I was misinformed about medical school. Growing up, I wanted to help people become healthy. After four years at the Ohio State University Medical School and three years of a family medicine residency, I still did not know enough to accomplish my goal. My training allowed me to become a disease-care expert, not a health care specialist. I was taught little to nothing about nutrition and true disease prevention. Despite this, I am not asking for a medical school refund — I claim full responsibility and then took the necessary steps to learn about health, nutrition, and diet so I could help my patients.
In 1903, Thomas Edison helped shed light on the doctor of the future, which we have yet to fully realize in our profession. He stated: “The doctor of the future will give no medicine, but will interest his patient in the care of the human frame, in diet and in the cause and prevention of disease.”
Most of us spent at least seven years of our lives learning how to diagnose, manage and treat chronic diseases and their sequela. Unless dealing with trauma or cutting things out, we have become experts on the management of chronic conditions such diabetes, hypertension, headaches, cardiovascular disease, autoimmune diseases and all the complications that occur as a result of these conditions, among many others.
However, when patients ask us, physicians, how they can prevent diabetes, hypertension, heart disease, migraines or reduce risk their of developing cancer, most doctors will have little to no idea how to answer them. Frequently, we tell our patients, in a cliché manner, “Watch your diet and get some exercise.” We can’t provide specific diet and nutritional information, as we simply don’t know. We know little about dietary programs and which are best for our patients.
We prescribe cholesterol-lowering medications and other pharmaceuticals to help “prevent” diseases. We prescribe “a pill for every ill,” as cardiologist and author Dr. Mimi Guarneri states. Further, despite the evidence of benefit, we collectively advise patients to eat a low-fat diet. Most health care providers have a poor understanding of true health, only disease, and its manifestations. Wellness is not simply the absence of disease.
A 2017 study in the American Journal of Medicine demonstrated this fact. Nine-hundred thirty cardiologists were surveyed. Ninety-five percent of the cardiologists believe and felt it was their responsibility to teach their patients at least basic information on nutrition. However, 90 percent reported they received no or minimal nutrition education during their cardiology fellowship. Almost 6 in 10 admitted they received no education training during their internal medicine training and 31 percent admitted to no nutrition-related education in medical school. Lastly, when asked about their diets, only one in five cardiologists admitted to consuming five or more servings of fruits and vegetables daily. This level is known to provide significant health benefits and help prevent chronic disease.
What is the best diet?
This is an evolving field. First, I recommend that my fellow physicians read, at least, the New York Times bestselling diet books, as these are the ones your patients are reading. In my opinion, this is crucial so we can have meaningful discussions with our patients and provide solid opinions. There is no one diet that is best for everyone. We need to remember this!
To date, the Mediterranean diet has the most evidence of heart-health benefit. This diet consists of fish (preferably low in mercury), monounsaturated fats, like those from nuts, seeds, and olive oil. It also includes generous servings of fruits, vegetables, whole grains, and legumes/nuts. The diet also allows alcohol consumption. Men should limit themselves to two servings per day while women, one serving. If you do not already drink, do not start.
The ketogenic diet is making a popular comeback. It consists of high healthy fat intake (60-75 percent of calories), moderate protein (15-30 percent of calories) and low carbohydrates (5 percent of calories). Originally, this low-carbohydrate diet was recommended for medication-resistant seizures. Now, however, when done right, it can be beneficial for weight loss and for the treatment of type 2 diabetes. There are even studies suggesting it can help those with cognitive impairment, such as mild to moderate Alzheimer’s disease.
Another popular diet is the Paleo Diet formulated by Loren Cordain, Ph.D. It is also commonly known as the “caveman diet.” This diet advises one go back to a diet similar to what our caveman or paleolithic ancestors consumed. The diet allows lean meats, nuts, seeds, fruits and vegetables while prohibiting grains and dairy products. Numerous studies have shown benefit including a 2017 study which concluded “A Paleolithic diet improves fat mass and metabolic balance including insulin sensitivity, glycemic control, and leptin in subjects with type 2 diabetes. Supervised exercise training may not enhance the effects on these outcomes, but preserves lean mass in men and increases cardiovascular fitness.”
There is the DASH diet, which stands for Dietary Approaches to Stop Hypertension. This diet is promoted by the U.S.-based National Heart, Lung, and Blood Institute to help reduce blood pressure. This diet recommends generous servings of fruits, vegetables, whole grains, and low-fat dairy. It also encourages fish, poultry, lean meat, nuts, and seeds. The important part about it is that it recommends avoiding sugary foods and sweetened beverages.
Lastly, for those who want to gain a better understanding of why we gain weight, I recommend The Obesity Code by Dr. Jason Fung. He discusses the role not only diet but also insulin plays. He demonstrates that the calories in vs. calories out belief is simply a myth and touches upon the concept of intermittent fasting and how that style of eating, no matter what diet one is on, can assist with weight loss and optimize metabolism. Further, insulin resistance is a risk for cancer so consuming a diet which reduces insulin production is crucial.
Eric Madrid is a family physician and can be reached on Instagram or Twitter @ericmadridmd.
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