“Amazingly, medical schools in the United States focus very little on nutrition. The topic, according to one study, gets less than 1% of the classroom time that aspiring physicians are required to sit through over four years -- even though the foods and beverages people ingest are far and away, in America, the biggest drivers of disease.
Because of the knowledge gap, doctors routinely miss opportunities to counsel their patients on the connection between nutrition and health -- thus allowing bad eating habits to keep doing major damage. This failure is one of many indictments that Robert Lustig, a physician, brings against America's medical-nutritional establishment in "Metabolical," a wide-ranging polemic that covers the misdeedsof food and beverage companies and the misinformation that, in his view, contributes to the undermining of health.
Early on, Dr. Lustig asks: "Why has our health status declined?" The chief culprit, he believes, is a change in food processing over the past 50 years. Food companies have concocted products with the healthy elements removed (vitamins, minerals, micronutrients, fiber) and unhealthy elements added (mostly sugar and salt). This transformation, he writes, has fueled a downward "vortex." It started slowly but has "picked up speed" and "overwhelmed our medical resources."
Of course, some minimal processing of food -- think of freezing fruit or cooking vegetables -- is a staple of healthy meal preparation. Dr. Lustig's real complaint is with "ultra-processed" products, which account for 58% of Americans' calorie intake. Such products -- candy, crackers, deli meat, frozen pizzas, fruit juices -- are increasingly found not just in supermarkets and restaurants but virtually everywhere: movie theaters, hardware stores, gas stations, even health clubs. They're typically mass produced, have a long shelf life and offer low nutritional quality.
How low? Dr. Lustig characterizes these products as "poison" more than two dozen times. To validate the claim, he describes in detail how the dominant features of such foods -- high in sugar but also teeming with nitrates and refined carbohydrates -- lead to cancer and other chronic diseases like diabetes and heart disease. Roughly 60% of Americans are afflicted with such diseases today (up from 30% in 1980). Relatedly, unhealthy eating has contributed to the decline in U.S. life expectancy in recent years.
That doctors don't do more to steer their patients away from such hazards is only part of Dr. Lustig's attack on the medical profession. He believes that, on the whole, doctors are "parochial," taking their cues mostly from other doctors and thus succumbing to herd thinking. He worries that too many elements in their professional world -- research, clinical meetings, webinars -- are underwritten by Big Pharma and that the little nutrition science they know is compromised by studies that are sponsored by food companies. He says that doctors "don't listen" to their patients and prefer to reach for the "quickest and easiest form of treatment," whether it works or not, in part because insurance companies have limited the length of patient visits. "Talking about lifestyle changes takes time that we don't have -- because that's how we've been trained and how we get paid."
Dr. Lustig fesses up to his own shortcomings: "I practiced medicine for my first twenty years as a pediatric endocrinologist (glandular and hormone problems in children) without a real clue of what was truly right or wrong when it came to disease." It was only when he began doing his own research that he discovered "the true path forward."
"Metabolical" is strikingly candid -- and sometimes strident. (The title is a fusion of "metabolic" and "diabolical.") Dr. Lustig says that his book is "both my act of contrition to you, the public, and my act of medical disobedience to the medical establishment." He hints that he could write such a book only after retiring from clinical practice -- at the University of California, San Francisco (where he is an emeritus professor) -- because "no ivory tower academic bastion would want to take credit for the 'medical heresy' that you'll find sandwiched within these pages."
He sees the focus on obesity per se as a "red herring," noting that, in 80% of cases, obesity stems from someone being "metabolically ill." Obesity (as he has argued in more detail elsewhere) should be viewed as a "marker" for conditions like diabetes, hypertension and heart disease. He's also dismissive of using the calorie as the key nutritional unit of measure. (The body treats 100 calories of broccoli differently from, say, 100 calories of butter.) The longstanding idea that all calories are the same, says Dr. Lustig, "has set medicine back at least fifty years." And nutrition labels on packaged foods are "mostly irrelevant -- what you really need to know is what's been done to the food, and no label tells you that."
How to get people to change their eating and drinking habits is the big challenge. "Nothing is more important than nutrition for correct and optimal bodily and mental functioning," Dr. Lustig writes, and he advocates eating what he calls "Real Food" that is low in sugar and high in fiber. "Metabolical" also includes a range of policy ideas, some of them drawing from the tobacco and alcohol playbook, such as regulatory controls on pricing, marketing and distribution. He proposes taxing products such as soda and soy and using the money to subsidize the consumption of fruits and vegetables. But the economic and logistical obstacles to such a plan are enormous.
One doesn't need to agree with Dr. Lustig's proposed cures, or his diagnoses, to find "Metabolical" an invigorating read. At the very least, he persuasively shows that the eating habits of Americans are too often a trigger for disease and that improving the nation's health depends on the medical profession focusing on preventing disease -- not simply treating it.” [1]
1. Rees, Matthew. Wall Street Journal, Eastern edition; New York, N.Y. [New York, N.Y] 10 May 2021: A.17.
Komentarų nėra:
Rašyti komentarą