anti-depressants and take these,and feel a damn sight better for it.

Or is it just a big f**king con,the docs get money,the pharma companies get money,the chemists/drug stores get money,who gives a f*ck as long as there's a pill for it and a pharma corporation owns the licence,never mind all these dodgy health food shops and supplement companies,right?

Welcome to the circle.


Now this is what I'm talking about,one the one hand many doctors (I mean your family doctor,a General Practitioner) don't know dick,but many have no knowledge of many areas yet give unsolicited,often UNINFORMED advice on nutrition/exercise.
Either STFU or get back to them when you do know....


Did you look in the aforementioned PDR to look at the percentage of people who actually experienced these side effects? If during the clinical trials, someone has a side effect, it gets listed, even if the percentage is small.

Drugs get tested on volunteers. I read an article in MH (i know, i know) about people lying and doing more than one study at a time, so that brings into question the actual validity of the studies that side effects show up in.

You as a consumer have an obligation to yourself to research things ahead of time. Did you in fact experience any of those side effects? If not what's the problem. If you looked a majority of medications, they come with a long list of potentially real fun side effects. Tylenol has the least I've come across, but can still kill you. Drugs approved by the FDA go through a testing process and are required to list side effects, supplements not approved do not have to list side effects, but you can find them, and they are just as fun as prescriptions. Supplements are not regulated like prescription drugs are, they aren't held to the same standard.

The side effects of depression aren't good either, weight gain (which can lead to heart attack, stroke, diabetes, the list goes on), possibility of suicidal thoughts, lethargy,
etc, etc.

Everything you put in your body can potentially do you harm, even water.


Okay look at all the supplements that are out there. You expect a doctor to know everyone? While I understand your gripe about doctors not even bothering to do some research, it's reads that you're upset because a doctor didn't know one supplement out of the millions of products that are out there.

My train of thought goes something like this A) talk to a psychiatrist since they are more apt to give out meds for depression and then ask them what the meds might interfere with if they don't know B) go see a pharmachist. They have different specialities for a reason, while a GP is good for an overall idea of what's up I wouldn't want him to perform brain surgery on me. Next time you ask a question and the doctor doesn't know simple ask him to refer you to someone he might know that would.


I'm not pissed,exactly,I'm looking for answers here and opening the floor to discussion.
Sorry if it came off that way.
I agree,the field of medicine is vast,precisely why your regular doctor here is called a GP-General Practitioner,they have a GENERAL knowledge of medicine.
Shit,I have a general knowledge of medicine!
I just find their 'general' knowledge SEVERELY limited in many areas,particularly wellness,and paticularly preventative rather than curative.
I can tell you what you need to take for an ailment-give me 5 minutes on the internet.
I certainly don't expect them to know every supplements interaction or effects,paticularly if it is a formula as opposed to a pure extract-indeed, biochemistry and sports nutrition are medical fields in their own right.
But I have asked on many occasions about popular well-known supplements to cover MY ass,and have been left wanting.
My doctor doesn't know about ginseng,or it's different varieties?-Our f**king cleaner knows what it is!
I think the example I gave was particularly relevant,as I showed him the bottle,with the chemical name on the front in big letters-Hydroxy-Tryptophan,a product of Tryptophan,the chemical precursor to Serotonin? A feelgood chemical? he doesn't KNOW this?
I could pick a handful of meatheads at random on T-Nation who could tell you something about tryptophan and serotonin....My doctor just scratched his head.
Also,I am partly on the side of the doctor,partly not-If they cannot be expected to know all this stuff,like I said,how about giving them a government sponsored website or textbook to fill this needs gap?
Just general exercise and nutrition stuff,with likely interactions,etc.-
I've never heard of anyone being referred to a dietitian or nutritional adviser over here?


QFT = quoted for truth


I didn't even know what a PDR was,do we have them in the UK too?
Did you read my post fully? Yes,I experienced MAJOR side effects-even worse depression and even worse suicidal thoughts than before.
I bought extra painkillers just in case I went for it.
The insomnia was excruciating-I was up for days with a couple of hours sleep.
I fantasized about ventilating my head with a shotgun,and researched applying for a hunting licence so I could buy one....I even wrote a suicide note and made some worrying late-night phone calls.
Before the anti-depressants,it was more like a fleeting fantasy of suicide rather than an actual gameplan.
What I was saying was on this anti-depressant,and many other SSRI anti-depressants,this is a VERY common side effect,it is the first one listed,with it's own section taking up half the leaflet that comes with the pills.
I got many others,including weight gain,bloatedness,puffy face,etc.
I took th 5-HTP and was like a new man,I'm still on it,with no side-effects.The side effects listed on websites are much less common,as are interactions.
Depression and increased suicidal thoughts are not listed and most anecdotal AND lab studies are positive-(in some studies,they were shown to be just as effective if not more effective than SSRI's) this is important,given what you and I already know about how lab studies are not always conclusive,etc. why can a supplement not be given a status or rating based on BOTH?
I don't think we have the equivalant of the FDA here in the UK,but we should,and ALL supplements should be subject to scrutiny.


