by Barbara Berkeley, MD
Here's a subject that most Americans don't want to discuss: We need to seriously change the way we eat.
Here's the drill:
- "We don't need to change what we eat. We just have to make better choices."
- "The food isn't the problem. It's just the fact that we have to be more responsible."
- "Every kind of food is ok. In moderation."
- "We'd be fine if we'd just learn to eat only when we're hungry."
- "The food isn't the issue. It's just that we are such emotional eaters."
The italicized words and phrases above are the ones that drive me to distraction. Kind of my personal "Niagara Falls" (for those younger than 50, you may want to Google that. See Abbot and Costello)
Those who don't want to have the discussion about major diet change include doctors. While all of us--docs and patients alike-- are waiting for the magic pill that will allow us mainline chocolate and McDonald's, we are rapidly becoming a nation of pill popping, insulin injecting, vascularly bypassed obeso-diabetics. I don't fault doctors for defaulting to medications to treat food-related problems like high blood pressure and diabetes. They have never been trained to do otherwise. I do fault them, however, for not tryng to learn more about the importance of eating for health. Twenty years ago, we were living in a different landscape. Now, we are seeing patients who already have seriously malfunctions in the way their bodies (the pancreas, the fat cell mass, the gut) deal with modern food. Why has treatment via diet remained so ignored?
This week in a publication called Gastroenterology and Endoscopy News, there was an article about irritable bowel syndrome. Those who have IBS are often plagued with uncontrollable diarrhea, cramps and alternating periods of constipation. As a former sufferer, I can tell you that I used to know the location of every clean public restroom in Manhattan. I once seriously considered writing a guide to New York bathrooms for those with irritable bowel. Bet it would have been a bestseller. Needing to know where the nearest bathroom lies is an all too familiar imperative for IBS folks. When I became primarily Primarian about 12 years ago, my IBS completely resolved. Coincidence? I don't think so.
The article on IBS is titled, "Expert Calls Diet 'Next Big Thing' in IBS". Why oh why are we JUST discovering that diet is involved in most of what ails us??
Here are some exerpts from this article:
"A large body of evidence suggests that diet modification can contribute to a substantial reduction in or elimination of symptoms associated with irritable bowel syndrome, according to an expert in the field."
"..a majority of patients report that the amount and type of foods they eat influence the risk or worsening of their IBS symptoms."
"...Dr. Chey recommended screening all patients with IBS for celiac disease. He acknowledged that the diagnostic yield may be low but cited several studies demonstrating that gluten-free diets can reduce symptoms of IBS substantially. For IBS patients who test negative for celiac disease, Dr. Chey considers a low carbohydrate diet."
"It is very clear to me that diet is the next big thing in IBS," Dr. Chey said.
The article then requested a comment from a physician in another institution. This doctor cautioned that all of these statements should be interpreted conservatively. Diet and IBS is "an extremely complex subject", he said, and all of the elements "require much more formal and detailed prospective studies."
I support evidence based medicine and I certainly support formal and detailed studies of the many drugs that alter our body processes and which we give to trusting patients who believe they will be safe. On the other hand, there is absolutely no reason not to try dietary change, particularly when the changes eliminate problematic foods that are not essential to human health anyway.
Is diet the next "big thing" in IBS? It has always been the "big thing" for every living organism! It's the big thing in controlling fat, in making diabetes go into remission, in resolving blood pressure, in halting coronary artery disease, in lowering the chances of developing cancer, in decreasing inflammatory diseases, in modulating autoimmune diseases, in allowing us to be fully functional. How much "bigger a thing" can it be??
And when will we physicians start to look at real diet change as arguably the most serious weapon we have against modern disease?