Diet has a major impact on health, but is largely ignored by GPs when talking with patients. Our new blogger, Dr Karine Nohr, looks at how to correct this.
I have always been amazed at the ratio of healthcare resources dedicated to pharmaceutical interventions, as opposed to those devoted to considering our diets.
Although I am a bit of a foodie (French mother, what do you expect?), surely it is plain common sense that the food that we consume contains thousands (millions?) of different chemicals impacting on our bodies and it is therefore imperative we eat well to maximise the benefits to our health.
At the end of the day, ‘You are what you eat'. But many hospitals still often serve unpalatable and poor quality meals to patients. Medical professionals seem to talk comparatively little about good nutrition, while the media is replete with dietary advice it varies in quality from the sound to the preposterous.
Medical training in nutrition is at a fairly rudimentary for most of us. When I started my Fellowship in Integrative Medicine, we had to sit an MCQ to find out the starting point in our knowledge base. I was embarrassed by how little I knew, compared to my American colleagues.
A diet much talked about in IM circles is the anti-inflammatory diet. Increasingly it is recognised that many of the modern day diseases probably have a significant inflammatory component in their aetiology. For example, coronary artery disease is now thought to be a primary pathological inflammatory process, precipitating a faulty healing attempt by the body that leads to cholesterol deposits.
The deposition of amyloid plaque and neurofibril tangles in Alzheimer's disease is also thought to be an inflammatory process. The same hormones that augment inflammation also stimulate cell proliferation and cell division, so may also heighten the chances of neoplastic change.
Traditionally the anti-inflammatory diet was recommended for conditions such as arthritis and the auto-immune diseases. But it would seem that this diet might be beneficial to us all.
Generally speaking, the diet should be:
1) varied and as fresh as possible
2) low in processed and fast food (major source of sugar and trans-fats)
3) high in fruit and vegetables.
Like all behaviours, when it comes to modifying people's eating habits, they can be very resistant to change. I frequently ask patients to walk me through their daily diet and am often horrified by what people tell me. Where do you start with someone who doesn't eat ANY fruit or vegetables, or who lives ENTIRELY off fast food?
In patient-centred work, you have to work with the patient's experience, enabling them to identify a starting point and how they might feel able to proceed. And, as we all know, if the patient isn't ready to look at change, then there is no point ‘taking the horse to water', it would be a waste of everyone's time. But if we get a whiff of ambivalence, then there is at least the potential to change.
A technique with proven efficacy in helping a patient to resolve their ambivalence in practicing health-promoting behaviours is ‘motivational interviewing'. Rather than relying on prescriptive advice, the aim is to create a set of conditions that will enhance the patient's own motivation for and commitment to change.
These are consultation tools many GP's will already be familiar with: reflective listening; affirmations and summarising.
‘So you recognise that your diet isn't great and you are asking yourself whether this is having an effect on your general health, part of you is ready to try and tackle it, but you are worried that it might cost more money and also you are asking yourself how the family might respond to a change of diet. So bearing all of that in mind, what changes do you think it might be easiest to start off with?'
In our practice, the nurses have been running a healthy eating group course for obese patients for a number of years. We offer a two hour session on a weekly basis for five weeks only. The patient's readiness is assessed before the group starts and basic parameters (weight, BMI, fasting lipids and FBS) are monitored; at the start, the end, six months and one year later. The group has proven enormously successful and popular with the patients.
For more detail about the anti-inflammatory diet and motivational interviewing on the web, here are a couple of suggestions:
http://www.drweil.com/drw/u/ART02012/anti-inflammatory-diet
www.motivationalinterview.org
Dr Karine Nohr is a GP in Sheffield
Dr Karine Nohr
