One More Question

By Deborah Gordon, M.D.,

- Paracelsus -

“Now that I know what you love to eat, tell me what you actually do eat.”

Much as I would like the perfectly selected remedy to cure everything, I have not always found that to be the case. Even people on a well-selected constitutional remedy have complaints, some temporary, some permanent, that require some additional attention. Perhaps pharmaceutical-avoiding homeopathic patients are healthier than the general population, but these days that’s not saying much, is it? Our modern world is immersed in epidemics of obesity, diabetes, metabolic derangement, dementia and premature chronic diseases, beginning to affect the health and lives of even children. I would suggest that nutritional evaluation and recommendations should be part of every general health assessment and intervention, including that performed in a homeopathic consultation. 

The Setting
As a physician I have always known that nutrition was an important aspect of health, but not until the last ten years has sufficient science and advocacy moved us beyond the nutritional platitudes that arose when we first started considering our dinner plates a matter of public health. 

Prior to the 1970’s no one talked much about what we should be eating, as our choices were not that great. Starting with the U.S. Senate Select Committee on Nutrition and Human Needs – addressing worries about health declines, small by today’s standards – referred to as the McGovern Committee, public pronouncements have suggested what we should be eating, and it is there that we first went astray. McGovern relied on the work of contemporary scientists who were viewing the world through their own rose-colored glasses (which at that time presumed dietary fat to be the source of all problems) as well as staffers with strong vegetarian leanings, and let their assumption tarnish their findings. We jumped on to a bandwagon of reduced fat, reduced meat and research biased by fat phobic pronouncements.

Relying on scientifically “vetted” food choices and the options for expanding post-World War II markets, food manufacturers and vendors have changed the face and belly of food in the modern world. Since the 1970’s there have been significant – no, huge – changes in our food supply, so numerous they are hard to list. We eat more packaged and commercially prepared food (all of which contain more sugar, fat, and salt than we would ever add to home-prepared food), the wheat has a higher gluten content, high fructose corn syrup is a major calorie source, right up there with newly designed vegetable oils, vegetarians eat more soy in a day than traditional Japanese families ate in a week, and many children are expressing fast food “brand loyalty” as early as age 2. 

The culminating blow has been the various incarnations of federally suggested food schemes, starting with the Food Pyramid (or how to eat if you want to be shaped like a pyramid) to the current MyPlate. What is particularly distasteful to me is that such recommendations don’t come from the Institute of Health, the Director of Public Health or even the Centers for Disease Control. They were developed by the U.S. Department of Agriculture. Just a clue, they are quite a bit more familiar with agri-business than they are with either the small farmer or the real health effects of food choices.

Parallel to the changes in our food supply, our collective health has deteriorated. I know you have not been living under a rock and so you are aware of the obesity epidemic that co-exists with an increase in diabetes and indeed in all chronic disease. What may not be widely publicized however is the crucial role that diet plays in almost every disease, not just obesity and diabetes. From acne to zoster, an individual’s nutritional status can impact their susceptibility to disease as well as their course of recovery. This is not to say that all disease can be reduced to food. It is certainly true that genetic and environmental factors play a role in the development of many chronic diseases – especially cancer – but we learn daily that food can support or sabotage our efforts to be healthy in almost every setting. 

But Who to Believe?

It’s not hard to be convinced that food choices are important. But clearly what has been recommended since the McGovern Commission has actually determined the nature and findings of nutritional research and nutritional experts. In my experience, holding a nutritional point of view different apart from the common wisdom makes that wisdom looks quite biased, even when it claims scientific objectivity. When a mainstream dietary study fails to find what is expected, it is not uncommon for the study to be blamed rather than the hypothesis!

Finally, we have seen this year, a mammoth indictment of the last thirty years of obesity-related research: University of South Carolina researchers found four decades of nutritional research flawed as they are almost all based on dietary recall and subsequent findings of guilt by association. http://www.eurekalert.org/pub_releases/2013-10/uosc-4yo100913.php 

So if the research that’s been driving our USDA food recommendations is not to be believed, where do we turn?

There is no universal, “one-size-fits-all” answer but there are some guiding principles that can help answer the question. For nutritional insights I rely on a three-legged stool:

1. Physiology: knowing what we do about how the body works sometimes answers questions about food choices.

2. Anthropology: successful food strategies can be identified in successful populations of people found both in ancient archaeological data and more contemporary observations of cultures around the globe, from Dr. Weston A. Price’s Nutrition and Physical Degeneration to research among present day hunter-gatherer populations. The diseases of modern civilization are truly endemic to modern civilization; previous civilizations generally had much lower rates of chronic disease.

