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Wednesday Oct 15, 2014

Patients Need Nutrition Facts From Their FP, Not Dr. Google

I enjoy discussing nutrition with my patients. It is an essential part of the lifestyle and prevention package that family physicians are uniquely positioned to prescribe.

Although I have not eaten meat in 40 years, I live with three people who consume it on a regular basis. I had to self-educate about nutrition when I chose to stop eating meat because this was before I had the benefit of the four nutrition lectures I got in medical school. During those years, I drank a lot of milkshakes and discovered that it picked me up for a short while, but fatigue would roll in within two to three hours.


Diet for a Small Planet by Frances Moore Lappe was my original textbook and guide. It's hard for me to believe that this book is now more than 40 years old. Fast forward to today, and our patients are taking nutrition advice from TV doctors, the Internet and other sources that might not be evidence based. Shouldn't they be hearing the facts from us?

Every time I sat down to write this blog post, a new latest-and-greatest declaration in some journal or meeting would derail me. But recently, the Annals of Internal Medicine published an NIH-funded study(annals.org) that confirmed some of the things I have been telling patients. Researchers suggest that a diet that cuts down on carbohydrates may work better than trimming fat to aid in losing weight.

There is no one diet that works for everyone. One size does not fit all. (That is one reason there are so many diets out there.) But it's worth noting that this study included males and females and was racially diverse.

The problem with limiting carbs is that it may lead patients to inadvertently skimp on dietary fiber, which is important for heart and colon health, as well as for making our patients feel "full."

I talk with my patients about moderation in a healthier diet, but the exception is dietary fiber. I talk about going from the national average intake of 14 grams a day up to 30 grams a day, increasing intake slowly. First we assess their consumption, and then we add only 3 more grams per week until we reach our goal. This regimen brought my own LDL cholesterol down by more than 40 points and has been quite effective for a number of my patients, although sometimes our guts tell us that they are not happy with our diet.

The motto of "First, do no harm" is critical, and that applies to supplements. Through my sports medicine affiliations I have been fortunate to glean excellent information on this topic. Just because something is natural does not imply it is safe. I have diagnosed new-onset hypertension in a number of patients who thought they were doing a good thing by taking a multivitamin but did not realize that in those supplements they also were taking herbs that raised their blood pressure. By taking them off the multivitamin, we were able to return patients' blood pressure to normal without medication.

At the end of the day, it is about balance and moderation and trying to get your nutrition from as primary a source as you can.

After I finish my term on the AAFP Board of Directors this month -- and eventually finish the patient-centered medical home recognition process, achieving meaningful use and transitioning to ICD-10 codes -- I think I will sit with a cup of tea and start an outline for a nutrition piece for American Family Physician to update our information because obesity is a prevalent disease, and family physicians are in a position to make a major impact.

Rebecca Jaffe, M.D., M.P.H., is a member of the AAFP Board of Directors.

Posted at 01:17PM Oct 15, 2014 by Rebecca Jaffe, M.D.

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