What sets this medical clinic apart from other ones?

There are two things that set us apart.

First, we operate with a healthcare team of doctors, scientists and nurses. This structure creates time for our doctors to truly listen to patients. The team will review lab results together and tap into their professional networks for additional brain power when necessary, thus ensuring patient cases and concerns are thoroughly addressed. We want to avoid the trap of typical medical clinics, where patients receive poor care because of overworked and uninformed doctors.

Second, we think that medicine can only be practiced scientifically when an evolutionary lens is applied. This means that we operate on the belief that how our ancestors lived and ate hundreds of thousands of years ago, provides important clues as to how we can live and eat healthily today.

Why does the clinic encourage me to take multiple blood tests? And what are some of these markers that I’ve never seen before?

The body is a dynamic system who’s function is best captured by following health markers change over time. It beats single point measures.

Furthermore, systematically collecting health data on patients enables our healthcare team to mine it for insights that could help them. Please read more about our data privacy policy.

Why do appointments at the clinic last 45 minutes instead of the typical 15?

We believe that when doctors do good by their patients, it’s largely due to the attention and compassion they provide. This cannot be done in 15 minutes which is typical for a medical appointment in Portugal. We budget 45 minutes per consult to make sure we’re up to date on

  • your life and family history
  • your pharmaceutical and supplement regimen
  • your diet
  • your exercise routine
  • your stress status
  • your goals
  • your questions and concerns

This format builds rapport and develops trust based on open and honest conversations.

  1. International variations in primary care physician consultation time: a systematic review of 67 countries (2017)
  2. The importance of physician listening from the patients’ perspective: Enhancing diagnosis, healing, and the doctor–patient relationship (2011)
What is continuous remote care and why does the clinic work that way?

Medicine is about so much more than yearly visits and lots of pills. In addition to the doctor-patient relationship (see previous section), the magic happens outside the clinic for patients; where small daily wins accumulate over months. Modern communications and medical devices unlock continuous remote care, allowing us to trouble-shoot problems rapidly. For example, by using connected bathroom scales we can catch fat-loss stalls early and offer solutions to get back on track.

  1. Telemedicine via Continuous Remote Care: A Proactive, Patient-Centered Approach to Improve Clinical Outcomes (2021)
Why would a doctor emphasize lifestyle changes so much? Does the clinic discount the value of modern medicine?

We acknowledge and celebrate the fact that when properly prescribed, pharmaceutical drugs can save lives and even improve quality of life. We just don’t think this happens nearly as much as it could (see previous FAQ).

‘Diseases of civilization’ like heart disease, diabetes and dementia are in the top 10 of causes of death. And drugs have largely failed to make a dent in patient survival for these conditions. The alternatives are lifestyle interventions such as paleo diets, exercise, sleep hygiene and stress management. They’re remarkably safe and effective but not widely adopted over the long-term. This is partly because your average doctor isn’t properly educated in this matter or is unwilling to risk deviating from the medical guidelines.

Every tool with interesting risk-to-benefit ratios we want to use, whether that’s pharmaceuticals, cognitive therapy, supplements or lifestyle interventions.

  1. The top 10 causes of death (2020)
  2. Adherence to Lifestyle Interventions for Treatment of Adults with Depression: A Systematic Review and Meta-Analysis (2021)
Why is ‘de-prescribing’ part of the clinic’s goals? Won’t patients miss out on helpful medications?

We all want to live in a world where good medicine can save us, it’s one of the joys of modern living. However, a lot of medications are over-prescribed or inappropriately so. They’re then less effective and more likely to hurt you and your wallet. Many people want to get off them and fortunately we can help with that.

  1. Ethics and Informed Consent (2021)
  2. Overprescribed Medications for US Adults: Four Major Examples (2019)
Why would a doctor recommend that I eat red meat? Won’t it give me a heart attack or colon cancer?

The diets our ancestors evolved on were rich in animal foods like fatty red meat. Our physiology is well adapted to it. Red meat is rich in vitamins, minerals, high quality protein and has a great fat profile that includes essential fatty acids. Contrary to what recurring media headlines warn us about, the evidence that meat causes colon cancer (or any cancer) and cardiovascular disease is extremely weak. Some fear that eating meat means eating less plant fiber and assume this will worsen gut health, when in fact removing fiber can actually benefit digestive conditions (see fiber question). We think red meat is an asset to your health.

  1. The evolution of the human trophic level during the Pleistocene (2021)
  2. Effect of processed and red meat on endogenous nitrosation and DNA damage (2009)
  3. Stopping or reducing dietary fiber intake reduces constipation and its associated symptoms (2012)
Why would a doctor recommend I tan, especially without a UV blocker? Won’t it increase my risk for skin cancer?

The natural environments we humans evolved in exposed us to sunlight. We’d seek shade or covered up to avoid burning. People who really avoid the sun take on as much risk of death as a smoker does. And to the surprise of many, the evidence that sunscreen reduces your risk of getting skin cancer is inconsistent. Furthermore, your odds of surviving melanoma skin cancer is worse if it’s found on parts of your body that are the least (not the most) exposed to sunlight! So we encourage you to spend time under the sun, but use your common sense to avoid burning: use clothing and shade, but resort to sunscreen when neither are available.

  1. Avoidance of sun exposure as a risk factor for major causes of death: a competing risk analysis of the Melanoma in Southern Sweden cohort (2016)
  2. A randomized controlled trial to assess sunscreen application and beta carotene supplementation in the prevention of solar keratoses (2003)
  3. Anatomic location of primary melanoma: Survival differences and sun exposure (2019)
Why would a doctor say fiber is optional or not essential in a healthy diet?

Fiber is greatly misunderstood. It doesn’t only come from plants, it’s also found in the cartilage and skin of animals. In practice, virtually everyone is getting the vast majority of their fiber from plants.

Fiber is not an essential dietary factor in any strict sense, meaning that removing it doesn’t inherently result in deficiencies or pathologies. Although it was once thought to help lower blood sugars it was later discovered that it in fact didn’t. What it does most notably is increase stool volume and contribute a small amount - maybe as much as ~ 4% - to total caloric needs via bacterial fermentation of fiber into fat in the colon.

Contrary to popular belief, reducing or removing plant fiber actually helps resolve constipation! Plant fiber also commonly contributes to bloating, digestive discomfort more generally, and can act as an antinutrient, reducing the biovailability of micronutrients by binding them in the gut. In sum, plant fiber is optional for two reasons: it’s non-essential and although many people tolerate some amount of it just fine, others need to moderate their consumption or avoid it entirely in order to avoid various symptoms.

  1. The evolution of the human trophic level during the Pleistocene (2021)
  2. Stopping or reducing dietary fiber intake reduces constipation and its associated symptoms (2012)
  3. To what extent does increased dietary fiber improve glucose and lipid metabolism in patients with noninsulin-dependent diabetes mellitus (NIDDM)? (1986)
  4. The Role of Dietary Fiber in the Bioaccessibility and Bioavailability of Fruit and Vegetable Antioxidants (2011)
Are vegans and vegetarians welcome at Clínica Pêro? Can you be pro-meat without being anti-vegan?

Yes, vegans and vegetarians are totally welcome! Our love for meat breeds no hate towards anyone. We keep science and medicine separate from ideologies, whether religious or dietary. We will work with anyone motivated to improve their health and performance. Our advice is always given out honestly, even if it conflicts with views of our patients.

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