Which Area in Health Care is Most Important: Nutrition or Medicine?

 

             Let Food Be Thy Medicine

                        or is it:

              Let Medicine Be Thy Food?

 Which Area in Health Care is Most Important: Nutrition or Medicine?

As both a nutritionist and a clinician I was often asked by my patients should they replace the medication given by their doctors with healing foods and nutrition?

Here’s a very brief summary of my views:  

There are a number of diseases that are nutrition related, either due to overnutrition or undernutrition, and there are also diseases that may not be linked to nutrition, either due to over or under nourishment with some reservation. Let us briefly have a look:  

Diseases caused by Overnutrition:

1. Obesity: Resulting from excessive intake of calories and lack of physical activity.
2. Type 2 Diabetes: Often linked with obesity and overconsumption of sugar and carbohydrates.
3. Hypertension (High Blood Pressure): Associated with high salt intake and obesity.
4. Cardiovascular Diseases: Including coronary artery disease, stroke, and heart attacks, often related to high cholesterol levels and obesity.
5. Metabolic Syndrome: A cluster of conditions including high blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels, often related to overnutrition and lack of exercise.

None of the above disorders can permanently be treated or cured by any drug, except life-long control by medication, but more importantly best treated through lifestyle modification, especially dietary changes.  It is very crucial to understand this both by the doctor and his patients.

What about diseases caused by undernutrition? These are:

1. Malnutrition: General term encompassing various deficiencies in nutrients, including protein-energy malnutrition (PEM), vitamin deficiencies, and mineral deficiencies.
2. Kwashiorkor: A severe form of malnutrition caused by inadequate protein intake.
3. Marasmus: Another severe form of malnutrition characterized by energy deficiency, resulting in emaciation.
4. Iron Deficiency Anaemia: Caused by insufficient iron intake, leading to decreased production of red blood cells. Vitamin A deficiency: Can lead to night blindness, dry eyes, and eventually total blindness.
5. Vitamin B1 deficiency (Thiamine deficiency): Causes beriberi, which affects the cardiovascular system and nervous system.
6. Vitamin B2 deficiency (Riboflavin deficiency): May lead to sore throat, redness and swelling of the lining of the mouth and throat, cracks or sores on the outsides of the lips.
7. Vitamin B3 deficiency (Niacin deficiency): Causes pellagra, which involves symptoms such as diarrhoea, dermatitis, and dementia.
8. Vitamin B6 deficiency (Pyridoxine deficiency): Can lead to anaemia, dermatitis, and neurological disorders.
9. Vitamin B9 deficiency (Folate deficiency): Can cause megaloblastic anaemia and neural tube defects in newborns.
10. Vitamin B12 deficiency (Cobalamin deficiency): Leads to pernicious anaemia, neurological symptoms, and fatigue.
11. Vitamin C deficiency: Causes scurvy, characterized by weakness, anaemia, gum disease, and skin haemorrhages.
12. Vitamin D deficiency: Results in rickets in children, causing bone deformities, and osteomalacia in adults, leading to weak bones.
13. Vitamin E deficiency: May lead to neurological problems and muscle weakness.
14. Vitamin K deficiency: Causes impaired blood clotting, leading to increased bleeding and bruising.
15. Iron deficiency: Results in iron-deficiency anaemia, characterized by fatigue, weakness, pale skin, and shortness of breath.
16. Calcium deficiency: Can lead to osteoporosis, characterized by brittle bones and increased risk of fractures.
17. Magnesium deficiency: May result in muscle cramps, weakness, and irregular heartbeat.
18. Zinc deficiency: Causes impaired immune function, delayed wound healing, and growth retardation.
19. Iodine deficiency: Results in iodine deficiency disorders such as goitre and cretinism.
20. Selenium deficiency: Can lead to muscle weakness, fatigue, and increased risk of infections.
21. Copper deficiency: Causes anaemia, bone abnormalities, and neurological issues.

