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Monday, September 23, 2013

Nutrition: What to eat or not to eat, that is the question

The China Study
A few weeks ago, a doctor who works at the same hospital where I practice came by to say hello, and I noticed he had lost some weight. When I inquired about his weight loss, he said that he had decided to do something to get rid of the extra pounds, but when I asked him what he was doing, he seemed a little hesitant to discuss what he had done. This is one of the worst things to tell someone like me because I'm kind of curious about all things I can't easily explain. How does a highly conservative doctor (yes, I'm also a little judgmental) make such an effective and rapid change in weight...and why did I feel like I was prying the method(s) out of him? He knows me well enough to say that I'm kind of a data addict and that I respect efforts that attempt to prove points by evidence-based information, so instead of telling me outright what he did, he referred me to a book (he even gave me a copy, perhaps because I'm also cheap) and said I needed to read it if I wanted to find out what he did and was continuing to do. I was hooked.
The book was one I would never choose to read on my own. The title was unattractive to me, and the purported subject matter was one that I have had little interest in exploring. Perhaps because as a medical doctor, I and many others have experienced little or no training in the subject and most of us consider the information about the subject as the purview of other professionals. The book is titled The China Study, and it was written by T. C. Campbell and T. M. Campbell. Its subject is nutrition, the subject matter best left to professional nutritionists, in the opinion of myself and many I thought.
The book is the summation of the lead author's lifetime journey through academia, which was and is focused on scientific studies related to nutrition. OK, it sounds boring. However, the authors have cleverly woven a life story about change, personal conflict, academic pressures, business interests, government regulations, and personality clashes, all linked to nutrition. To do that and present data to support many of the turning points involved in his life is a remarkable accomplishment to me because it held my interest.
More important perhaps than holding a reader's interest, the book made me rethink what I know about nutrition and its potential impact upon my family members, friends, and my patients' health. I decided to first go back to the basics, which to me helps clarify subjects; that basic point is to define terms that often have several meanings. There is a lot of confusion and much advice about what to eat and what not to eat in order to have a healthy diet. But first, what is a diet, anyway? The term diet as defined by several dictionaries is supposed to mean the usual or customary intake of food and drink by people or animals. A secondary meaning is a regulated or prescribed intake of food and drink for medical or cosmetic (for example, weight loss) purposes. The first definition does not imply that someone's food and drink intake is healthy; it simply means a person's diet is what they normally eat and drink. However, the second definition clearly implies that a diet is regulated or prescribed for specific reasons that are often health related. Consequently, it is fair to state that everyone has or "is on" a diet, but clearly not everyone's diet fits the second meaning. In my view, the second "diet" definition suggests that sometimes a person's customary intake needs to be regulated or prescribed for specific purposes, the first of which is medical. Many doctors (and patients) don't or won't like the sound of that. Why? It implies that someone (the doctor) knows what is medically best for someone else (the patient) to eat and drink.
My experience has led me to believe that diet (food and drink intake) is to most people a very sensitive, complex, and personal decision. Much of our experience with foods and drink are based on family experience, but individual decisions about taste, consistency, and even socialization and emotion can play a significant role in our diet (the first meaning of the word). Most people do not want anyone to "intrude" on basic aspects of their life and lifestyle.


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