These pieces will not appear on your boards exam. They are not part of the 7 Bets or Mo Depth. They exist because passing boards and restoring health are two different skills, and the gap between what we prescribe and what the evidence supports deserves honest examination. Read these to think upstream, to question, but not to score points.
What boards teach
Psoriasis is an idiopathic, genetic autoimmune skin disease managed by dermatologists using topical steroids, systemic immunosuppressants, and targeted biologic therapies. Diet is considered largely irrelevant beyond general weight management.
What evidence says
Psoriasis is the cutaneous manifestation of chronic intestinal permeability and endotoxemia driven by an evolutionary dietary mismatch. The skin is merely the collateral damage of a gut-associated immune system overwhelmed by modern food antigens.
What boards teach
Acne vulgaris is a genetic and hormonal disease of follicular hyperkeratinization and Cutibacterium acnes colonization, managed largely with long-term antibiotics, topical retinoids, and isotretinoin.
What evidence says
Acne is a visible manifestation of evolutionary mismatch, driven by hyperinsulinemia and persistent mTORC1 activation from high-glycemic carbohydrates and commercial dairy.
What boards teach
Migraines are primary neurovascular pain disorders driven by trigeminal nerve sensitization and CGRP release, managed with acute abortives and chronic suppressive pharmaceuticals.
What evidence says
A migraine is a forced evolutionary shutdown mechanism triggered by a localized brain energy crisis in a metabolically inflexible host incapable of utilizing ketones.
What boards teach
GERD is caused by an overproduction of gastric acid damaging the esophagus, requiring long-term chemical suppression via proton pump inhibitors to heal the mucosa and prevent strictures.
What evidence says
GERD is a mechanical failure of the lower esophageal sphincter driven by increased intra-abdominal pressure from carbohydrate fermentation and an age-related decline in the gastric acid required to signal sphincter closure.
What boards teach
Elevated low-density lipoprotein (LDL) cholesterol directly infiltrates the arterial wall, causing atherosclerotic plaque formation and cardiovascular disease, dictating that LDL should be lowered as aggressively as possible.
What evidence says
LDL is a vital lipid-transport and immune-defense molecule that only becomes atherogenic when structurally modified by oxidation or glycation in the presence of hyperinsulinemia and endothelial degradation.
What boards teach
Type 2 diabetes is defined by hyperglycemia due to relative insulin insufficiency, treated by lowering HbA1c through escalating pharmacotherapy, including exogenous insulin, to prevent vascular complications.
What evidence says
Type 2 diabetes is a state of cellular energy toxicity driven by an evolutionarily mismatched food environment, where insulin resistance acts as a protective mechanism to prevent further nutrient overload.