All the above are nutritional deficiency diseases that can only be treated by food and adequate nutrition, and not by any drug. It is very crucial to understand this, both by the doctor and the patient.  

Then what about diseases not related to nutrition? Some of the diseases not related to nutrition are listed below. But are we quite sure they have nothing to do with food and diet? We shall explain this a bit later:

1. Genetic Disorders: Such as cystic fibrosis, Down syndrome, and sickle cell anaemia.
2. Infectious Diseases: Including bacterial, viral, and parasitic infections such as tuberculosis, HIV/AIDS, and malaria.
3. Autoimmune Disorders: Such as rheumatoid arthritis, lupus, and multiple sclerosis.
4. Neurological Disorders: Like Alzheimer's disease, Parkinson's disease, and epilepsy.
5. Mental Health Disorders: Such as depression, anxiety disorders, and schizophrenia.

The above categories aren't mutually exclusive though, as some diseases may have multifactorial causes, including both genetic and environmental factors. Although some diseases named above may not be directly nutrition related, at least that what nutrition scientists, nutritionists or doctors think, some diseases like cancers and other degenerative diseases may also be dietary related due to excessive free radical damage to the cells generated from the metabolism of food, especially due to an overload from excessive eating. Free radicals generated by food intake and metabolized by the body play a part in the aetiology of these diseases and are not exclusive as not nutrition related. Let's have a look. 

We, nutritionists and clinicians sometimes also encounter inborn error of metabolism that requires nutrition counselling and dietetic approach for their management. Just to briefly describe some of them below:  

1. Phenylketonuria (PKU):
• Cause: Deficiency of the enzyme phenylalanine hydroxylase, leading to the accumulation of phenylalanine.
• Management: Dietary restriction of phenylalanine and supplementation with a phenylalanine-free amino acid formula.
2. Maple syrup urine disease (MSUD):
• Cause: Deficiency of the branched-chain alpha-keto acid dehydrogenase enzyme complex, leading to the accumulation of branched-chain amino acids.
• Management: Dietary restriction of branched-chain amino acids and supplementation with specialized formulas.
3. Galactosemia:
• Cause: Deficiency of enzymes involved in galactose metabolism, such as galactose-1-phosphate uridyltransferase.
• Management: Elimination of galactose from the diet by avoiding lactose-containing foods.
4. Homocystinuria:
• Cause: Deficiency of enzymes involved in homocysteine metabolism, such as cystathionine beta-synthase.
• Management: Supplementation with vitamin B6, B12, folate, and dietary restriction of methionine.
5. Gaucher disease:
• Cause: Deficiency of the enzyme glucocerebrosidase, leading to the accumulation of glucocerebroside.
• Management: Enzyme replacement therapy, substrate reduction therapy, and supportive care.
6. Fabry disease:
• Cause: Deficiency of the enzyme alpha-galactosidase A, leading to the accumulation of globotriaosylceramide.
• Management: Enzyme replacement therapy, pain management, and supportive care.
7. Hurler syndrome (Mucopolysaccharidosis type I):
• Cause: Deficiency of the enzyme alpha-L-iduronidase, leading to the accumulation of glycosaminoglycans.
• Management: Enzyme replacement therapy, supportive care, and sometimes hematopoietic stem cell transplantation.
8. Wilson disease:
• Cause: Mutation in the ATP7B gene leading to impaired copper metabolism and accumulation of copper in the liver and other organs.
• Management: Chelation therapy (e.g., D-penicillamine), zinc supplementation, and dietary restriction of copper.
9. Medium-chain acyl-CoA dehydrogenase deficiency (MCAD):
• Cause: Deficiency of the enzyme medium-chain acyl-CoA dehydrogenase, leading to the inability to metabolize medium-chain fatty acids.
• Management: Avoidance of fasting, frequent meals, and emergency protocols in case of illness.

