

The Nutrition Gap: Are Doctors Ready to Think Outside the Pillbox? - sergeant3
http://www.newrepublic.com/article/121806/nutrition-gap-are-doctors-ready-think-outside-pillbox

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wisty
> I had stumbled across Helen's blog last year. As a physician, I was unnerved
> by her approach and agreed with her doctors: Multiple myeloma requires an
> aggressive, chemotherapeutic strategy, especially in someone so young.
> Skipping chemo in favor of a dietary cure would almost certainly reduce her
> chances of survival—not unlike doing nothing at all to address the disease.
> Yet throughout medical history, renegades like Helen have given us plenty of
> insights about how diseases work, and how they might be better treated.
> Could Helen be onto something? Might the Western diet be responsible for
> more than the obesity epidemic? Could food be both the cause and the cure of
> some of our modern diseases?

OK, so the article is being provocative. The author knows that eating lettuce
won't cure cancer, but is dismayed by the lack of focus doctors have on diet.

I think that's partly wrong. Any doctor will tell a patient to eat more
veggies and get more exercise, and if you've got some specific issue they
might get more specific (or refer you to an expert).

Most patients don't need to even go to a doctor to know they are eating shit
foods.

The larger problem is FDA standards, vs the usual standard of proof. The FDA
has its weaknesses, but it's rigorous. Anything not regulated (including
surgery!) is a barely-scientific mess.

There's no regulator demanding companies prove that spinach is healthy, and
side effect free. They pretty much only regulate pills and devices, not
surgery, and certainly not foods. Obviously, the lack of a patent holder is an
issue here - no-one owns the patent for spinach, so the FDA can't find a
target to force to pay for the studies.

~~~
saosebastiao
Very few foods are unequivocally bad. The FDA _shouldn 't_ tell people _in
general_ to avoid calorie-dense diets...they have to figure out how to tell
just overweight people to avoid calorie-dense diets, because if they
accidentally tell an athlete, or a nursing mother, or someone with ALS, they
could end up doing them a lot of harm. And they can't tell people _in general_
that lots of Tomatoes or Spinach are good, because some people would end up
with Barrett's Esophagus, Acid Reflux, or Kidney Stones.

The problem the FDA has with regulating unhealthy food is similar to one the
EPA has with regulating CO2, because the goal isn't complete avoidance, it is
maintaining a safe equilibrium. But with the EPA, they have all the tools at
their disposal to monitor the environment (and we are so far gone at this
point that there is little risk to treating all CO2 like a bad thing). The FDA
still has to rely heavily on doctors and other health professionals to make
recommendations on top of their recommendations, because they don't have the
tools to monitor health.

Maybe devices are what we actually need. A device that could monitor someone's
actual health and diet and provide daily recommendations would be an amazing
thing for the FDA to work towards.

~~~
orky56
If we were able to socialize healthcare to a greater degree, we could regulate
it on a regional basis as we do with districts for education. The same way we
provide standard curricula to teachers and administration & then
evaluate/incentivize them based on the performance of their students, there
must be a similar method we could use for health and wellness.

We have superintendents responsible for arbitrary school districts, post
offices for zip codes, etc. If we had a public health official or body in
charge of a region, they would be responsible for the health of their
constituency. They could administer the right combination of food & drugs to
ensure that wellness was being achieved.

At the end of the day, we know CO2 is something that affects everyone so it
needs to be regulated. We are at the point where public health & preventive
epidemics such as childhood obesity do affect everyone and society at some
level, even just due to the interconnected nature of the cost of insurance,
drugs, and various externalities.

~~~
wisty
There's problems with top-down incentives, if they aren't well thought-out -
[http://highered.blogspot.hk/2009/01/well-intentioned-
commiss...](http://highered.blogspot.hk/2009/01/well-intentioned-
commissar.html)

Optimisation can be a literal genie, even when it's humans doing the
optimising.

------
tomohawk
While there are some astoundingly amazing treatments out there in modern
medicine, I've experienced the most benefit from simple nutritional and habit
changes.

The best bet for a healthy life is to listen to your body and take an active
role in getting proper nutrition and exercise. If you're not doing that, very
few doctors will be able to help you.

I've had many doctors, but only one of them was really great. She was
unabashed in providing non pharmaceutical guidance in addition to traditional
doctor fare. This included nutrition. Unfortunately she's retired, and I've
yet to find a doctor that can do much besides being a traffic cop or pill
pusher. I'm no longer surprised at the number of overweight, out-of-shape
doctors and nurses.

If you can find a doctor that takes a wholistic approach, realize that they
are worth their weight in gold.

