by wayne perskyFounder and President of the Microscopic Colitis Foundation |
That's obvious in articles written by doctors and published on medically oriented websites, such as an article recently published on Medscape (Mandrola, 2024, February 22).1 Medscape is a website claimed to be read by many doctors, so it's probably safe to assume that the conclusions stated by an article such as this are popular among doctors. Prestigious medical journals and medical websites are loath to publish articles that include unpopular conclusions.
Doctors love to cite medical trials.
So naturally, since this is a medical article, Dr. Mandrola (the author), cites a medical trial as evidence in his argument against using "food as medicine". And medical researchers love to publish research studies that doctors will choose to reference. Consequently, this study appears to have been designed to prove a preconceived agenda. The researchers were well aware that they couldn't actually prove that food could not be effectively used as medicine to treat diabetes, as that had been convincingly demonstrated by the Diabetes Control and Complications Trial (DCCT) and other studies, over the years (Richardson, Castle, Cercone, Lyon, Mueller, and Snetselaar, 1993; Celli, et al., 2022; Sami, Ansari, Butt, and Hamid, 2017; Mudaliar, 2023; Forouhi, Misra, Mohan, Taylor, and Yancy, 2018).2, 3, 4, 5, 6 So the trial was designed using devious and circuitous methods, so as to give the illusion that it failed to prove the benefits of "food as medicine" (Doyle, Alsan, Skelley, Lu, and Cawley, 2024).7
This research project appears to have been designed to yield a negative result.
At first glance, the trial appears to have a useful design. But closer scrutiny shows that actually, the study compared patients who were being medically treated for type II diabetes, with patients who were being medically treated for type II diabetes plus the addition of what they considered to be "food as medicine", in the form of 10 meals per week (not 21 meals, as most people would normally eat — only 10 meals per week).
Not all patients love medical treatments.
Many patients prefer to choose a "food as medicine" treatment program whenever they can, because they want to avoid taking medical treatments in the first place (if they possibly can). So they want to know if eating a properly selected diet can resolve their health problems as effectively as a conventional medical treatment. Unfortunately, this trial wasn't designed to provide such beneficial information. This trial was designed to convey the misconception that "food as medicine" is not a useful concept.
The trial did not compare patients who had type II diabetes, who were treated with (only) "food as medicine", with patients who were treated with a conventional medical treatment. Instead, both groups in the study (both treated patients and controls) were being medically treated for type II diabetes, presumably with the most up-to-date medical treatments available, because according to the article, patients in both groups were carefully selected (the researchers screened 3700 patients and only selected 500, 349 of which completed the study). The only difference between the two groups was the addition of a prescribed plan for the treatment group, that provided 10 meals per week from a "fresh food pharmacy" (whatever that is) and dietary advice from a dietitian, nurse consultations, coaching, etc.
But since both treated patients and controls were receiving similar medical treatments for their type II diabetes, it's certainly not surprising that both patients and controls experienced similar declines in A1C levels, conveniently demonstrating a lack of benefit from the 10 meals per week of "food as medicine". But so what?
The trial did not compare patients who had type II diabetes, who were treated with (only) "food as medicine", with patients who were treated with a conventional medical treatment. Instead, both groups in the study (both treated patients and controls) were being medically treated for type II diabetes, presumably with the most up-to-date medical treatments available, because according to the article, patients in both groups were carefully selected (the researchers screened 3700 patients and only selected 500, 349 of which completed the study). The only difference between the two groups was the addition of a prescribed plan for the treatment group, that provided 10 meals per week from a "fresh food pharmacy" (whatever that is) and dietary advice from a dietitian, nurse consultations, coaching, etc.
But since both treated patients and controls were receiving similar medical treatments for their type II diabetes, it's certainly not surprising that both patients and controls experienced similar declines in A1C levels, conveniently demonstrating a lack of benefit from the 10 meals per week of "food as medicine". But so what?
Two opposing diabetes treatment camps have existed ever since insulin was discovered.
Some doctors believe that blood sugar is best controlled by diet and exercise, along with insulin, while others believe that diet and exercise make little difference, and are more trouble than they're worth, because they have an adverse impact on lifestyle. Doctor Elliott P. Joslin (a founding member of the first group) was the first to recommend teaching patients to care for their own diabetes, and he was also a recognized pioneer in glucose management (Wikipedia Contributors., 2024, March 5).8 Doctor Mandrola is obviously a member of the second group.
Note that the DCCT, referenced above in the second paragraph, published in 1993, validated Joslin's approach, 30 years after his death. The DCCT clearly showed that retinopathy was significantly reduced among patients who tightly controlled their glucose, compared with those who follow the usual routine. Furthermore, the patients who tightly control their glucose reported no adverse impact on their lifestyle.