3. Clinical science: modern clinical papers and current scientific research can be valuable but must be taken with “a grain of salt” as they are usually observational (can’t be sure of cause and effect) and time-limited (long-term consequences uncertain). Just as in Hahnemann’s time, clinical observations from practicing physicians can be very informative. 

When I am thinking most conscientiously about my patients, I factor in one additional concern. I believe that all of us, including our children’s children, will enjoy greater health if we have local access to food grown on small, multi-crop farms, at least in those areas where temperatures permit. Even though villagers in Alaska cannot rely on local farms in the winter (perhaps even in the summer), their world will be better if most of the lower 48 states can develop a network of vibrant organic farms, free of chemically and genetically modified interventions. A long-term study based at Iowa State University confirms that organic farms can provide similar yields, higher economic returns, and greater opportunities for employment than conventional farms. 

Organic and traditional farming yields nutrient dense foods that far surpass what can be found in industrial agricultural products, and I’ll refer to these valuable foods in my recommendations. I would suggest that once one grasps the difference – in nutritional quality, economic and environmental impact – it becomes impossible to buy mass-produced and fast foods and still sleep at night! When we buy organic food, we are voting with our wallets for a system in opposition to the dominant trend. Our federal tax dollars heavily subsidize industrial agriculture, many current farmers are facing retirement, and there are substantial economic interests in conflict with the wishes of those who would farm sustainably, saving and harvesting seeds free of genetic modification, growing crops free of chemical pesticides, and raising animal species distinct from those bred for mass handling.

Organic foods in high-end supermarkets can be challenging to the budget, but great savings can often be found buying direct from the farmer, either at the farm or at farmers’ markets. Investing in a freezer to buy a portion of an animal can yield meat that all prices out at hamburger costs. Beyond speaking through our wallets, I would encourage you to familiarize yourself with zoning laws in your area (are farmlands being priced similarly to housing developments, effectively removing local farms?) as well as inspiration, life-changing programs such as Farm to School. “Farm to school improves the health of children and communities while supporting local and regional farmers.” Visit http://www.farmtoschool.org/ to see if there is a program in your area. 

And What to Eat?

Although there is no single diet that meets every person’s individual needs, there are many aspects shared among different versions of a healthy diet. Let’s look at them by macronutrients: protein, fat and carbohydrates.

Protein is a vital nutrient that our body uses for building muscles, bones, connective tissue, as well as supporting numerous healthy functions throughout the body. No arguing, we all need to eat protein. What kind of protein, and how much gets a little more controversial. I recommend organic, pasture-raised animal protein as the optimal source of protein itself as well as the minerals, fats, and vitamins that enhance absorption and utilization of the proteins. Proteins are sensitive to heat, so avoid charring or searing at high temperatures.

Ruminants (I love that word!) raised on grass or pasture include cows, goats, lambs, and wild game. Eat a palm-sized portion at 1-2 meals a day and develop a taste and ability to eat organ meats. (If we were competing with a wolf for the meat from an elk, the wolf would take the organs and laugh as we reached for the skeletal muscle. “Chumps!”) If you haven’t developed a taste for organ meat, seek out a butcher who makes sausage with organ meat, grind liver with other meats for meatloaf, or turn to chicken for milder tasting liver.

Pork is not well-tolerated by everyone, and not acceptable to some religious traditions. If you like pork, look for free-range pork and see if you can eat both cured meats (bacon, ham) and fresh meats (steaks, ribs, chops). Some folks do better choosing one or the other.

Wild-caught, cold-water fish eaten twice a week will provide essential omega-3 fatty acids. Salmon, halibut and cod can be found fresh or frozen (even at Costco); you are more likely to find herring, mackerel, and sardines in tins or jars. Other fish are good for you, too, less frequently. Consult Monterey Bay Aquarium’s website to avoid the fish known to have higher mercury levels.: http://www.montereybayaquarium.org/cr/cr_seafoodwatch/sfw_recommendations.aspx

Poultry is higher in omega-6 fatty acids, because the animals eat the plant seeds rather than the grasses. So poultry once a week is fine: chicken, duck, turkey, quail, goose: what else?

Eggs: eat as many as you like. The yolks are best for you, but contain fragile ingredients: if you can cook them with the yolk intact (not so much scrambling), you will subject them to less oxidation, and require less anti-oxidation on the part of your body.

Dairy should be full-fat and organic. Not everyone tolerates dairy: if you think you have a problem, the easiest dairy to digest is butter, followed by hard cheeses and yogurt or kefir. Whole milk and cottage cheese can prove the most challenging. 

Fats are actually good for us! They too provide essential ingredients, including cholesterol (produced in our liver but relies on some dietary fats to do so), fat-soluble vitamins and the substrate for production of hormones, the calming of inflammation, and more. Organic is important for fats: any pesticides or other chemicals are usually fat-soluble, can even be concentrated in the fat, and do us no favors when we eat them.