Besides inborn errors of metabolism, we also have quite a common genetic disorder called G6PD deficiency occurring in Malaysia where I have encountered a number of cases when I was working at the Institute for Medical Research

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a genetic disorder characterized by a deficiency in the enzyme G6PD, which plays a crucial role in protecting red blood cells from oxidative damage. G6PD deficiency is inherited in an X-linked recessive manner, meaning it primarily affects males, although females can also be affected if they inherit two defective copies of the gene (one from each parent).

The condition arises due to mutations in the G6PD gene, which provides instructions for making the G6PD enzyme. These mutations result in a deficient or dysfunctional enzyme, leading to an inability of red blood cells to effectively neutralize oxidative stress. Various mutations exist, and the severity of the deficiency can vary depending on the specific mutation.

G6PD deficiency can manifest in different ways, ranging from mild to severe symptoms. Common effects include:

1. Haemolytic Anaemia: One of the most significant effects is haemolytic anaemia, where red blood cells are destroyed faster than they can be produced due to increased vulnerability to oxidative stress. This can lead to symptoms such as fatigue, pale skin, shortness of breath, and jaundice (yellowing of the skin and eyes).
2. Episodic Symptoms: Individuals with G6PD deficiency may experience episodic symptoms triggered by certain factors, such as:
• Infections
• Fava beans or other foods containing high levels of oxidants.
• Certain medications (e.g., antimalarial drugs, sulphonamides, some pain relievers)
3. Severity Varies: The severity of symptoms can vary widely among individuals, ranging from asymptomatic to life-threatening complications.

The management of G6PD deficiency involves several approaches aimed at minimizing symptoms and reducing the risk of complications:

1. Avoidance of Triggers: Individuals with G6PD deficiency should avoid triggers that can induce haemolysis, such as certain medications (e.g., sulphonamides, antimalarials) and foods rich in oxidants (e.g., fava beans) which is a nutritional and dietetic approach.
2. Medication approach involves healthcare providers who should carefully review medications they take to ensure that they do not pose a risk of haemolysis in individuals with G6PD deficiency. Alternative medications or herbal medicines may be prescribed when necessary.
3. Nutritional therapy includes the use of folic acid supplementation to support red blood cell production and counteract the effects of haemolysis. This again is nutritional medicine, and not drug based.  
4. Management of complications from severe haemolytic anaemia or other complications, requires supportive measures such as blood transfusions or other treatments that may be necessary.
5.  Genetic counselling is recommended for individuals and families affected by G6PD deficiency to understand the inheritance pattern and assess the risk of passing the condition to future generations.

Overall, management of G6PD deficiency focuses on minimizing triggers including the food and diet the patient takes, addressing symptoms, and preventing complications to improve quality of life for affected individuals. Regular follow-up with healthcare providers is essential for monitoring symptoms and adjusting management strategies as needed.

The illustrations I gave above on genetic diseases may not necessarily be non-nutritional in origin as some  clinicians think, and yet they have no choice, but to refer their patients to the dietician for dietary mangement.  

Likewise, even infectious diseases generally caused by infective agents may be nutritionally related. It is known that in the event of severe malnutrition, especially in kwashiorkor from protein malnutrition, such a person, especially children are very prone to infectious diseases with high mortality due to lowered immunity caused by a deficiency of immunoglobulins (antibodies) in the blood since these antibodies are made from proteins in the diet. Immunoglobulins are 'natural drugs' secreted by the body, and are not chemical drugs given outside the body  

Let us very briefly summarize the role of nutrition and medicine in both preventive and curative medicine.

We can say both nutrition and medicine play critical roles in disease prevention, but they operate in different capacities and are often complementary.

Role of Nutrition:

A healthy diet is foundational for overall health and disease prevention. Consuming a balanced diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats provides essential nutrients that support the body's immune system, cellular function, and overall well-being. Certain nutrients, such as vitamin C, vitamin D, zinc, and antioxidants, have been linked to boosting immune function and reducing the risk of chronic diseases like heart disease, diabetes, and certain types of cancer. Additionally, maintaining a healthy weight through proper nutrition can lower the risk of obesity-related diseases such as type 2 diabetes and cardiovascular disease.

