Addressing
Controversial Food Claims with Patients
The internet has had a resounding impact on human health. There is
so much information at our fingertips but unless you are an authority
interpretation of what we read in the media is open to debate. Since I am a
nutritionist my patients are quite curious around commentaries that imply
soybeans cause breast cancer, that gluten causes Alzheimer’s disease, that
ketogenic diets are an ideal weight loss strategy, etc. I have been challenged
to explain these controversial claims in simple terms but after a few
iterations, I’ve come up with a three-pronged approach that is both effective
and appreciated:
2. Discuss
the potential consequences of the claim
3. Provide
alternative recommendations
I first start by explaining the science behind the headline.
Sometimes the claim is derived solely from experiments conducted in test-tubes
or in rodents. These data often do not translate to humans, or, translation
studies have yet to be preformed.
For example, the relationship between soy and cancer stems from
studies with a breast cancer cell line. These experiments showed that the
phytochemical in soybeans, genistein, increases the growth of MCF7 cells at low
concentrations but inhibits their growth at high concentrations. Several
meta-analyses looking at outcomes in humans have shown that soybean consumption
not only reduces the risk of breast cancer, but it also reduces rates of
reoccurrence of breast cancer and increases lifespan in breast cancer patients.
Calorie restriction is another hot button topic that purports
extended lifespan when calorie consumption is limited. This theory has only
been documented in cell lines, rodents, and monkeys, and has yet to be proven
in humans. I have a strong opinion regarding calorie restriction in that I do
not allow any of my patients to consume fewer calories than their metabolism
will support which is typically 1,500 calories for women and 2,000 calories for
men.
I then explain the physical consequences of following through on
these types of claims. Eliminating entire food groups is rarely a good idea. A
large percentage of my patient population is interested in testing out, for
example, a ketogenic diet for weight loss or a Paleo diet if they suffer from
an autoimmune condition. Following a ketogenic diet, where 70 to 80 percent of
your calories are derived from fats, is a short-term strategy that will produce
short term results. Tricking the body into using fats instead of glucose for
energy will starve the body of fiber and critical nutrients such as folate
(B9), biotin (B7), selenium, choline, vitamins A, E, and D, chromium, iodine,
and magnesium, leading to malnutrition and a wicked case of constipation. Furthermore,
compliance among my weight loss patients following a ketogenic diet is zero
percent.
Exclusions in the Paleo diet include whole grains, legumes, and
dairy, which lead to deficiencies of B vitamins, calcium and vitamin D. These
deficiencies alone greatly increase the risk of osteoporosis. Although these
gaps may be corrected with supplements, the body assimilates nutrients best
from foods that dilute and disperse among other substances that facilitate
their absorption and use by the body.
I am currently working with a young mother, diagnosed with Graves’
disease, who is still nursing her son. She has been strictly following a Paleo
diet to alleviate her hyperthyroid symptoms. Her condition has not improved and
she risks a calcium and vitamin D deficiency, which could be detrimental for
both the mother and her baby.
As a former pharmacologist who has developed drugs for just about
every therapeutic indication you can think of, I’d like to point out that
medicines are nothing more than nutrients that are structurally modified to
make them more potent than their original form. Medicines are used
therapeutically to correct chemical deficiencies. Food, on the other hand, is
used for disease prevention and health maintenance. Looked at another way, food
truly is medicine, and if you do not get enough nutrients from food then
medicine will become your food.
Fresh food contains all the nutrients you need in just the right
concentration that nature intended. Pharmaceutical “nutrients” are at least
10,000 times more potent than the nutrient from which they are derived. This increase
in potency increases risk of off-target activity and subsequent side-effects.
Over-eating is akin to a nutrient overdose, which also has side-affects,
including bloating, gas, diarrhea, and heart burn.
Finally, after explaining the controversy and consequences, I
provide my patients with an alternative recommendation. I cannot think of any
better dietary strategy then a Mediterranean diet, which does not eliminate any
food group. This meal plan focuses on consumption of fruits, vegetables, and
whole grains with modest consumption of animal protein and healthy fats that
include avocados, olive oil, nuts and seeds. A Mediterranean diet has been
clinically proven to reduce all-cause disease risk and to increase lifespan
when routinely followed.
For patients who are concerned about food sensitivity, I offer
blood testing that measures immunoglobulin levels produced in response to 96
different food antigens. If a bona fide food allergy is suspected, then I refer
my patients to a reputable immunologist.
I welcome my colleagues and all members of the nutrition community
to adopt these three useful strategies for answering patient concerns around
food, explaining the controversy, discussing the consequences, and providing
alternative recommendations based on scientific data. I have found that this
increases compliance with my suggested guidance and prevents patients from
following ideas that may not be beneficial to their health.
References
Crous-Bou, M., Fung, T.T., Prescott, J., Julin, B., Du, M., Sun, Q., Rexrode, K.M., Hu, F.B., and
De Vivo, I. (2014) Mediterranean diet and telomere length in Nurses’ Health
Study: population based cohort study. BMJ (Clinical research ed.).
Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4252824/
Jacobs D.R. Jr., Gross, M.D., and Tapsell, L.C. (2009) Food
synergy: an operational concept for understanding nutrition. American
Journal of Clinical Nutrition. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/19279083
Pons, D.G., Nadal-Serrano, M., Torrens-Mas, M., Oliver, J., and
Roca, P. (2016) The Phytoestrogen Genistein Affects Breast Cancer Cells
Treatment Depending on the ERα/ERβ Ratio. Journal of Cellular Biochemisty.
Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/26100284
Sizer, F.S., Whitney, E. N. (2017) Nutrition: Concepts and
Controversies 14th Edition. Cengage Learning
Shu, X.O., Zheng, Y., Cai, H., Gu, K., Chen, Z., Zheng, W., and
Lu, W. (2009) Soy food intake and breast cancer survival. JAMA. Retrieved
from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2874068/