~~~
jkarneges
A healthy doctor probably weighs less than average, so let's make the gold
inversely proportional.

------
matthewmacleod
Count me among the skeptics.

Nobody's fool enough to deny that diet has an impact on health; it's obvious,
and well-researched. It's almost certainly the case that nutritional
interventions can reduce the severity or course of some diseases.

And I don't agree with the thesis – that doctors don't pay any attention to
diet. Generally speaking, they do – doctors will frequently offer advice
advice regarding foods which should or should not be consumed based on an
individual's medical conditions. "High levels of dairy consumption are a " was
the advice given to a relative who had cancer, for example.

What they won't do is advocate the use of nutritional therapies in place of
conventional medicine. That's because, as far as I'm aware, there is no
convincing scientific research that demonstrates a case where nutritional
changes are more effective than conventional treatment options.

It's trite, but we have a name for 'alternative medicine' that works – it's
just 'medicine'. The benefits of particular diets are ultimately due to
compounds that they do or do not contain, and that's something that can be
studied. Until there is research done, such cures will remain firmly in the
domain of pseudoscience.

------
drpgq
Is there any specific nutritional regime that physicians recommend for cancer
patients currently?

~~~
copperx
None. The aim is to avoid muscle wasting, so they recommend high-calorie foods
if possible. If that's not possible, they stress the patient to eat __whatever
__they find appetizing.

------
noondip
A personal anecdote: I recently visited my doctor for an annual physical exam.
Since my last visit, I adopted a vegan diet void of animal products and
proudly announced I've never felt better, how my skin and mood improved, etc.
But to my surprise, the doctor was dismayed. "No bacon?", she cried. I
affirmed she wasn't joking, and decided not to question her further. On my way
out, she reminded me I should think about eating meat "for protein" \- an
absurd argument, considering there is no shortage of protein in a proper
plant-based diet.

The apparent contradiction was confusing. After all, even I know nutrition
isn't found in steaks, fish tacos, grilled cheese sandwiches, bacon omelets
and glasses of milk. I went home to learn more and found nutrition is regarded
as more of 'soft science' in medical education today. Suffice to say, doctors
don't have all the answers, or even most of them. Many are presumably ignorant
altogether.

And if the inane imprisonment, torture, rape, mutilation, and murder of tens
of billions of helpless animals every year doesn't make you want to cut out
meat from your diet, I recommend looking at the overwhelming evidence pointing
out a plant based diet is ideal for human health and the environment. Here is
a good starting point:
[https://www.youtube.com/watch?v=e-F8whzJfJY](https://www.youtube.com/watch?v=e-F8whzJfJY)

~~~
jessaustin
_rape_

Ummm, maybe I've seen different feedlot videos than you have?

~~~
noondip
How else would you describe the practice of forcing animals to be repeatedly
and forcibly impregnated against their wills with long steel devices that
shoot semen into their vaginas for the entirety of their insufferable lives?

~~~
dublinben
"Rape" implies a lack of consent, when there could have been consent. Animals
are unable to give consent, so the idea of "rape" is nonsensical.

~~~
shanusmagnus
What is nonsensical is a definition of consent that denies that animals are
able to give it. You know how when you try to do stuff to them, and they run
away or attack you or whatever? It's not a subtle message they're sending. At
least in most cases.

Of course, it's probably important to admit that 95% of Western civilization
(and maybe all civilization; and maybe all of humanity) agrees with your
perspective on this topic, to my dismay.

Edit: although when you consider all relevant issues about the morality of how
humans use animals, the ethics of forcefully inseminating them come pretty low
on the list, imo.

~~~
Ollinson
I've raised free range chickens on my small personal farm for years and let me
assure you, they don't need to any human intervention to be inspired to
procreate.

If anyone is committing rape on my farm it's the roosters, not me.

