What’s up Doc?

When something goes wrong or you don’t feel well or right, you make an appointment with your family doctor. The doctor takes your history and examines you.  Usually, you’ve just picked up a virus, minor bacterial infection or a common cold.  The doctor will advise you on the best treatment and when necessary, prescribe the right medicine.

Sometimes, especially as we age, problems can be a little more serious.  Type 2 diabetes, high blood pressure, high cholesterol and obesity have become more common.  From the pharmaceutical point of view, your doctor is the most qualified person to treat whatever you might have.  However, many doctors have become aware of how much proper diet plays into health.   People are telling me that some of their doctors have given them some general direction as far as eating better and exercising more.  So how should a doctor advise his patients regarding issues of nutrition and lifestyle in general?

As medicine evolves, doctors are becoming more proactive in preventative medicine and not just treatment and cure. One of the prime resources for quick information for doctors and other health professionals over the last 10 years is the online service Medscape.  Recently, Dr. Naveed Saleh and Registered Dietician Renee Simon put together a guide for doctors based on reliable studies showing that acting on 6 different areas will change a patient’s health for the better.  They point out that proper nutrition is a critical component to human health.  For instance, we know with certainty that half of cardio-metabolic deaths are directly linked to poor diet.

Here are the 6 suggestions mentioned by Dr. Saleh and Renee Simon:

1. Choose foods with a wide variety of colors and textures, in their most natural forms.

   Foods that are enjoyed in a natural state provide the greatest satiety and nutritional value. A wide variety of unprocessed colors and textures will make the most significant difference in long-term health and longevity.

7.4% of all cardio-metabolic deaths were linked to sugar-sweetened beverages, and 8.2% were linked to processed meats.  A March 2017 study published in JAMA showed that one half of all cardio-metabolic deaths in the United States “were associated with not enough intake of vegetables, fruits, nuts, and seeds, as well as omega-3 fatty acids.”  As a result doctors are being asked to emphasize avoiding sweetened drinks and processed meats. Still,  doctors need to encourage consumption of more nutritional foods.

2. Avoid or dramatically minimize processed foods.

Processed foods and beverages, such as packaged snacks, deli, white flour, and sodas, should be avoided.

Many nutritionists and clinicians are concerned about blood glucose levels, obesity, diabetes, and other health implications. They believe that sugar is the “new tobacco.” Recent studies also indicate that artificial sweeteners and diet soda may not be protective, and may even cause harm.

Sodium is another long-time concern, and is prevalent in processed foods. Americans ingest sodium mostly from foods prepared outside the home, as opposed to the sodium naturally present in whole foods. Doctors are being asked to advise people to prepare most of their own meals, especially avoiding packaged foods.

3. Choose realistic, balanced diets for weight loss and weight maintenance.

The most successful diet is one that people can stick to. Plenty of diets have proven effective for weight loss and weight maintenance. When dieters fail, it is because they attempt to follow diets that are too restrictive, unbalanced or cause rapid weight loss. This leads to yo-yo dieting.  They should recommend the Mediterranean diet, portion-control plates the DASH diet or seeing a qualified dietician.

All eating plans should include the following:

• Increased vegetable and fruit intake
• Consumption of foods that are high in fiber
• Consumption of whole-grain foods
• Increased water intake
• Decreased intake of dietary sugar
• Sufficient intake of healthy fats

One helpful rule of thumb is to have half a plate of vegetables, one fourth a plate of lean protein, one fourth a plate of high-fiber complex carbs, and one serving of healthy fat.

4. Consume healthy oils for heart health: fish, olive, avocado.

Fish oils can prevent further illness in those with a history of heart disease. The AHA recommends eating fish that are rich in omega-3 fatty acids.  Other beneficial fats include olive oil, avocado oil, canola oil, walnut oil, flaxseed oil, and chia seed oil.

7.8% of cardio-metabolic deaths were tied to low levels of omega-3 fatty acids in the diet. Although understanding the complex interplay between good fats and bad fats is an ongoing challenge, certain fats and oils are known to have benefits; these include fish oil and olive oil. You can get omega-3 from salmon, and certain other fish.  Although fish oils are considered the ideal source, vegetarian and vegan patients can use flaxseed, walnut, or chia seed oils, which contain alpha-linolenic acid, a precursor to the omega-3s. Consumption of fish itself is always the optimal choice, but fish oil supplements are also available over the counter.  Research has also found that vitamin D works in conjunction with the omega-3s to improve cognitive function and social behavior, as well as overall mood.

5. Forego red meat and live longer.

Although red meat is a principal source of protein and fat, research shows that consumption of red meat is linked to increased risks for cancer, diabetes, and cardiovascular disease, all of which decrease longevity. In a 2012 study titled “Red Meat Consumption and Mortality: Results from Two Prospective Cohort Studies,” Pan and colleagues prospectively followed 37,698 men and 83,644 women, all of whom were health professionals, during a maximum period of 28 years. These participants did not have cardiovascular disease or cancer at baseline. The researchers found that consumption of red meat increased risk for cardiovascular, cancer, and total mortality.

The researchers also found that substituting one serving of red meat per day with one serving of fish, poultry, legumes, nuts, whole grains, and low-fat dairy was associated with a 7%-19% reduction in mortality risk. Moreover, if participants consumed less than one half a serving of meat per day then 9.3% of deaths in men and 7.6% of deaths in women could have been prevented.

6. Consume fermented foods/probiotics and fiber for gastrointestinal and overall health.

   Probiotics contain microorganisms that bring gastrointestinal benefit. They are commonly found in yogurt, kefir, and unpasteurized fermented foods and drinks. They can also be taken in supplement form. In order to thrive, probiotics require prebiotics as food, which can be found in fiber. The human microbiome has been implicated in a wide variety of health and disease states. Research is still ongoing, but for now, probiotics have definitely been found to benefit gut health.

One recent study found that indolepropionic acid, a metabolite produced by intestinal bacteria and fortified by a fiber-rich diet, is protective against type 2 diabetes, whereas another study found a protective link against colon cancer. Research into the microbiome/mental health connection has also been intriguing.

Less is more

Doctors have also been asked not to give too many suggestions at once.  Unless a doctor knows that his patient has an exceptional memory, he should give 2 solid suggestions at a time. These suggestions should focus on changing behaviors that are potentially hazardous to health into positive habits.

Traditionally, physicians have focused on clinical treatments, leaving matters of diet to the registered dieticians and nutritionists. With great amounts of diet advice being spread around on a regular basis, some might be tempted to stay clear of this domain. With evidence mounting that diet plays a significant role in health and disease, it is important that each clinician remind patients of the most important dietary tips they should be following. With enough reinforcement, it could make a big difference in their patients’ health.

Many doctors have finally initiated a look at diet and exercise as first-line treatment almost as much as medicines.  We need this to become the standard.  After all, exercise and good eating is the best medicine there is to stay healthy and out of the doctor’s office.   The first choice is still seeing a registered dietician and an exercise specialist in order to get the most out of diet and exercise.  But now our primary care givers, our doctors, have started encouraging their patients to make changes in their eating and develop good exercise habits, in order to “add hours to our day, days to your year and years to our life”.