Nutrition therapy is a whole new paradigm for the role of physicians. After all, in China, it wasn’t that long ago that patients paid doctors to keep them healthy. If they did get sick, they didn’t have to pay the doctor a cent – until they were well again.
In ancient Greece, the sages scorned physicians who did not advise patients about diet.
Canadian nephrologist (kidney specialist) Dr Jason Fung has watched in horrified fascination as doctors have mutated from ‘the person who keeps you healthy’ to ‘the person who gives you drugs and surgery’.
He says it’s time for doctors to educate themselves about therapeutic nutrition. Fung sees it as the future of medicine for diet-related disease. He should know. Kidney disease is one of the most common complications of untreated or badly treated diabetes. It is also a major complication of obesity that plays a role in diabetes.
Fung sees the ravages of diabetes and associated obesity on his patients daily. He also knows that both are diet- and nutrition-related diseases.
Fung has become messianic about the role of nutrition therapy in chronic disease. Jewish Middle Ages physician Maimonides would have approved. He said that ‘no disease caused by diet should be treated by any other means.’ Fung calls for a radical paradigm shift back to that ancient wisdom. Here’s what he has to say on the subject. – Marika Sboros
By Jason Fung
Does your doctor talk about nutrition? My guess is no. My feeling, as a physician, is that most doctors know very little about nutrition. Why?
It happened so gradually that most doctors are not even aware of it. The physician’s path has been corrupted over the last few decades. It has moved from “the person who keeps you healthy” to “the person who gives you drugs and surgery”.
Let me explain.
A physician’s job has always been to heal the sick and give advice on how to stay healthy. There were medical treatments, to be sure — leeching, purging, and my personal favourite, eating ground up powdered mummies.
Yes. You read that correctly. For thousands of years, eating the ground up mummified remains of long-dead embalmed human beings was considered good medicine.
The demand for powdered mummies was so great that hucksters would grind up dead beggars and plague victims and sell them as mummies.
The history of medicine is the history of the placebo effect. This mummy-eating practice died out in the 16th century. Other equally useless procedures replaced them — such as the lobotomy to cure mental illness. Hey, let me shove this ice pick through your eyeball and mash up parts of your brain like I’m mashing a potato.
Lobotomy as ‘cutting edge medicine’!
The inventor of this procedure (Portuguese neurologist Dr António Egas Moniz) received the 1949 Nobel Prize for Medicine. This was the cutting edge of medicine circa 1949.
The paradigm of medicine as a semi-useless, semi-horrifying profession began to shift with the development of antibiotics — starting with penicillin in 1928. Now, we had an effective treatment for infectious disease, which had been the major medical problem of the 20th century.
Doctors, for virtually the first time ever, had something reasonably useful to fight illness. Doctors had something better to offer than mummy extract or shoving sharp metal pointy things in through the eyeball. Yaaayyy!
Similarly, with the advent of modern anaesthesia and surgical techniques. We had effective treatments for diseases, such as ruptured appendices, gallstones and so on.
Prior to that, surgery was a grisly sight. There were no effective antibiotics or anaesthesia. Thus, postoperative complications were many. It was really just some guy with a saw, ready to cut your leg off, give you a rope to bite down on so you didn’t scream. You were just as likely to die from the surgery as the disease.
Click here to read: A ‘cure’ for type 2 diabetes: Dr Fung’s 2 easy steps
By the middle of the 20th century, this all changed. Researchers discovered concepts of germs and the importance of antiseptics. They also discovered anaesthetic agents. And they discovered penicillin and other miraculous antibiotics. That led to improved public hygiene and sanitation.
Doctors, pills and snips
And the doctor-patient relationship changed. Now, physicians saw themselves as the fix-it guy or girl. You have a disease, I give you a pill, you get better. Or, you have a disease, I give you surgery, you get better.
