New Book on Nutrition

January 7, 2009

This is a part of the New Book on Nutritition expected to hit the

stands this year.

One of the major idiosyncrasies of medical world is the gap between

the science of medicine and the art of medical practice. The doctor

cannot preach what he knows. Not that this is true only in medicine.

May be this is true for all sciences where practicing involves human

beings. The philosopher may not be able to speak out his heart for

fear of a religious backlash. The artist paints a picture and runs

for his life. But nowhere does this involve every individual at

micro level as it does in the field of medicine. The patient goes to

the doctor because she is unwell or perceives to be unwell. She

expects the doctor to give her relief. She has certain physical

signs and symptoms to present to the physician. The problem starts

the moment these two meet.

The patient has grown up in an environment, to a set of parents, in

a particular community, in a specific religion, studied in an

university culture and imbibed all of these in her mind. She has

developed her understanding of disease and health from the

community. This community is clouded by myths, by home remedies, by

alternative practices, by religious teachings and also by home made

medical experts. This patient grows up with a model of disease and

treatment in her mind that is quite far from the truth, or should I

say contemporary scientific knowledge. Her expectation from the

doctor is interrelated to this model. Nowhere it is more acutely

open to the elements as in cases of chronic disease. The patient

gets enough time to think and react; she gets enough reinforcements

from the surroundings to justify her own beliefs. Thus when she

faces the doctor, she creates a barricade in front and protects her

faith ferociously. She even concocts symptoms and modifies the

existing ones in such a way that the whole story justifies her own

diagnosis. She would exaggerate some symptoms using superlatives,

and ignore some symptoms with the brush of a hand. For example any

patient talking about gas would use all possible superlatives

like `excessive', `extreme'; talking about constipation she would

declare that she does not pass stool at all. Unknowingly the patient

guides the doctor to the diagnosis she likes to hear, the one she

believes in.

When the subject is food and nutrition, the belief is stronger; the

model is more substantial and the crowd merrier and more

participating. Nutrition is one subject where everyone is an

authority. Every community, every religion, every country has its

own nutritional taboos, beliefs and myths and these are deeply

ingrained in the minds of people. Starting from fear of sugar in

Diabetes to fear of oil in hypertension, these myths are so widely

and deeply held that it would need a philosopher of the stature of

Socrates to dispel them. There are two aspects of this social

information. Some ancient information is so accurate and so profound

that modern science looks like a toddler facing the sea. These are

the information that came after generations of intelligent

observation by minds extraordinary. The British mothers knew that

oranges cured scurvy, not the British doctors. How an apple a day

kept the doctors away, the medical fraternity was oblivious. Much

before the amino acids were discovered and essential amino acids

were listed, society found a way out to avoid shortages of any

essential amino acid by combining Rice and Pulses or Wheat and

Pulses as the staple diet for people. Science took aeons to

understand how Indian vegetarians were doing so well.

Unfortunately with time this changed. Science took over as the

guiding force, nothing wrong in that, other than the fact that it's

shoulders were not strong enough for the burden. Thus a lot of

doubts remained, a lot of questions that science could not answer.

Then came the other answers, without observation, or I should say

without intelligent observation. Potatoes were blamed for Diabetes

and obesity; fruits were blamed for acidity and high blood sugar.

Rather than adding extra strength to the diet of a sick man, society

and doctors started removing articles from diet. The new diet charts

became charts for restriction. The meek ware denied protection. That

became the order of the day. Some drug companies took advantage of

the prevalent ignorance and `discovered' new diseases for which they

had answers. People grabbed the popular diseases by both hands and

feet and stomach and heart and everything. The light of science

created a curtain of ignorance.

Let us take a look at the doctor now. This young man also grows up

in an environment where he faces the same exposure, develops the

same medical model in his mind. But then he goes to the medical

school. He learns new ideas in isolation. He learns that all fat is

not bad, that there are good fats and bad fats, and sugar is not the

killer; it is the excess that is bad. This doctor from inside his

heart does not accept the new information but as a sincere science

student he imbibes all that and religiously passes his exams. The

conflict between what he `knew' and what he learns now takes an

interesting turn. He starts quarantining the new information in the

texts about subjects that he already `knows'. He now has two sets of

information, without having any idea about the conflict in his mind,

ones that he truly believes in and ones that he learns for his

exams. Gradually he is unable to differentiate between these two

sets of knowledge and puts them in the same pedestal. Thus he knows

about `Gas' and its treatment. He `knows' diabetic diet and all the

restrictions essential for survival, he `knows' about all the

harmful affects of fruits in diabetes. He `knows' about blood

pressure and `no's associated with it. He also has the opposite

information in his head, for he has exams to pass. Science and

nonsense co-exist.

