Are We Up to Date? Ana M. Negrón, MD 2/26/23

I am currently studying for my board recertification—and you know something… so far not even one review question addresses food and lifestyle. Instead, every one deals with drugs, dosing, and procedures.

Because I don’t rely on memory for this type of information, I searched for a reference program where I could quickly look up such data and of course was led to the most common resource with over 2 million users worldwide: UpToDate. I remember buying the program 35 years ago when it was sold in a disc. I found the current version very efficient and organized regarding symptoms, drug treatment, and dosing. However lacking, just as it was then, in nutrition, medical prevention, recovering of health, non-commercial food centered dietary education for the patient, or lifestyle interventions. In fact, some of the references on diabetes and heart disease are quite dated (they stop around 1990). However, explicit bogus caution regarding incomplete amino acid composition of plant diets and generous industry guided recommendations on the consumption of cow’s milk and other dairy products, abound.

I became more specific in my search and looked for what it might say on insulin resistance—found nothing other than treatment with drugs. I checked what it would have on actual data for cardiac rehabilitation, (such as the (Dr. Dean) Ornish program paid by Medicare)—nothing; and on coronary arteriography evidence of reversion of atherosclerosis with diet /lifestyle—zippo.

By now I am on a mission—they clearly must have information on the physician authors of well known chronic disease reversal studies—Caldwell Esselstyn, Dean Ornish, Neal Barnard—no mention of them. The China Study or T Colin Campbell, PhD—nope. The Blue Zones—don’t exist. Research done at Loma Linda, California on chronic disease and longevity—not found. Alzheimer’s research by top neurologists Drs. Dean and Ayesha Sherzai—who?      It began to dawn on me why my colleagues don’t know any of this. After a medical education without nutrition content, they all use the same source and learn that the practice of medicine is nothing but tests, drugs, and procedures; where food plays no role and where screening with tests is confused and misunderstood for true prevention using recommended food and lifestyle.

Still not believing the incomplete nature of the data presented in this universally used program, I moved to the very relevant topic of fiber and found they had this to say:  “The recommended amount of dietary fiber is 20 to 35 grams per day” (the actual current recommendations are for at least 38 grams a day)  They go on to say “Because high-fiber foods may be healthy for reasons other than their fiber content, the research has not always been able to determine if fiber is the healthful component. (!) A high-fiber diet is a commonly recommended treatment for digestive problems, such as constipation, diarrhea, and hemorrhoids, although individual results vary widely, and the scientific evidence supporting these recommendations is weak” (No mention of the microbiome here and as for the existence or benefits of short chain fatty acids, totally ignored). We pay $600 a year for this!!

It’s not that physicians don’t know how to prevent and reverse chronic illness; it is that most health care professionals don’t even think or know it is possible. Whenever diet or lifestyle is mentioned in the references presented in UpToDate and whether it has any effect on health, it is to say that the evidence is weak.

Remember: this popular program/ app which is almost universally used in clinics, private offices, and medical schools, serves more than 2 million health professionals worldwide—is relying on information filtered through what I would call an “echo chamber medical news channel”. Many of the authors have ties with Pharma or food industry, while the disclaimers point out: “all of the relevant financial relationships listed have been mitigated”.

As they say, we don’t know what we don’t know—until it is pointed out to us. To know better—is to be able to do better! How can we address this collective blind spot?

First, we could recognize that our education has been (and continues to be) biased, partial, not whole.

Second, we must fill the gaps with comercial free and truly up to date scientific content. If you pay to use UpToDate, voice your displeasure regarding its incomplete content. Share this concern with colleagues. Create a movement for the benefit of all.

Third, even if our practice is already successfully established, pull back and assess how we can better protect and help our patients recover their health, instead of just be content to chronically suppress their symptoms.

It will be painful to change course (it always is)—but when we know better, we must do better.

Ana M. Negrón, MD is a Board certified practicing bilingual family physician from Puerto Rico living in Pennsylvania since the 1979; over thirty years vegan plant based; mother, teacher, volunteer, mentor, composter; geothermal home system since 2003; fully electric car since 2015, writer, author of Nourishing the Body and Recovering Health: The Positive Science of Food published by Sunstone Press; vice-chair of The Center for Nutrition Studies T Colin Campbell