This worked really well from the 1940s to the 1980s. Most of the major health issues were infectious diseases. From bacterial pneumonia to bacteria, such as H Pylori, to viruses, such as HIV, to Hepatitis C, people were getting better. You can see this clearly in the life expectancy of people, 65 and older. This removes the effect of child mortality and wars etc., concentrating on chronic disease.
During this time, medical school training reflected this new role that physicians saw for themselves. We wanted to know about drugs, and surgery and more drugs and more surgery. Obesity, a dietary disease that we should treat with, I know, drugs! If that doesn’t work, then, I know, surgery!
To the doctor with a hammer, all problems are nails.
The rise of nutrition-related diseases
Nutrition training is virtually non-existent in medical school. During residency (the five years of training after medical school) we didn’t learn about it. So we didn’t care about it or to learn about it.
Click here to read: Physician, health thyself! Learn about nutrition
Being a doctor meant “I don’t care about nutrition” because that’s what the medical school taught us in medical school. Not overtly, mind you, but we were the fix-it guys and girls. The drugs and surgery gang. Not the nutritionists.
Which was fine as long as the major health problems were infections and surgical problems. Things changed by the end of the 20th century. The big problems were no longer infectious diseases.
Starting in the late 1970s we had a massive obesity epidemic. Then 10 years later, a massive diabetes epidemic. Our drugs and surgery tools were completely inadequate to deal with this new reality.
We tried to apply the 20th-century attitude to the new 21st century medical problems. But these are largely obesity-related and metabolic in nature. We tried. You have type 2 diabetes, let me give you a pill (or insulin). It was a dismal failure. We tried. You have obesity, let me give you surgery. It works, kind of, but there are a lot of complications.
So, we, as doctors, were lost. We were reduced to giving simple, puerile, and utterly ineffective advice such as “Eat Less, Move More”. Or “Count your calories”. Or “It’s all about the Calories”.
Click here to read: Think you can outrun a bad diet? Fat chance!
We didn’t understand obesity and its hormonal nature. And we didn’t know how to treat it. So, most of us admitted defeat by pretending that type 2 diabetes is a chronic and progressive disease. We pretended that obesity is a natural consequence of ageing even though it had never happened on this scale in human history. Both statements, of course, are completely false.
Weight loss woes
Losing weight often reversed type 2 diabetes, so we told people to lose weight. But we didn’t tell them how to lose weight.
Without any training, we gave the only advice we knew — Eat less, move more. This is rather ironic, considering that all available evidence from our studies shows that restricting calories is a completely ineffective method of weight control. (See The Lack of Evidence for Caloric Restriction).
We introduced non-physiologic concepts from physics, such as calories, to try to explain weight loss. ( The Useless Concept of Calories). We knew that about 99% of the time, this Caloric Reduction as Primary strategy failed, but we didn’t care.
It was the best we had, so that’s what we gave.
But there is hope. More doctors are starting to recognise that the related conditions of the metabolic syndrome are all closely related to obesity. And they are treatable, not druggable conditions. This includes obesity, type 2 diabetes, cardiovascular disease, cancer and Alzheimer’s disease.
Seeking nutrition therapy
So, the weapon of choice for metabolic problems of the 21st century is not a new drug or a new type of surgery. There are many who try to medicalise a dietary problem. But no, the best option is to treat the root cause. Treat the dietary disease with correction of the underlying diet. In other words, nutrition therapy.
The weapon of choice in 21st-Century medicine and nutrition therapy will be information. That means information far beyond the simplistic notions of calories. It also means information about the ancient practice of fasting. Information about the dangers of excessive fructose intake. Information about reducing refined foods especially carbohydrates. And information about the hormonal basis of obesity and type 2 diabetes.
The great news is that this information is not limited to doctors. Anyone with an internet connection can find it. That is precisely the point of this article, its related books and related podcast. It is detailed discussion about the science of obesity, the science of nutrition and the science of type 2 diabetes.
That is precisely the point of our online Intensive Dietary Management program. Nutrition therapy, nutrition as a therapeutic option for nutritional diseases. That is the future of medicine.