Saturated fats are solid at room temperature and most stable with higher cooking temperatures. Butter, lard, and coconut oil are all good choices. If you like palm oil, look for brands that are “sustainable”, rather than derived from clear-cutting of old palm forests.

Mono-unsaturated fats are solid when refrigerated. The most useful one is organic, extra virgin olive oil. You can cook over very gentle heats with olive oil, or eat it raw on salads.

Poly-unsaturated fats are liquid even in the fridge. Here is where things get complicated. Naturally occurring in foods (especially wild fish) they are known to be beneficial, particularly those called “omega-3” fatty acids. Also essential are some “omega-6” fatty acids, but the Standard American Diet typically contains far too many. In excess they are implicated in many diseases from arthritis to breast and colon cancer and cognitive decline. Nuts and seeds are good sources of differing amounts of all the kinds of fats. (Raw nuts can contain anti-nutrients as mentioned in the “Grains” discussion below, and if eaten in abundance, merit special processing.) Industrially processed seed oils are to be avoided; particularly corn, cottonseed, and soy which are heavily genetically modified. I only make omega-6 recommendations in cases of individual clinical conditions.

Carbohydrates can cover the greatest amount of real estate, so to speak, on your dinner plate, but they are actually essential to only very small degrees. 

Fruits and vegetables provide complex arrangements of nutrients, most visibly the brightly colored anti-oxidant components present in densely colored berries, dark leafy greens, and fresh tomatoes.

The sugar content of fruits and vegetables can be considerable. People who carry excess weight and would like to lose some fat pounds do well either avoiding or restricting high sugar choices such as root vegetables, dried fruits, and sweet, white fruits such as apples, pears, and bananas.

Individuals with digestive challenges or digestion-related health conditions (irritable bowel, autism, and more) often do well with carbohydrate restriction and selectivity, as described in programs such as Low FODMAP diets, Specific Carbohydrate Diet and the GAPS diet, each of which could merit a separate discussion

Grains may provide the “bread of life”, but they are not essential and for many people and in many forms they are harmful. 

The Weston A. Price Foundation has educated thousands (tens of thousands!) of people regarding the process of sprouting grains before they are eaten. Some period of soaking denatures the phytic acid coat of grains which interferes with digestion. People interested in optimizing their nutrition should seek grain products that are either sprouted or fermented in a sourdough manner of production.

The Paleo or Evolutionary or Ancestral Health movements have taken an even broader eraser to our grain consumption, asserting that humans evolved for millions of years without grains, and that many people (not all) are not properly suited to our 10,000 year fascination with grains. They suggest a grain elimination, with individual grain reintroduction to assess individual tolerance.

Celiac disease and gluten sensitivity occupy a fair amount of network bandwidth and medical journal space! Once thought to be a rare disease manifest only through severe intestinal symptoms, we now know that gluten sensitivity might provoke symptoms in any organ system of the body. Avoiding gluten for a month or two can reveal those symptoms, or reliable testing arranged through Cyrex Laboratories. (Conventional celiac panels find only a small portion of gluten sensitivities. If a conventional celiac test is abnormal, it is quite reliable; if it is negative, you can’t presume that you are completely normal. You might still be sensitive to other components of the gluten, which could be determined by an avoidance diet or Cyrex testing.)

Added sugars: okay, they’re a lot of fun, but I think even the most die-hard sugar addict no longer believes that they are just another source of calories. Sugars and sweets are potentially addictive, hazardous to our health and over-consumed by a large portion of the population. Minimizing added sugars is a sensible plan, though difficult for some. Some brutal personal honesty is needed if every day is a special day and a good enough reason to buy a donut!

Whew! If that description seems overly long and complex, please see my valiant attempt to be more concise on my website, where I describe The Ideal Diet, knowing of course, that it’s almost as impossible to generalize nutritional advice as it is to generalize homeopathic advice!

Additional topics of interest to me are the nutritional treatments specific to individual health concerns, the judicious use of wisely chosen supplements and the growing support for nutrient dense food that is also sustainable and gentle on the earth. What are your interests when it comes to food? Do you take a nutritional history with your homeopathic clients? I would love to hear your comments, questions and concerns!

Deborah Gordon, M.D., a fully-trained Family Physician, has had a homeopathic and integrative medical practice in Ashland, Oregon for almost thirty years. She enjoys consulting with patients and colleagues, writing, teaching, and rowing with the Ashland Rowing Club. For more information, please visit her website at DrDeborahMD.com or write to her directly at Deborah@DrDeborahMD.com.