Thursday, February 14, 2019

We are what we eat

Doctors tend to treat patients’ ailments and try to prevent disease with pills. It is what we learn most about in medical school. Most doctors give very little attention to diet for several reasons. First, most doctors know little about diet; very little time is spent on diet in medical school curriculums and it is rarely part of our postgraduate education or continuing education courses. We are bombarded with information about drugs in our journals and at medical conventions and we are heavily marketed in our offices by “drug reps,” salespeople for pharmaceutical companies. I never saw a dietician in my office in the 40+ years I practiced. Finally, we are all too well-aware that changing diets is difficult and feel, probably correctly, that it is easier to get our patients to take a pill once daily than it is to change their habits.
At the same time, there is growing evidence that dietary habits have a major influence on our health. Three recent studies brought the point home to me. A report from the long-running Women’s Health Initiative found that frequent eating of fried chicken, fish or shellfish was associated with a higher risk of cardiovascular (CV) disease and death. Another study looked at boys who had fatty liver disease, a condition associated with obesity that has become epidemic in this country. It can go on to cause severe liver disease. They found that a diet low in free sugars resulted in improvement in the liver disease. A third study recently reported looked at the protective effect of a Mediterranean diet on the adverse effects of air pollution in 6 states and two cities in the U.S. Air pollution causes increased cardiovascular disease and death. The people in the study who stuck most closely to a Mediterranean diet had less CV and overall death.
Just as with most topics in medicine, there is a lot of conflicting and confusing information out there. Over the years, I have seen come and go such fads as the Atkins diet, the Scarsdale diet, the “paleo” diet and many others. The only consistent support for health benefits, however, seems to attach to the “Mediterranean diet”. What is this? The Mediterranean diet emphasizes:
• Eating primarily plant-based foods, such as fruits and vegetables, whole grains, legumes and nuts
• Replacing butter with healthy fats such as olive oil and canola oil
• Using herbs and spices instead of salt to flavor foods
• Limiting red meat to no more than a few times a month
• Eating fish and poultry at least twice a week
• Enjoying meals with family and friends. (I think the reason the French live longer is not the red wine so much as it is taking a two-hour break for a leisurely lunch with friends and family.)
• Drinking red wine in moderation (optional). One pleasure doctors don’t have to forbid!
• Getting plenty of exercise
Try it. Hopefully you will like it and you will probably live longer!

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