Legislating diet

Like a heaping pile of hot pastrami on the cardiac special from New York’s Carnegie Deli, the devastating research linking poor diet to chronic disease exposes a weighty problem in today’s medical system: Doctors are woefully uninformed about “medical nutritional therapy”—using food to manage and even cure chronic health conditions.

Yet these chronic problems—heart disease, diabetes, obesity and cancer—account for at least 70 percent of the nation’s health-care expenses.

A Grass Valley attorney and Santa Rosa physician want to revolutionize the treatment of chronic disease in California by passing legislation requiring that doctors discuss nutrition as an alternative to standard treatments for diabetes and heart disease in nonemergency cases.

While the bill, Assembly Bill 1478, now rests quietly in the Assembly’s Committee on Business and Professions until January 2010, if passed it would send a pointed message to physicians that food is often a powerful alternative to insulin shots and invasive heart procedures. Meanwhile, the bill’s authors are lining up supporters to defend its merits against powerful opposition from entrenched medical interests.

Dr. John McDougall, a board-certified internist, co-wrote A.B. 1478 based on his 30-year experience with “lifestyle medicine.” Dispensing dietary and exercise advice rather than prescriptions, he’s seen significant improvements with type 2 diabetics by weaning them from insulin and substituting a low-fat diet instead. He’s also seen cardiac patients reverse heart disease while avoiding invasive procedures like angioplasties, stents and bypass surgery.

Is McDougall a rebel? One look at the American Heart Association’s latest guidelines for preventing heart disease proves otherwise.

“Maintaining a healthy diet and lifestyle offers the greatest potential of all known approaches for reducing the risk for CVD [cardiovascular disease] in the general public,” reads the latest AHA Diet and Lifestyle Recommendations report. “This is still true in spite of major advances in clinical medicine.”

The one-page A.B. 1478 is straightforward in its request: “Inform the patient or the patient’s legal representative of the option of medical nutrition therapy treatment for diabetes or heart disease, respectively, including a description of the potential risks, consequences, and benefits of this treatment relative to other medical treatment options.”

A spokesperson for the Assembly’s Health Committee said the bill is the first time “medical nutritional therapy” has appeared in any California legislation.

Nationally recognized nutrition expert Dr. Clare Hasler gushes over the proposed bill. “A kind of bill like this is groundbreaking,” she says. “I think it’s the only thing I may ever campaign for.”

Hasler is executive director of the Robert Mondavi Institute for Wine and Food Science at UC Davis, where she explores the latest scientific discoveries linking food and health. With dual doctorates in environmental toxicology and human nutrition, she also pioneered a functional foods program at the University of Illinois.

Hasler groans when discussing the sorry state of doctors and nutrition. “They’re not at all trained in nutritional therapy. They’re trained to deliver drugs, not to prevent disease. There’s been very little change in that regard.”

Require doctors to discuss nutrition with patients? Hasler goes one step further.

“If I had my druthers, any physician who was dealing with diet-related disease would have a registered dietitian mandated on staff,” she says. “The science clearly says for heart disease and diabetes prevention strategies that diet and lifestyle changes are the first line of defense.”

“The public is being fooled into believing [traditional] treatments work, when every single physician who reads the literature knows this is not the case,” agrees McDougall.

As proof, McDougall cites three diabetes articles published last year in The New England Journal of Medicine. “All three showed that you hurt people when you provide aggressive therapy for diabetes,” he says. Injecting insulin shots, checking blood-sugar levels and taking diabetic pills actually promoted a greater risk of death, heart disease, obesity and hypoglycemic reactions, says McDougall.

The bill’s co-author, Grass Valley attorney James Henderson, threw himself into the issue of diet as curative after his partial retirement from medical malpractice law, and began studying Hippocrates—author of medicine’s Hippocratic oath—who wrote, “Let food be thy medicine, and let medicine be thy food.”

Statistics from the Centers for Disease Control and Prevention show that 10 percent of American adults 20 and older have diabetes, 11 percent live with heart disease and a whopping 66 percent are either overweight or obese.

Michael Pollan, perhaps the country’s most recognized expert on food and health, and author of In Defense of Food: An Eater’s Manifesto, has identified an American tradition that now echoes across the globe. When the “Western diet” is introduced internationally—with its excess fats, carbohydrates and sugars—in every case an epidemic of disease follows close behind: heart disease, type 2 diabetes and obesity.

Yet despite all this evidence, can eating right be legislated?

Local independent physician Dr. Michael Kwiker, focuses his practice almost solely on diet for restorative health. A devotee of the Eat Right 4 Your Type program, Kwiker has gained a faithful following among alternative health-care seekers around the state.

Yet Kwiker opposes the legislation. He says that all doctors have different ideas about nutrition, and forcing them to discuss the variety of potential diets could be calamitous. Instead, he suggests, the pressure for change should come from patients themselves.

“When the patient demands it, I promise you, (doctors) will flip over and go to their nutrition classes,” he says.

The California Medical Association swiftly opposed the legislation when it was introduced. Teresa Stark, associate director for CMA’s Center for Government Relations, says the bill intrudes on the relationship between doctors and patients.

“If you start to mandate … a discussion about every alternative for every disease, regardless of whether it’s right for that patient, there won’t be time to discuss the real issues that are relevant to the patient, and it’s going to be burdensome on everyone,” she says.

“We believe it’s well-intentioned,” says Stark of the bill. “[But] medicine is an art as well as a science, and each individual physician needs to make recommendations to his patients based on that patient’s individual medical situation.”

Such restrictions, adds Stark, become a “one-size-fits-all approach” that can delay treatment and mislead patients.

“‘One size fits all’ is what they’ve been doing all along,” scoffs McDougall. “For heart disease everyone gets surgery, and for type 2 diabetes you’re given a bag full of pills. What we’re trying to do is provide freedom of choice—a reasonable, healthy and effective alternative.”

While CMA opposes more bureaucratic layers of informed consent, Dr. Don Forrester says consent laws are typically welcomed by patients. For 30 years a family physician with Kaiser Permanente, he recounts the barbaric days when women were forced to accept an unsightly mastectomy until offered the option—now mandated in discussions over breast cancer—of lumpectomy.

“People think that if they have heart disease or diabetes they can’t reverse it,” says Dr. Forrester, formerly chief of preventive medicine and patient education for Kaiser’s Sacramento region in the 1980s. Dietary treatments are readily available, but “there’s no money in prevention.”

“We are literally digging our own graves with our spoons,” says attorney Henderson, author of the book Indicted! The People Vs. the Medical and Drug Cartel. “There’s more money to be made by keeping people sick for the rest of their lives.”

While the evidence mounts for diet being a major cause of chronic illness in America, it remains to be seen whether Californians will demand better health with their mouths and pocketbooks, or look to the government to force the hands of doctors.