He faces his first patient. The patient has a set of beliefs. The

information she gives to the doctor comes out of her beliefs. Deep

inside the doctor also agrees with the disease model the patient

presents to him. He has the same knowledge but also has another set

of information that contradicts these ideas. His mind weighs these

two. The deluge of informed patients overwhelms him. He struggles a

bit; he is no philosopher, so surrenders. The old model matches with

that of the patients and wins. The result is what we see all around

us. The doctor tells the next patient; you are diabetic, no sugar,

no sweets and no fruits. The patient is happy, so is the doctor and

the disease. The woman with `extreme gas' in her body, gas that

caused her headaches, vertigo, chest pain, weakness in the limbs and

also sleeplessness gets a dose of omeprazole. The doctor asks her to

drink two liters of water in empty stomach in the morning. She gets

no relief but is happy to get a good doctor who gave her a

sympathetic hearing and agreed with her. The next hypertensive gets

a dose of atorvastatin, every one is happy; only this time everyone

includes the drug industry.

This book is an attempt to look at nutrition with an open mind away

from faiths and beliefs. Evidence is truth. This truth would be

discarded when newer evidences arrive. But there are certain ideas

that cannot be challenged by any one. One such idea is that `I do

not know everything about anything'. Naturally, we are not in a

position to know everything about nutrition at present. But we need

results today and cannot wait for posterity to get answers for

questions we do not understand. In this book I looked for a solution

without knowing all. It is an endeavor to get the whole answer

without trying to solve the riddle of life. It is an attempt to

understand nutrition as part of life itself. I am hopeful that the

words in this book will help the reader understand the relation

between life, food and nature.

January 7, 2009

Very interesting Dr Ashok, all the best to you :-)

Ravin '82

January 7, 2009

Ashok,

You have always held a contrarian viewpoint. All the best for your book.

Kishore Shah 1974

New Book on Nutrition

> This is a part of the New Book on Nutritition expected to hit the

> stands this year.

>

> One of the major idiosyncrasies of medical world is the gap between

> the science of medicine and the art of medical practice. The doctor

> cannot preach what he knows. Not that this is true only in medicine.

> May be this is true for all sciences where practicing involves human

> beings. The philosopher may not be able to speak out his heart for

> fear of a religious backlash. The artist paints a picture and runs

> for his life. But nowhere does this involve every individual at

> micro level as it does in the field of medicine. The patient goes to

> the doctor because she is unwell or perceives to be unwell. She

> expects the doctor to give her relief. She has certain physical

> signs and symptoms to present to the physician. The problem starts

> the moment these two meet.

>

> The patient has grown up in an environment, to a set of parents, in

> a particular community, in a specific religion, studied in an

> university culture and imbibed all of these in her mind. She has

> developed her understanding of disease and health from the

> community. This community is clouded by myths, by home remedies, by

> alternative practices, by religious teachings and also by home made

> medical experts. This patient grows up with a model of disease and

> treatment in her mind that is quite far from the truth, or should I

> say contemporary scientific knowledge. Her expectation from the

> doctor is interrelated to this model. Nowhere it is more acutely

> open to the elements as in cases of chronic disease. The patient

> gets enough time to think and react; she gets enough reinforcements

> from the surroundings to justify her own beliefs. Thus when she

> faces the doctor, she creates a barricade in front and protects her

> faith ferociously. She even concocts symptoms and modifies the

> existing ones in such a way that the whole story justifies her own

> diagnosis. She would exaggerate some symptoms using superlatives,

> and ignore some symptoms with the brush of a hand. For example any

> patient talking about gas would use all possible superlatives

> like `excessive', `extreme'; talking about constipation she would

> declare that she does not pass stool at all. Unknowingly the patient

> guides the doctor to the diagnosis she likes to hear, the one she

> believes in.

>

> When the subject is food and nutrition, the belief is stronger; the

> model is more substantial and the crowd merrier and more

> participating. Nutrition is one subject where everyone is an

> authority. Every community, every religion, every country has its

> own nutritional taboos, beliefs and myths and these are deeply

> ingrained in the minds of people. Starting from fear of sugar in

> Diabetes to fear of oil in hypertension, these myths are so widely

> and deeply held that it would need a philosopher of the stature of

> Socrates to dispel them. There are two aspects of this social

> information. Some ancient information is so accurate and so profound

> that modern science looks like a toddler facing the sea. These are

> the information that came after generations of intelligent

> observation by minds extraordinary. The British mothers knew that

> oranges cured scurvy, not the British doctors. How an apple a day

> kept the doctors away, the medical fraternity was oblivious. Much

> before the amino acids were discovered and essential amino acids

> were listed, society found a way out to avoid shortages of any

> essential amino acid by combining Rice and Pulses or Wheat and

> Pulses as the staple diet for people. Science took aeons to

> understand how Indian vegetarians were doing so well.

>

> Unfortunately with time this changed. Science took over as the

> guiding force, nothing wrong in that, other than the fact that it's

> shoulders were not strong enough for the burden. Thus a lot of

> doubts remained, a lot of questions that science could not answer.

> Then came the other answers, without observation, or I should say

> without intelligent observation. Potatoes were blamed for Diabetes

> and obesity; fruits were blamed for acidity and high blood sugar.

