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The DO | Patient Care | Art of Healing

What’s for dinner? How DOs are helping patients figure out what to eat

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Today’s gluten-free diet fad reminds Antoinette M. Cheney, DO, of the fat-free craze of the 1980s, when health-conscious consumers gorged on low-fat muffins and other reduced-fat products, unwittingly fueling the nation’s growing obesity problem.

“Manufacturers still had to make products that tasted good. So when they took the fat out, they added more sugar, creating products even higher in calories,” she remembers.

A gluten-free diet benefits patients who have celiac disease, but it has not been shown to promote weight loss or alleviate the symptoms of autism or attention-deficit/hyperactivity disorder, two conditions for which the diet is hyped to treat. Such a diet, in fact, can produce harmful side effects, including weight gain and vitamin B deficiencies, says Dr. Cheney, a family physician in Lone Tree, Colo.

“People have the University of Google at their disposal and come in with some dangerous notions about diets that I try to counter.”
Dr. Grogg

“As I tell patients who ask me about this diet, a lot of the products marketed as gluten-free will have more sugar, saturated fat or different types of additives to make them more palatable,” she says.

Many osteopathic primary care physicians such as Dr. Cheney, who try to persuade patients to eat healthfully and exercise, must also dispel misconceptions about diets and particular foods, ingredients and processes.

Battling ‘quick fixes’

Celiac disease affects 1 in every 133 individuals in the U.S., but that didn’t stop actress Miley Cyrus from tweeting that all of her fans should embrace a gluten-free diet for better skin.

“As a society, we want a quick fix for our problems, so we tend to believe what we see on the Internet,” Dr. Cheney says. With so many people carrying smartphones and tablets everywhere they go, erroneous information can be transmitted like never before.

“People have the University of Google at their disposal and come in with some dangerous notions about diets that I try to counter,” says Stanley E. Grogg, DO, a professor of pediatrics at the Oklahoma State University College of Osteopathic Medicine in Tulsa. One of his biggest concerns is the increasingly popular vegan diet, which eliminates all animal products.

“A vegetarian diet isn’t all bad if kids are eating eggs and cheese. But a true vegan diet without any animal protein can harm children,” Dr. Grogg says. “It can cause decreased bone density, so kids get more fractures, and can adversely affect their growth.”

Noting that “it isn’t easy to sort through all of the information available about nutrition and food choices,” the Centers for Disease Control and Prevention devotes several pages of its website to evidence-based healthful eating. While he likes this and similar government-sponsored websites, Dr. Grogg tends not to suggest them to parents.

“Many people distrust the government and would not consider these sites good, neutral sources of nutrition information,” he says.

Instead, Dr. Grogg urges parents to look at the latest “Best Diet” rankings of U.S. News & World Report. “These diets are backed by scientific evidence, and the website explains them in an easy-to-follow manner,” Dr. Grogg says.

All of the diets at the top of the list stress eating fruits and vegetables, lean protein, whole grains and low-fat dairy products while reducing salt and sugar. Dr. Grogg advises parents that such common-sense balanced diets benefit the whole family.

Adarsh K. Gupta, DO, in comparison, promotes the National Library of Medicine’s MedlinePlus to his patients and even passes out information cards touting the site’s URL. The Stratford, N.J., family physician also asks his patients to use Google Scholar rather than the basic Google search engine when looking for studies on particular medical topics.

For his part, Steve Feder, DO, a pediatrician in Boothbay, Maine, steers parents to HealthyChildren.org and the website of the American College of Osteopathic Pediatricians for nutritional and other information.

To address particular health issues, such as obesity or diabetes mellitus, DOs may suggest specific diets and food.

When patients need to lose weight, for example, Patricia J. Ausman, DO, recommends the Weight Watchers program, which is ranked as the top weight-loss diet and one of the best overall diets by U.S. News.

“Weight Watchers teaches you portion control and how to prepare your own meals,” she says. “In contrast, on a fast weight-loss diet like the Jenny Craig program, people can lose weight while they’re on it by sticking to the prepackaged meals. But once they go off of it, they gain the weight back because they’re not really taught how to eat.”

On the table

In some parts of the country, more and more patients are telling their DOs that they buy only organic produce, grown without synthetic pesticides, and organic meat and dairy products, produced from pasture-raised livestock not given antibiotics or growth hormone.

