THE DOCTOR IN YOUR FRIDGE

BY FAIZ SAULAT – Every 3 months my mother and father visit their doctor to monitor and discuss the status of their diabetes, blood pressure, blood sugar, and cholesterol. Specifically, my father is a type 2 diabetic and, as a result, has his hemoglobin A1c checked. HbA1c is a measure of the average amount of glucose-bound hemoglobin an individual has had in their blood over the last 2-3 months. During his first few visits, my father was prescribed Metformin, Rosuvastatin, and Januvia, each at least one to two times per day. In other words, my father was told to take at least 3 anti-diabetic pills per day along with other medications as a solution to his diabetes.

However, as a Pakistani family, our household does not trivialize eastern medicine and the effect of diet. My father decided to reduce his intake of the prescribed drugs by half and focus more on watching his food consumption. Upon his most recent visit, his A1c values, which are measured on a scale of 5.4 to 16.5, were expected to be in the diabetic range of 7.5 to 8; his was 5.8. As a middle-aged, south-Asian, working, male immigrant with family history of high blood pressure, diabetes, stroke, and heart attack, these results were unheard of. Not to mention that diabetes is commonly a progressive disease, which means that consistent regression in HbA1c numbers is not common. This begs the question, why didn’t the physician prescribe a diet along with the medication to my father? On an even wider scale, is nutrition in general given enough of a priority in modern American healthcare?

First, it is important to understand how, and to what extent, diet affects overall health. The story of my father is more than just anecdotal. In a 2005 study, researchers placed 25 overweight participants on a low-carb, ketogenic diet. Throughout the diet, patients’ medication dosage was reduced periodically and their HbA1c levels were measured over a 16-week trial. The dietary improvements in most patients resulted either in a dramatic decrease or full discontinuation of medication. This study has also been confirmed by four other research papers that resulted in similar outcomes for patients as a result of carbohydrate-restrictive diets. The phenomenon of food as treatment is not just limited to diabetics either. Atherosclerosis, or buildup of fats in the arteries, is among the leading causes of death in the United States. However, research has shown that plant-based diets may have protective effects against atherosclerotic coronary artery disease.

It is no surprise that what we eat closely influences our susceptibility to illness. The scientific research community has, and continues to, publish countless papers on the benefits of a balanced diet and careful nutritional planning. Except, none of this information is very useful if it is not relayed to medical students. According to the Journal of the Association of American Medical Colleges, medical schools are recommended to teach 25 hours of nutrition either within a course or during clinical rotations. However, only 27% of U.S. medical schools actually meet this standard; the rest average 19.6 hours of nutritional education. Herein lies the upstream cause of modern medicine’s neglect towards diet-based solutions. Without meeting these educational standards, modern medicine will not shift towards nutrition as part of the paradigm of diagnosing patients or encouraging preventive health measures via diet.

While the problem seems to be deep rooted, there do exist innovative solutions. Physicians from U.Chicago’s Pritzker School of Medicine have partnered with dieticians and chefs from Kendall College to develop a 4-week, hands-on program that allows medical students to not only study nutrition but also practice it in the kitchen. NYU’s Langone Medical Center has also implemented a similar program known as Cook Healthy, Eat Fresh (CHEF). In this program, graduate nutrition students lead culinary classes for medical students, teaching them to cook meals that are healthy and within a budget. Medical schools could also begin on a smaller scale by simply increasing instructional time for nutrition-related topics in their curriculum. However, even if medical school curriculum is unable to accommodate more nutrition education, practicing physicians could at least refer patients to professional dieticians as part of their diagnosis. The current paradigm of medicine in the West seems to be reactive and drug-based. However, with a shift towards reliance on nutrition and diet, healthcare has great potential to prevent or even reverse commons sources of illness through more holistic mediums.