Role of Medicine:

Includes, vaccines, antibiotics, and other pharmaceutical interventions, also plays a crucial role in disease prevention. Vaccines are one of the most effective ways to prevent infectious diseases by training the immune system to recognize and fight specific pathogens. Antibiotics are essential for treating bacterial infections, preventing the spread of infectious diseases, and reducing the risk of complications. Other medications may help manage chronic conditions and prevent their progression, thereby reducing the risk of associated complications.

In brief, both nutrition and medicine are essential components of disease prevention. A balanced diet provides the body with essential nutrients and supports overall health, while medicine, including vaccines and pharmaceutical interventions, helps prevent and manage diseases, particularly infectious ones. Integrating both approaches is often the most effective strategy for maintaining health and preventing illness.

Indeed, the quote commonly attributed to Hippocrates, "Let food be thy medicine, and medicine be thy food," emphasizes the importance of nutrition in maintaining health and preventing disease. However, there is no evidence that Hippocrates actually uttered “let medicine be thy food”?

Can any sane person, be he a doctor, a patient or any ordinary lay person believe that we only need to take antibiotics, pain killers, antihypertensiive and antidiabetic, antiinflammatory drugs, and all those agents listed in the  pharmacopoeia as "let medicine by thy food" ?  

“Let medicine be thy food” was put into the mouth of the long-dead Hippocrates by pharmaceutical companies and introduced to modern medical doctors today to promote chemical drugs under the glorified and hidden name as “medicines”.

Pharmaceutical drugs were never used during Hippocrates' time. Chemical drugs made from petroleum chemicals was introduced by John D. Rockefeller (1839 – 1937) here:

https://dta0yqvfnusiq.cloudfront.net/allnaturalhealingsrq/2019/04/How-Rockefeller-Founded-Big-Pharma-and-Waged-War-on-Natural-Cures-5cb3d7374f337.pdf

Hippocrates, often referred to as the "Father of Medicine," lived in ancient Greece around 460-370 BCE. During his time, medical treatments were quite different from modern practices. Hippocrates focused on naturalistic explanations for disease and advocated for a holistic approach to healthcare, emphasizing factors like diet, exercise, rest, and emotional well-being.

Hippocrates didn't have access to the pharmaceutical drugs we have today. His approach to medicine was based on principles that are still relevant. Many of his teachings, particularly regarding the importance of lifestyle factors in health, have influenced modern medical practice.

Here are some of the methods and treatments that Hippocrates and his followers employed:

1. Diet and Nutrition: Hippocrates believed in the importance of diet in maintaining health and treating diseases. He recommended specific dietary changes and restrictions based on the individual's condition.
2. Herbal Remedies: Herbalism was a significant part of ancient Greek medicine. Hippocrates and his followers used various herbs and plants for medicinal purposes. These included plants like aloe, garlic, and liquorice, among others.
3. Hygiene and Cleanliness: Hippocrates emphasized the importance of cleanliness and hygiene in preventing disease. He advocated for practices such as washing hands and maintaining clean living environments.
4. Exercise and Physical Activity: Physical activity was considered crucial for overall health in Hippocratic medicine. Exercise was prescribed as a treatment for certain ailments and was also seen as a preventive measure.
5. Massage and Manipulative Therapies: Hippocrates recognized the therapeutic benefits of massage and manual manipulation of the body. These techniques were used to relieve pain and promote healing.
6. Fasting and Rest: Hippocrates believed in the body's natural ability to heal itself, and he often recommended fasting and rest as therapeutic measures to allow the body to recuperate.
7. Observation and Diagnosis: Hippocrates stressed the importance of careful observation and clinical examination in diagnosing illnesses. He developed a systematic approach to examining patients and recording symptoms, which laid the foundation for modern medical diagnosis.

I don’t think even Sir William Osler, MD (1849-1919), considered as the father of modern medicine, advised the use of pharmaceutical chemical drugs for managing diseases.

