“You are what you eat.”

Stephen Follansbee

I googled this sentence and guess what? I got only 72,100,000 results. I guess more than a few people think this is true. In this issue of San Francisco Medicine, the articles will address various innovations in the area of food and health. While readers may ask, “What could be less controversial?” the fact is that food and health have been topics of debate since long before medicine, as we know it, existed. Our patients often present us with a long list of questions regarding food and health. They are worried about diet and cancer, heart disease, diabetes, Alzheimer’s disease, depression, and arthritis, just to name a few concerns. But the relationship between diet and health can be divided roughly into two major categories: prevention and treatment. What dietary changes or innovations are necessary to prevent disease? What dietary changes or innovations have been shown to modify the course of disease? As physicians, what are our responsibilities in terms of advising patients on diet?

We must listen. Patients usually want to know how to proceed with diet and nutrition; they are eager for our advice. But first we must listen to their concerns and ideas. That helps us frame the discussion in a way that will be useful for them.

We must not be too quick to judge. Much of the information that our patients bring to us comes from other people who sincerely want to help. Of course we can discount advertisements and promotions for the “best” approach, and our patients do not want to spend excessive amounts of money based on misleading information. But a lot of the anecdotal information that our patients bring to our offices is provided by people who perceived a benefit or read of a benefit to others. They are not being malicious or greedy; they are just trying to help. So we must be understanding and patient with some of the ideas and concepts they bring up.

We must be scientific. I think this issue of San Francisco Medicine will help establish a foundation for current knowledge in several areas. We know, for example, that omega-3 fatty acids do not help prevent cardiac arrhythmias, but they do have a role in lipid metabolism. We will learn more about their role in depression, since many ongoing studies are investigating these issues.

We must not be afraid or reluctant to refer patients with important nutrition needs or concerns to experts or expert websites—as long as we help them sift through the results. On a roll with my research, I googled “food, dementia” and got 1,260,000 results. I now “know,” among other things, that dementia can be “prevented” by eating more blueberries, more dark chocolate, more fish (but read Jane Hightower’s article on mercury in fish first!), and by eating less of everything else. These are just a few points of view out there in cyberspace. I encourage patients to bring in such results of their research for me to review, because I think our scientific background as physicians affords us the ability to render expert opinion on these materials. Our scientific background teaches us not to react immediately to every new piece of information or advice, but to research the context of the results and integrate this information into what we already know.

These are all ways we can act as individual doctors to best advise our patients. But we also have a role to play as members of the San Francisco Medical Society. The SFMS has taken important public positions in the area of food and nutrition. We are on record as concerned about childhood obesity and, under the guidance of former SFMS President Dexter Louie, we have participated in programs addressing the issue. We have supported efforts to get healthy foods into the schools. We have opposed the use of antibiotics in animal husbandry, under the direction of former SFMS President George Susens. We have supported the regulation and reporting of mercury content in fish products, under the guidance of SFMS Executive Board member Jane Hightower. If you have concerns or ideas about how SFMS can be more proactive in these or other related areas, we would like to hear from you. 

If we are going to be innovative in our approach to food and health, we should not just be talking about what we eat, but about how we eat, how much we eat, and why we eat the way we do. We are committed to a healthy community. Read on, and learn. Eat happily and well!