Why gastroenterologists should counsel patients on nutrition

One of the most frequent questions gastroenterologists are asked about is diet, health and disease; and some of the questions gastroenterologists are least comfortable answering are about diet, health and disease. This disconnect occurs for several reasons. Although the subject of nutrition is taught in medical school, it usually covers malabsorption of nutrients, vitamins and minerals that have limited relevance to the concerns of most patients. The modern physician does not see many cases of scurvy or beri beri. Unfortunately, there is also a dearth of sound data on this topic, forcing physicians to operate outside their comfort zone.

It is important to consider the goal of a diet. There are focused diets to address very specific diseases (celiac disease, diabetes), diets to ameliorate more general medical problems (heart disease, obesity), diets that attempt to reduce symptoms — intestinal or otherwise — and diets with a more global and diffuse aim of promoting overall health and well-being.

In contrast, patients may be concerned about how diet may be causing a specific disease or symptom, or, alternatively, whether a specific diet may cure their disease. In this age of obesity, people are always seeking the newest and most improved advice on diet and weight loss.

Gastroenterologists are in a unique situation to counsel patients on nutrition. We see patients needing nutritional education and support at both ends of the spectrum: underweight patients or patients at risk of malnutrition due to a variety of medical and/or surgical conditions, and obese patients at risk for obesity-related health complications, such as non-alcoholic fatty liver disease.

Amongst all the challenges busy gastroenterologists have, keeping current with the ever-changing “latest and greatest” dietary breakthroughs inevitably assumes a low priority. However, it may be worthwhile to add a component of nutritional expertise to the array of services provided. The American Gastroenterological Association provides some good insight for those considering adding nutrition services to their practice.

Away from the doctor’s office, patients often look to the Internet, abound with anecdotal testimonials and frank hucksterism. The evidence for most of the popular modern-day diets is slim and slanted. The American fixation on diet is reflected by the fact that 40 percent of the New York Times Advice Best Seller List is related to diet. U.S. News and World Report, famous for its annual ranking of colleges and universities, now does the same for popular diets.

For the most part, today’s diets may promote weight loss and probably are not harmful. Some patients will claim significant improvement on one or another of these diets. Whether it is a placebo effect or some yet to be determined nutritional effect on the gut microbiome remains to be determined. Because there are so little hard data to evaluate, it will continue to be a challenge for physicians to advise patients on what to eat and why.

For now, the best advice is to stay current on the latest diet fads to better inform and educate your patients. It will, of course, be difficult to predict what the next new diet sensation will be — perhaps the Twinkie diet?

Joseph Sellin is a professor of medicine, division of gastroenterology, Baylor College of Medicine, Houston, TX. He article on this topic can be found in Clinical Gastroenterology and Hepatology, the official clinical practice journal of the American Gastroenterological Association.

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