Dr. Cheney

“I may tell a patient, ‘If deciding between two cans of green beans, choose the one lower in sodium, with the fewest listed ingredients.’ ”
Dr. Cheney

People who feel passionately about organic food often do eat more healthfully than the general population, Dr. Cheney says. “But the studies on organic versus nonorganic are up in the air,” she argues. “It’s hard to say for sure that antibiotic-free milk, for example, is much better for you because it takes years for health problems to show up that we can link to such issues.”

Because organic foods tend to be more expensive, not everyone can afford them, Dr. Cheney notes. This keeps her from recommending them to most of her patients. For patients who have the means, however, she does suggest buying the organic versions of produce eaten with the skin on.

For the most part, though, she simply asks her patients to choose fresh food over processed food whenever possible. While the jury is still out on many of the additives in processed food, these products are known to contain excessive salt and sugar, Dr. Cheney says.

Dr. Grogg urges parents from all socioeconomic backgrounds to plant vegetable gardens with their children, noting that food stamps can be used to purchase vegetable seeds. Those who live in apartments can sometimes start community gardens, as well as grow fresh herbs on their windowsills.

For patients who don’t want to garden, Dr. Cheney will suggest visiting farmers’ markets, where produce prices are typically lower than those of supermarket chains. Some patients resist her advice, however.

“Unfortunately, processed foods are cheaper and more convenient. They’re in a package and there to grab,” Dr. Cheney says. “And our American palates have become accustomed to processed food. It tastes good.”

When patients continue to buy processed food for convenience, affordability or taste, Dr. Cheney advises them to read labels. “I may tell a patient, ‘If deciding between two cans of green beans, choose the one lower in sodium, with the fewest listed ingredients.’ ”

But Dr. Ausman stresses to patients that processed food really is not more convenient.

“Patients complain that preparing food at home takes so much time, but I tell them it really doesn’t,” says Dr. Ausman, who practices family medicine in Philadelphia. “I tell my patients, ‘Don’t buy frozen microwavable food. You can make your own.’ ”

Dr. Ausman urges her patients to cook in bulk on the weekends and freeze the leftovers. “I’ll tell them that these homemade frozen meals are a lot more healthful for them and don’t have all the chemicals,” she says.

She frequently shares recipes and cooking advice with her patients.

“I was trying to get one of my diabetic patients to lay off heavy sauces,” Dr. Ausman remembers. “I told her how to cook carrots with just a smidgen of butter and tarragon. The next time I saw her, she said, ‘I never knew carrots were sweet.’ She had never truly tasted a carrot before. She had only tasted the sauces that were on it.”

So that children grow up enjoying lower-sodium food, Dr. Grogg encourages parents not to keep a salt shaker on the dining table, though he tells them that cooking with some salt is acceptable. He also advises families to use salad plates rather than dinner plates for major meals so less food will be consumed.

More or less

Primary care physicians may concur on the superiority of fresh versus processed foods, but there is less agreement on the benefits of taking supplements.

“After age 2, multivitamins are a waste of money,” Dr. Grogg says. “They go in the front end and out the bottom.”

Dr. Ausman, in contrast, recommends multivitamins and Vitamin D-3 supplements to patients.

“I think everyone should be on a D-3 supplement because we’re a nation that is D-3-depleted,” she contends. “Most of us have office jobs, and we’re not getting out in the sunshine. When we do get out, it’s usually for limited amounts of time, such as getting in and out of a car while running errands.”

The president of the Maine chapter of the American Academy of Pediatrics, Dr. Feder points out that roughly 80% of the parents he sees are already using some aspect of complementary and alternative medicine to treat their children. Rather than tell them not to use supplements or herbal remedies or other alternative modalities, he steers them toward those that have been supported by some scientific studies and away from those that have clearly been refuted.

Using The Holistic Pediatrician as a guide, he has recommended, for instance, that children with ADHD take Omega-3 fatty acid supplements, which, he says, can reduce the amount of stimulant medication needed.

Dr. Feder says he tactfully tries to disabuse parents of such fallacies as sugar or food coloring causing hyperactivity.

“I will ask, ‘What kinds of things have your heard? And what have you tried?’ ” he says. “I will then discourage them from what we know doesn’t work, suggesting options that are more promising. Knowing that your physician has an open mind about alternative medicine goes a long way toward fostering trust.”

More than any other substance, food has been credited both with causing disease and promoting health. Helping patients cut through the clutter is essential, many DOs say.

While factors other than diet affect health, there is no doubt that food has a big impact, Dr. Cheney says. “But the day we can convince all of our patients to make better choices,” she says, “will be the day we can quit practice and retire.”

cschierhorn@osteopathic.org

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