July 30, 2013
We all know that nutrients are essential to maintain normal cellular function, and it is widely accepted that diet can play an important role in managing chronic diseases like hypertension and diabetes. It’s also recognized that a wholesome diet is essential for preventing malnutrition and maintaining a normal body weight throughout life, which confers its own set of benefits, including reducing the risk of life-threatening diseases like cancer and heart disease while ensuring optimal body function.
Although it’s clear that nutrition is important, it seems that it’s still often overlooked. Generally, if there is a medicine to treat a condition, the inclination seems to favor prescribing rather than advising. This, to me, seems like such a missed opportunity. I recognize that there are times when using medication is absolutely necessary, but I don’t understand why the prescription route is the preferred go-to remedy and why diet often isn’t part of the discussion, even if just as a complementary therapy. It would certainly help reduce healthcare costs and perhaps result in more patients adopting healthier lifestyles.
Several years ago, my mother went to see her primary care physician for a physical, which revealed that she had a high level of triglycerides and low-density lipoprotein (LDL) cholesterol and a low level of high-density lipoprotein (HDL) cholesterol. Based on these findings, her physician immediately wanted to prescribe atorvastatin. Always being suspicious of medications, my mom read up on it and became concerned because of the potential for hepatic injury. She had experienced liver issues before, so she expressed her concerns to her doctor, which were dismissed as he handed her the prescription. Always being interested in nutrition, my mom did additional reading and put herself on a strict vegetarian diet. She wanted to see if a dietary approach could correct the problem, and when she went back to the doctor a few months later for a follow-up examination, the proof was in the proverbial pudding. Her LDL cholesterol level was on the low end of normal and her triglycerides and HDL levels were in the optimal range. Adjusting her diet was all it took.
Of course, this was only one instance, and I know I can’t generalize, but I witnessed more of the same with my mother-in-law. In this case, she was battling breast cancer. Never once during her cancer journey did the oncologist bring up diet, except to say “eat whatever you want.” Now, I know that diet would not have cured my mother-in-law, and I know that her treatments were an absolute necessity, but guidance on how to eat may have spared her some of the side effects that she suffered as she was being treated. Eating right may have also helped her feel more energetic earlier in her journey and prevented some of the horrific adverse effects she experienced towards the end of her life. At the same time, I’ve learned by now that there is a time when eating without limitations is an appropriate strategy, but this was the only “strategy” she was provided, from diagnosis through hospice care.
At first it seemed to me that my mother-in-law did not receive any nutrition guidance because she was being treated in a community-based oncology clinic, rather than a cancer treatment center, and resources were limited. But as she was struggling with her cancer, I happened to sign a contract to coauthor a cancer nutrition book and soon learned that relatively few cancer patients receive any kind of nutrition guidance, regardless of where they’re treated. This surprised me and seemed counterintuitive, particularly because cancer is a cellular disease that often requires such harsh treatments that you’d think patients would be advised to nourish their healthy cells, even if just as a prophylactic measure.
As I worked with both a cancer nutritionist and oncologist on the book, I learned so much about eating when you have cancer—things I wish I would have known sooner so that I could have shared them with my mother-in-law when they may have made a difference. Of course, unlike my mom, my mother-in-law never saw much value in diet and was always afraid of getting too many vitamins and minerals, even though she only supplemented when instructed and favored processed foods. So I doubt she would have listened to me much anyway, but she was very much about following doctor’s orders, so had her oncologist guided her on the nutrition front, I’m sure she would have made an effort to comply.
As the case for nutrition continues to build, I really hope that more healthcare providers will consider diet an important tool in their disease-fighting arsenal and advise their patients accordingly, regardless of the disease their patient is facing. If they don’t, patients may not benefit from this important weapon, or, even worse, they may just follow that crazy fad diet they saw on the cover of the tabloid they bought on their way out of the supermarket.
Of course, while diet can be an effective and important tool, we’re learning more about how nutrient demands change with age, and it has become clear that diet is a tool that needs to be personalized. Both Annals of Long-Term Care and Clinical Geriatrics have published several important articles on nutrition focused on the older adult, which you’ll find the links to below. I hope that you’ll take the time to read these articles and share your thoughts and experiences with us. We’d like to know your approach to addressing diet with your patients. For instance, now that the American Medical Association has classified obesity as a disease, will diet be your go-to weapon for your overweight and obese older patients, or is this now another disease for which a script will suffice?