Nutrition as a tool in clinical practice

Well, if that isn’t a beautiful sounding and attention grabbing title for a post, then I don’t know why you’re reading this. Loljksmiles, hello again. I didn’t stop blogging, I just didn’t feel inspired. But here we are! I’m now in grad school, studying nutrition. At the moment the course I’m taking is about nutrition in health and disease, and one of the lectures we had today was really motivating and engaging for me. I might have been talking a little bit too much, but in all honesty — if I’m in a classroom where nobody is answering any questions that the professor throws out there, I’m not going to leave him or her hanging. I’m there to learn and to participate, no matter how strange that might sound.

Anywhoozles, the part of the lecture that really got me going was when we spoke about the reasons for why nutrition isn’t used so much as a treatment strategy in the clinical setting, and why doctors receive little or no training in the field. According to the physician that gave the lecture, there are too few studies in the area that have clinically relevant end points. Doctors need support and proof from randomized controlled studies to be able to give certain recommendations to their patients.

While I see the point in this, there is still something not solid about this argument. Actually, there are several holes in it according to yours truly. Maybe you can help me out here. First of all, and this can probably not ever be given a certain and generally true answer, but: are physicians and patients ready to take the healing potential of nutritious food into serious consideration when it comes to curing (and more importantly, preventing) illnesses? It’s not a pill that you take, where the effects come into play more or less immediately. It takes patience, and consistency. It’s not life in the fast lane. An illness for which food can function as a cure isn’t likely to have mysteriously appeared overnight, either. Second, and building on the previous point, when maintaining a healthy diet for long periods of time is (likely to be) what brings forth it’s health-preserving and healing powers, and when inter individual variability concerning physiological processes cause the definition of a ‘healthy diet’ to differ between people/populations, then how can we produce any sort of the proof that is asked for with regards to the efficacy of nutritional interventions and/or preventive measures? I can only think of pretty unethical cohort studies here.

This brings me to the second realm of questions, which pertain to the research methodology that is more or less demanded. Don’t get me wrong — there is not a hair on my head that wishes to argue against the integrity and legitimacy of a solid randomized controlled trial when it comes to research questions that are well suited for them. With nutrition and different dietary recommendations, there are so many factors that influence the end results that I’m heavily doubting whether it can all be accounted for. People in a study won’t be able to accurately report everything about their lifestyle that may bear an influence on their health. Happiness and contentment matters: how do you objectively measure and quantify that? And, how do you find the influence thereof on a persons general health status?

Variability in research results hampers their applicability. So what do we do in such a situation? There are several options, and I will mention two. First, we can increase the sample size, and do sub-group analyses. For instance take a look at the differences between age groups, between men and women, and so on and so forth. Second, we can increase the specificity of the study. For example, if we’re investigating what effects fish consumption may have on variable X, we can isolate the nutrient in fish that we suspect is the one that lends the effect. Yet, the truth of the matter is that we don’t consume nutrients in isolation, and when giving supplements these usually contain greater amounts of the nutrient than would a serving obtained through food sources. Moreover, nutrients interact and the absorption thereof may be enhanced or diminished by the presence or absence of a given nutrient, as well as by the method with which the food has been prepared (e.g. cooked, raw, etc).

In sum: YES we need more peeps to conduct research, but I still doubt whether this will change much. What do you think?

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