Osler was the preeminent physician of the 20th century together with the Big Four (Osler, Welch, Kelly, Halsted) who shaped the professionalization of American medical education, taking it from a conceptual revolution spelled out by Abraham Flexner to a systematized bedside clinical practice with an ethical professional character built upon beneficence.

Nevertheless, the sentiment behind the quote “Let Food be Thy Medicine” aligns with the fundamental concept that a healthy diet plays a significant role in promoting overall well-being.

While the emphasis on nutrition as a form of medicine is valid and supported by modern scientific understanding, I think it is fundamental for us to recognize that there are limitations that rely solely on food for the prevention and treatment of all diseases. While a healthy diet can contribute to overall health and disease prevention, there are instances where medical interventions, including pharmaceuticals, are necessary and lifesaving especially in a medical emergency for which I am more familiar, but less useful for chronic disorders using pharmaceutical drugs. 

As a healthcare professional myself in both areas – nutrition and medicine, I think it is crucial to strike a balance between utilizing the healing properties of food and acknowledging the advancements in medical science that have led to the development of effective treatments and medications for various health conditions.

Both nutrition and medicine have their place in promoting health and treating illness, and a holistic approach that incorporates both is often the most effective strategy for optimal well-being.

Both nutrition and medicine play critical roles in disease prevention, but they operate in different capacities and are often complementary.

Both nutrition and medicine are essential components of disease prevention. A balanced diet provides the body with essential nutrients and supports overall health, while medicine, including vaccines and pharmaceutical interventions, helps prevent and manage diseases, particularly infectious ones. Integrating both approaches is often the most effective strategy for maintaining health and preventing illness.

While the emphasis on nutrition as a form of medicine is valid and supported by modern scientific understanding, it's crucial to recognize that there are limitations to solely relying on food for the prevention and treatment of all diseases. 

In short, I think we must strike a balance between utilizing the healing properties of food and acknowledging the advancements in medical science through medical research that have led to the development of effective treatments and medications for various health conditions. Both nutrition and medicine have their place in promoting health and treating illness, and a holistic approach that incorporates both is often the most effective strategy for optimal well-being.

Additionally, certain diseases may be exacerbated by both overnutrition and undernutrition, such as diabetes and cardiovascular diseases.

Both the nutritionist and the medical doctor are qualified healthcare professionals to advise, though sadly some doctors who have not studied nutrition as part of their training thinks that only medicines can “cure”.

Food and nutrition are so crucial and vital to sustain life and health, that even hospitals provide breakfast, lunch, afternoon tea plus dinner (albeit very bland and not so tasty) every day to all patients besides just medication, except in the event patients need to fast overnight for a few hours in order for a medical or surgical procedure to be done the next morning.

Nutrition for all hospital patients is so important even if patients are unable to feed orally. In that case, they are given parenteral nourishment by intravenous administration of nutrients outside of the gastrointestinal tract or by enteral feeding directly into the gastrointestinal tract via a nasogastric tube to sustain life and to support their recovery. 

Isn't that nutrition coming in to aid the practice of medicine?  It is not just medicines they were given. Note this carefully.     

The nutritionist undergoes a 4-year structured course in a university studying the same basic medical sciences as a medical student, in fact much more not covered in medicine, while a medical student take 5 years, just one more extra year mainly to concentrate  on diagnosis and therapeutics 

Both the nutritionist and the medical doctor are registered and licenced health care professionals in Malaysia for practice under the Allied Health Professions Act 2016 [Act 774] by the Ministry of Health Malaysia here:

Hebahan Pendaftaran Sektor Swasta bagi Pengamal Profesion Kesihatan Bersekutu.pdf - Google Drive

or under Medical Act 1971 here:

https://mmc.gov.my/wp-content/uploads/2022/06/Medical-Act-1971.pdf

I hope I managed to summarize.

Thank you for asking.

Lim ju boo