So..instead of bitching about how doctors don't know shit, why don't you become one. A doctors job is more than just knowing supplements.They go to school studying common ills. Sure , some doctors seem like they barely graduated med school, but hey...at the end of the day they graduated. That takes some skill.


Ok,but I didn;'t ask him what he thought of a FORMULA like HOT-ROX or something as new/complex as that,I asked him about Ginseng and Lecithin in the past,amongst others.
I have an understanding of those,he knew dick.
I asked him about 5 HTP,gave him the bottle,which has the chemical name on it in big letters on the front of it-Hydroxy Tryptophan.
He just shrugged and scratched his head-he said he had never heard of it-excuse me?
I explained it's effects and purported biochemical reaction.
he just looked bemused/embarassed and simply said 'Hmmph,give it a try,I suppose' and gave me some more SSRI's.
I then informed him that according to what I've read,the main contraindication is you cannot take them with SSRI's for fear of serotonin overload,but I'll take them as a backup.
Now,I've told him I'm gonna take these,I told him how they (theoretically) work,he says ok take them,than gives me SSRI's-even if he is not aware of this drug,is he not aware of lethal serotonin overload?
It's not always easy getting a referral,I asked for a second opinion from a dermatologist for an ongoing skin condition I had for years,and was given an appointment....in 6 months time,then it was moved to 3 months later....and so on...it took me almost a year.
But yeah,the pharmacist is a good call-nice one.


Thank you for the compliment. More precisely though, while I studied some graduate level pharmacology along the way as it is part of the program, my education is in medicinal chemistry. Not exactly the same fields: pharmacology deals with the mechanism of action of drugs, or more broadly effects of compounds which change biochemical processes, and determining these mechanisms of action; while medicinal chemistry deals with finding and designing new drugs, as well as developing lead compounds into candidate drugs. Though it is not unusual to have to do some pharmacology along the way in the process.

It is also rare for me to be accused of being a genius, but thank you.


Because as I said,the whole medical community place too much emphasis on curative rather than preventaitve medicine,I would become disillusioned real fast.
Besides,I don't want to be looking at peoples ingrown toenails or sticking my finger up their asses.
As I said,and I hope I don't have to keep reiterating this.

This isn't a 'I hate my doctor' thread.
I'm saying many don't know dick about exercise/nutrition,even a basic grasp,don't you think they should take the time to learn,or be encouraged to do so?
a frickin weight management/sports nutrition course can be doine over a weekend,
I'm not suggesting they do my job and write a frickin' exercise programme or a diet plan,but they could have a database to access,even.
If this isn't feasible,why don't they refer more or work more closely with people who DO know? phone a gym! phone me! either GET an opinion,and get back to your patient,instead of taking an uninformed,off-the-cuff opinion or scratching your head.
Hell,thats not bitching about them,that's trying to give them some support!

Here's the thing,in many cases,as a personal trainer,I have to get many exercise/diet plans approved by a doctor,or at least consult with their doctor.
So they do,and the doctor scratches his head and shrugs and says 'Hmph,give it a try I suppose.' I'm in the business of WELLNESS,are they in the same field,or are they just in the business of ILLNESS? wouldn't it be nice to ask your long-time family doctor,who knows your medical history better than most,for ADVICE on matters such as this?
His professional opinion?
Or are all these doctors sitting in their chairs with wave after wave of phonecalls and visitors asking for advice on exercise and nutrition,with them simply scratching their heads wondering why people are asking THEM for advice?

If even ONE person in the gym asks me about a supplement/injury/training method/illness,even if it is not my area of expertise or I haven't heard of it,I don't scratch my head or mutter something,I'll ask for more info,refer them to a specialist,or if that is not available/they don't have the money,I FIND OUT whatI can, and get back to them with an informed,educated opinion,letting them know the limits of my expertise.
I do this whether they are my client or not,because that is the business I am in.