> Rather than adding extra strength to the diet of a sick man, society

> and doctors started removing articles from diet. The new diet charts

> became charts for restriction. The meek ware denied protection. That

> became the order of the day. Some drug companies took advantage of

> the prevalent ignorance and `discovered' new diseases for which they

> had answers. People grabbed the popular diseases by both hands and

> feet and stomach and heart and everything. The light of science

> created a curtain of ignorance.

>

> Let us take a look at the doctor now. This young man also grows up

> in an environment where he faces the same exposure, develops the

> same medical model in his mind. But then he goes to the medical

> school. He learns new ideas in isolation. He learns that all fat is

> not bad, that there are good fats and bad fats, and sugar is not the

> killer; it is the excess that is bad. This doctor from inside his

> heart does not accept the new information but as a sincere science

> student he imbibes all that and religiously passes his exams. The

> conflict between what he `knew' and what he learns now takes an

> interesting turn. He starts quarantining the new information in the

> texts about subjects that he already `knows'. He now has two sets of

> information, without having any idea about the conflict in his mind,

> ones that he truly believes in and ones that he learns for his

> exams. Gradually he is unable to differentiate between these two

> sets of knowledge and puts them in the same pedestal. Thus he knows

> about `Gas' and its treatment. He `knows' diabetic diet and all the

> restrictions essential for survival, he `knows' about all the

> harmful affects of fruits in diabetes. He `knows' about blood

> pressure and `no's associated with it. He also has the opposite

> information in his head, for he has exams to pass. Science and

> nonsense co-exist.

>

> He faces his first patient. The patient has a set of beliefs. The

> information she gives to the doctor comes out of her beliefs. Deep

> inside the doctor also agrees with the disease model the patient

> presents to him. He has the same knowledge but also has another set

> of information that contradicts these ideas. His mind weighs these

> two. The deluge of informed patients overwhelms him. He struggles a

> bit; he is no philosopher, so surrenders. The old model matches with

> that of the patients and wins. The result is what we see all around

> us. The doctor tells the next patient; you are diabetic, no sugar,

> no sweets and no fruits. The patient is happy, so is the doctor and

> the disease. The woman with `extreme gas' in her body, gas that

> caused her headaches, vertigo, chest pain, weakness in the limbs and

> also sleeplessness gets a dose of omeprazole. The doctor asks her to

> drink two liters of water in empty stomach in the morning. She gets

> no relief but is happy to get a good doctor who gave her a

> sympathetic hearing and agreed with her. The next hypertensive gets

> a dose of atorvastatin, every one is happy; only this time everyone

> includes the drug industry.

>

> This book is an attempt to look at nutrition with an open mind away

> from faiths and beliefs. Evidence is truth. This truth would be

> discarded when newer evidences arrive. But there are certain ideas

> that cannot be challenged by any one. One such idea is that `I do

> not know everything about anything'. Naturally, we are not in a

> position to know everything about nutrition at present. But we need

> results today and cannot wait for posterity to get answers for

> questions we do not understand. In this book I looked for a solution

> without knowing all. It is an endeavor to get the whole answer

> without trying to solve the riddle of life. It is an attempt to

> understand nutrition as part of life itself. I am hopeful that the

> words in this book will help the reader understand the relation

> between life, food and nature.

>

> ------------------------------------

>

> ------------------------------

> Website: www.mgims.ac.in------------------------------

January 7, 2009

It is not clear whether Dr Shah has reviewed some book or authored it himself.

Anyway, it promises to be good. Talking about the patients' symptoms, we should

not be prejudiced in any way. If it is only a perceived symptom, we have to take

into account the distorted perception. A patient with somatoform disorders is

likely to be occupied with illnesses and/or symptoms. This peoccupation will

extend to every aspect of health, including nutrition.

A doctor is required to be perceptive of the patient's 'perceptions' and

undersatnd his/her real difficulty.

Bharat

1979 Batch

January 8, 2009

Dear Bharat,

That book has been written by Dr. Ashok Sinha of the 1973 batch, whose

earlier mail you seem to have missed.

Kishore Shah 1974

Re: New Book on Nutrition

It is not clear whether Dr Shah has reviewed some book or authored it

himself. Anyway, it promises to be good. Talking about the patients'

symptoms, we should not be prejudiced in any way. If it is only a perceived

symptom, we have to take into account the distorted perception. A patient

with somatoform disorders is likely to be occupied with illnesses and/or

symptoms. This peoccupation will extend to every aspect of health, including

nutrition.

A doctor is required to be perceptive of the patient's 'perceptions' and

undersatnd his/her real difficulty.

Bharat

1979 Batch

January 9, 2009

The book sounds interesting - more so because it seems to be a perspective on

the patient - doctor interface through the prism of something so essential as

nutrition.

Prabha '84

Subject: Re: New Book on Nutrition

To: mgims

Date: Wednesday, January 7, 2009, 6:54 PM