By Sophiya Uprety (Nutritionist) and
Dr. Ramesh Kant Adhikari (Professor of Pediatrics and Former Dean, Institute of Medicine)
“Let food be thy medicine and medicine be thy food.”
Hippocrates, a Greek physician and the Father of Medicine, coined this wisdom more than 2,000 years ago. Food has long been understood to have protective and healing properties. Nutrition was clearly embraced at the very beginning of the modern medical profession. In spite of that, the evident gap between doctors and nutrition at present is a strange paradox.
“When diet is wrong, medicine is of no use; if diet is correct, medicine is of no need.”
Old Ayurvedic Proverb
Evidence-base to Reconnect
Modern medical science relies on scientific evidence as the gold standard. The past research focus was disproportionately tilted towards the curative side. More evidence were generated on treatment rather than on the cause of diseases. This seems to have happened more after the boom of pharmaceutical companies during the first half of the 20th century. Preventive aspects on the role of wholesome and nutritious diet were thus missed from the research purview. This led to the paucity in evidence proving the protective and promotive role of nutrition. Furthermore, the impacts of nutrition on health are often gradual with cumulative effect. This is another reason why the value of good nutrition gets overlooked. Consequently, nutrition science was unable to fit within the realm of medical science leading to an unfortunate disconnect between the two.
However, the evidence base for nutrition have been gradually accumulating. In depth understanding of essential micro nutrients have brought about significant changes in health around the world. The earliest discovery was on Vitamin C when citrus fruits effectively treated scurvy. Similarly, researches on iodine has helped improve growth and development and on Vitamin A have contributed to saving eyesight and millions of children.
Role of good nutrition to ensure optimal physical growth and cognitive development of children has been firmly established. The associated health benefits are long term and reduces the risk of various chronic diseases as adults. Furthermore, well-nourished children are able to be more productive with better income earning potential in life.
A 2016 report of Global Panel on Agriculture and Food Systems has predicted that six of the top 11 risk factors driving the global burden of diseases will be diet related. Nutritionally poor diet are now well understood as high in sugar, refined carbohydrates, salt, and saturated fat while low in fruits and vegetables, wholesome carbohydrates. These have been proven to be key underlying risk factors for overweight and obesity as well as heart diseases, cancers, stroke and diabetes.
“He that takes medicine and neglects diet, wastes the skill of the physician.”
Old Chinese Proverb
Positive Ripple Effect
Doctors are bestowed with an enormous amount of public trust. Some even regard them as God! Their advice and recommendations are highly likely to be remembered and followed. Doctors are a relatively untapped resource who can be powerful allies in efforts to improve public health and nutrition.
Similarly, nutrition counselling can be a simple and an effective tool up the sleeve of the doctors to boost recovery as well as prevention from many ailments. Some enlightened doctors have thus been promoting nutrition. It also spares the patients from needless sufferings. Basically, embracing nutrition results in a win-win situation all around!
The fundamental principles on healthy diet have always remained the same. Nutrition advice given to patients for one condition hence can help to curb or prevent many other diseases. Pediatricians for example can help to instill the healthy eating habits early on promoting long term good health and development. In this way, doctors can create a positive ripple effect for good health and ultimately a better quality of life.
The best doctor gives the least medicine.
Nutrition gap in medical training as well as practice can be bridged by following concerted efforts:
Doctors need to be empowered with the required knowledge to enhance their nutrition competency. Medical curricula should be updated in view of the latest evidence of nutrition science and also reflecting upon the related ancient wisdom. Nutrition should be made either a prerequisite or a complementary course in the degree of general medicine. In addition, all medical specialization degrees should have a mandatory nutrition course related to the particular field. Nutrition should also get its due importance in exams which in turn highlights its value to the students.
Visit to doctors must be accompanied by a conversation on nutrition. This should be embedded in the standard protocols for out-patient and in-patient treatments. Nutrition advice have to be standardized. For instance: instead of simply saying ‘eat right,’ doctors should give key messages on what it entails. Nutritious foods should also be routinely prescribed alongside the medicines, lab tests and surgeries!
There should be an established norm of referring to dietitians or nutritionists by doctors as per the need. Dietitians and nutritionists are holistically trained on nutrition and are equipped with the necessary skills. They will be able to better carry out detailed nutrition assessment and comprehensive nutrition counselling. Group nutrition sessions for general information and awareness should also be in the practice.
Food services within the premises of health institutions must embrace nutrition, to lead by example. Patients should also proactively seek nutrition information from doctors, related to specific conditions as well as on general well being.
Nutrition has a powerful role in prevention and recovery from illness. This ancient wisdom is reinforced by mounting scientific evidence. Nutrition, therefore, ought to be re-positioned as central to modern medicine. The Hippocratic Oath or the core medical ethic of ‘do no harm,’ and embracing nutrition have the same origin. The two philosophies are inherently connected and strongly uphold each other!