Sunday, February 26, 2012

Nutrition and other Thoughts on Medicine

     From time to time I have had certain thoughts about the practice of medicine as well as what patients have been told by their doctor, or by advertisements, or by TV "talking heads". Some of the thoughts are summarized below. Please remember that due to my training in and work in physics, I cannot accept any statement about medical treatment unless it has been substantiated by at least one clinical trial. Often medical treatments or suggestions are inferred and never tested. As a writer once remarked: "Just because roses smell sweeter than cabbages do, it does not follow that rose soup tastes better than cabbage soup, or that rose soup is healthier".

     Let me first re-iterate an important point about all studies of human diets and their conclusions: A laboratory white rat reproduces every 30 days, so in six months I can study six generations of rats, and develop a pretty good idea of foods that are beneficial for or harmful to them. Humans reproduce every 25 years, and the longest forward interventional study was a five year study of approximately 5,000 American women, or a study that just looked at 20% of the human reproductive time. We have absolutely no good interventional studies in humans, i.e. where  we have a study group and a control group and the diet of the first group is artificially controlled.

     What we do have is a lot of epidemiological, retrospective studies, comparing groups of humans on one diet with those on a different diet. Coincidence and correlation are not the same as CAUSATION, and the results suggested by a statistical analysis of human diets should be treated as hypothetical, to then be verified by a proper single or double blind study that goes forward in time. In an earlier blog I have mentioned some of the statistical problems that arise when we do such comparisons.

     I am constantly astounded at the number of different vitamins and "health" foods my patients ingest. They all assume that if a little is good, then a lot is better, and that no "health food" could possibly be dangerous. I will tell you here and now that almost no health food has been tested on humans with a view for looking for dangerous side effects, probably because it is not in the manufacturer's best interests to do so. For instance it is widely assumed that milk thistle is protective of the liver,  but I know of no study that looked to  see if milk thistle can damage the liver or elevate liver blood tests.

     Except for the fat-soluble vitamins A,D,E, and K, if you ingest more of a vitamin that the body needs, then it is excreted (usually unchanged) in your urine. The B-complex vitamins cause the urine to look deep yellow or gold, so now we know why the book was titled "The Golden Stream". (For those of you who lever learned this joke in elementary school, the author of the book is I. P. Daly.) A curious fact is that penicillin is excreted almost 100% unchanged  in the urine. When it was first introduced, supplies were scarce, so the urine of any patient given penicillin was collected, and the penicillin re-crystalliazed from the urine to give to the next patient. So the members of the richest country in the world have the richest urine in the world.

     I think that it is healthy to be at ideal body weight (whatever that is) and to take a vitamin a day to prevent any deficiencies  that may develop as well as 1 mg/day of Vitamin B12 and400 Units /day of Vitamin D.
One should also remember that it is easier to achieve a balanced (i.e. contains the eight amino acids and three fatty acids as well as all the vitamins  that the body cannot manufacture for itself) diet with a meat diet that a vegetarian diet.There is no evidence to show if it is healthier to eat one, two, three or many meals a day, and whether or not all meals should have an equal calorie content. Or if the Spaniards are healthier or not because they start their largest meal at 10PM. When we look at long-lived octogenarian (age 80 +) people around the world, they have widely varying diets, because your diet is largely a function of where you live: north Africans eat more orzo than we do, the Far Easterners eat more rice, and people more than 500 miles from a lake or ocean eat very little fish. BTW, there is no evidence that a daily children;'s aspirin (81mg) is beneficial for the average patient with no chronic diseases.

     Every study shows that moderate drinkers live longer and have fewer heart attacks than non-drinkers. I have seen studies with scotch, wine, beer, brandy, etc. Our government has accepted this fact half-heartedly: They say that if you are a moderate drinker, please continue, but if you do not drink, don't start. Huh? If doing something is beneficial for your health don't start doing it? Also I have seen at least two studies showing that the consumption of a glass of wine or its equivqalent on a daily basis for a pregnant woman does not cause any damage to the fetus.

     Your parents may have told you that swallowing watermelon seeds or chewing gum is dangerous to your health, or not to swim right after eating, or to drink eight glasses of fluid a day----all bushwah.

     Do you recall the food pyramid you learned about in school up to about the year 2000? The pyramid has now been inverted by nutritionists, and the foods at the top, of which you were supposed to eat only once a day, you now should eat frequently (!?) And there is no mention of two key food groups: caffeinated coffee, especially in the morning, and (dark?) chocolate. Who among us could eat just one Mallomar after opening the double box? I have been reliably informed that in Ohio a giant Mallomar is sold without the cookie crust on the bottom, and is called a "Chocolate Whip".

     If you leave the table before you are completely full, avoid white potatoes (including French fries) because they are the most glycemic food of all, and remember that ALL white bread is useless calories (exception made for dipping French bread into bouillabaise), you should be able to lose weight easily.

     "I can resist anything except temptation"----Oscar Wilde

     "I wish I had drunk more champagne----Jackie Kennedy on her deathbed.





  1. I think that the current emphasis on what you eat (sugars,fats) is less important than how much you eat when it comes to preventing obesity. We have to convince both adults and children to eat less. One piece of chocolate is OK, but 12 pieces are not. One easy way to reduce your intake of food is to cut your dinner entree in half, and eat the half you take home for lunch the following day.

  2. And once again, in two separate articles published in the New England Journal of Medicine on March 26, 2012, is was shown that gastric bypass surgery was greatly superior to medication in achieving better sugar control,more weight loss, and lower cholesterol in patients with adult onset diabetes.