Sorry I am not sure if this goes in the medical section or nutrition.
I recently visited a DR. of Endocrine (wrong term?). because of my Type 2 diabetes, TRT and high Cholesterol and Triglycerides. After the visit, I walked out feeling like something was fishy. Obviously, I am paying him because he is an expert. that being said I am either in for paradigm shift in my life or he is not giving me the best advice.
Question 1- My AIC had been 6.1 or lower for the last three years taking Glyxambi (the lowest dose). He took me off of this because I had a yeast infection two years ago. and placed me back on Metformin which I told him gives me an upset stomach and was not as effective. Is this really warranted?
Question 2- He wants me to swith from the current diet (roughly aTBAB) to a whole food plant-based vegan /Non-GMO diet. When asked about protein he said to stay away from Tofu but not to worry I will get plenty form the veggies, chickpeas, and beans. He also wants me to supplement my omega-3s and B-12 with pills (why not eat fish and beef). If I am understanding the BBM’s view based on the most current studies, this sounds fishy to me. Would/have you ever prescribed this diet, or one similar, to any of your patients?
Question 3- I have been on TRT for a little over three years. I didn’t know BBM’s stance on TRT when it was first prescribed but It has had amazing results with my mood and energy levels so I have been hesitant to change. Without and review, testing or questions this DR wants me to stop taking it for a year, retest and evaluate why my testosterone is low. This actually makes some sense to me but thin he through in the that he will proscribe Viagra for me and that he will not prescribe testosterone so that I can build muscle. I am not taking anywhere near enough for that. -IIs this a reasonable approach?
It is important to view your physician as someone who you, the patient, approach for consultation regarding your health. They are not “in charge” of you, but rather are there to provide recommendations which you are then free to take, or not, as an autonomous individual.
I would approach this as a discussion of risks vs. benefits of each medication. It was previously thought that this class of drugs is associated with an increased risk of yeast/urinary tract infections, although more recent data have brought that into question ( http://cmajopen.ca/content/6/4/E594 ).
With that said, having one episode several years ago does not make this medication absolutely “contraindicated” (i.e., dangerous/risky or necessarily avoided). This class of medications has significant benefits outside of diabetic control (including weight loss and cardiovascular risk reduction) that should be factored into this conversation. Without knowing all the details of the case, I would not necessarily be opposed to continuing the Glyxambi or potentially switching to one of the GLP-1RA drugs (e.g., liraglutide, exenatide, semaglutide, or dulaglutide) over going back to metformin, if you did not do as well on that medication.
We are, in general, fans of increasing plant/vegetable intake as part of an overall dietary pattern. We do not typically go for vegan options unless that fits with a patient’s personal preferences (in which case B12 status may become an issue; otherwise, we would not typically supplement with either of those things).
It is not necessary to be off of TRT for a whole year to sort this out.