I am currently studying for my board recertification—and you know something? So far, not even one review question has addressed food and lifestyle. Instead, every single question deals with drugs, dosing, and procedures.
Because I don’t rely on memory for this type of information, I searched for a reference program to quickly look up such data; this led me to the most common resource, which has over 2 million users worldwide: UpToDate. I remember buying this program 35 years ago when it was sold on a disc.
What’s surprising are the ways UpToDate hasn’t changed. Yes—I found the current version very efficient and organized regarding symptoms, drug treatment, and dosing. But it remains lacking in nutrition, medical prevention, recovery of health, non-commercial food-centered dietary education for the patient, and lifestyle interventions. In fact, some of the references on diabetes and heart disease are very dated (stopping around 1990). There is an explicitly bogus caution regarding the incomplete amino acid composition of plant-based diets; meanwhile, generous industry-guided recommendations on cow’s milk and other dairy products abound.
I became more specific in my search, looking for what it might say about insulin resistance— nothing other than treatment with drugs. I checked on actual data for cardiac rehabilitation (such as the Ornish program paid by Medicare)—again, nothing. Coronary arteriography evidence of reversion of atherosclerosis with diet and lifestyle? Zippo.
By now, I was on a mission. Surely it would have information on the authors of well-known chronic disease reversal studies, such as Caldwell Esselstyn, Dean Ornish, and Neal Barnard. No mention of them. The work of T. Colin Campbell? Nope. The Blue Zones? Don’t exist. What about the research done at Loma Linda, California, on chronic disease and longevity? Not found. Alzheimer’s research by top neurologists Drs. Dean and Ayesha Sherzai? Who?
Is it any surprise that my colleagues don’t know this information? After completing a medical education without nutrition content, they all use ubiquitous resources like UpToDate, and what do they learn? That medicine is nothing but tests, drugs, and procedures; that food plays no role; that screening with tests is the extent of prevention.
Here is what they had to say on the subject of fiber: “The recommended amount of dietary fiber is 20 to 35 grams per day [. . .] Because high-fiber foods may be healthy for reasons other than their fiber content, the research has not always been able to determine if fiber is the healthful component.” (No mention of the microbiome.) “A high-fiber diet is a commonly recommended treatment for digestive problems, such as constipation, diarrhea, and hemorrhoids, although individual results vary widely, and the scientific evidence supporting these recommendations is weak.” We pay $600 a year for this!
So the problem is not that physicians don’t know how to prevent and reverse chronic illness; the problem is even worse—most health care professionals don’t know it’s possible. Whenever diet or lifestyle is mentioned in the references presented in UpToDate and whether it has any effect on health, it is to say that the evidence is weak. And this is the popular program used in clinics, private offices, and medical schools worldwide, serving more than 2 million health professionals. Many of the authors have ties with the pharma or food industries, although the disclaimers claim: “all of the relevant financial relationships listed have been mitigated.”
Suggestions
We don’t know what we don’t know—until it is pointed out to us. When we know better, we are able to do better. More than that, even though it can be painful to change course, we must do better. So, how can we address this collective blind spot?
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