Note that the DCCT, referenced above in the second paragraph, published in 1993, validated Joslin's approach, 30 years after his death. The DCCT clearly showed that retinopathy was significantly reduced among patients who tightly controlled their glucose, compared with those who follow the usual routine. Furthermore, the patients who tightly control their glucose reported no adverse impact on their lifestyle.
It's no wonder that the healthcare system is losing the trust of patients.
Actually, this trial proved nothing worthwhile, making the study irrelevant, for all practical purposes. It only proved that eating 10 meals of prescription foods per week in addition to their regular medical treatment did not decrease the effectiveness of the existing medical treatment for diabetes, for the patients in this study. And yet Dr. Mandrola proudly points to this study as clear evidence that "food as medicine" is a meritless concept. Really?
And it's no wonder that healthcare is so expensive.
The saddest part is that instead of wasting all that money on a worthless trial, the researchers could have just as easily been comparing patients who used medical treatments with those who only used "food as medicine" as a treatment for their type II diabetes (or some other useful concept), and instead of encouraging disinformation, they could have provided the healthcare system, and the world, with some worthwhile information that many of us would have sincerely appreciated.
Misguiding articles such as this example probably link back to the problems with the electronic medical records system (EMR).
Patients and doctors alike might prefer to use dietary intervention and lifestyle changes to treat diabetes, for example, but unfortunately, insurance companies won't pay for ongoing lifestyle coaching. Instead, they prefer to pay for expensive prescription drugs. Consequently, the EMR discourages dietary intervention and lifestyle changes for treating disease, and instead, promotes the use of prescription drug treatments, by making them appear to be much more practical choices.
There are too many disincentives.
And to further discourage doctors from trying to persuade patients to use dietary intervention and lifestyle changes for treating disease, many patients would rather simply pop a pill than go to the extra trouble and expense of following a healthy diet, getting enough exercise, and making other needed lifestyle changes that will improve their health, and their quality of life. And as doctors enter their treatment information for each patient into the EMR, the system rewards them for choosing prescription drug treatments over alternative treatments, such as diet and lifestyle changes. The bottom line appears to be, "Healthcare seems to have accumulated more than enough disincentives to guarantee that it will never perform at optimum levels."
References
1. Mandrola, J. M. (2024, February 22). Food As Medicine: A Great Idea That Didn't Work. Medscape, Retrieved from https://www.medscape.com/viewarticle/1000187?ecd=wnl_infocu1_broad_broad_persoexpansion-both_20240302_etid6347803&uac=95382HN&impID=6347803#vp_1
2. Richardson, M., Castle, G., Cercone, S., Lyon, R., Mueller, D., and Snetselaar, L. (1993). Nutrition interventions for intensive therapy in the diabetes control and complications trial. Journal of the Academy of Nutrition and Dietetics, 93(7), pp 768–772. Retrieved from https://www.jandonline.org/article/0002-8223(93)91750-K/abstract
3. Celli, A., Barnouin, Y., Jiang, B., Blevins, D., Colleluori, G., Mediwala, S., . . . Villareal, D. T. (2022). Lifestyle Intervention Strategy to Treat Diabetes in Older Adults: A Randomized Controlled Trial. Diabetes Care, 45(9), pp 1943–1952. Retrieved from https://diabetesjournals.org/care/article/45/9/1943/147289/Lifestyle-Intervention-Strategy-to-Treat-Diabetes
4. Sami, W., Ansari, T., Butt, N. S., and Hamid, M. R. A. (2017). Effect of diet on type 2 diabetes mellitus: A review. International Journal of health sciences (Publication by Qassim University), 11(2), pp 65–71. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5426415/
5. Mudaliar, S. (2023). The Evolution of Diabetes Treatment Through the Ages: From Starvation Diets to Insulin, Incretins, SGLT2-Inhibitors and Beyond. Journal of the Indian Institute of Science, 1(11). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9942084/
6. Forouhi, N. G., Misra, A., Mohan, V., Taylor, R., and Yancy, W. (2018). Dietary and nutritional approaches for prevention and management of type 2 diabetes. BMJ, 361, k2234. Retrieved from https://www.bmj.com/content/361/bmj.k2234
7. Doyle, J., Alsan, M., Skelley, N., Lu, Y., and Cawley, J. (2024). Effect of an Intensive Food-as-Medicine Program on Health and Health Care Use: A Randomized Clinical Trial. JAMA Internal Medicine, 184(2), pp 154–163. Retrieved from https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2812982
8. Wikipedia Contributors. (2024, March 5). Elliott P. Joslin. Wikipedia, Retrieved from https://en.wikipedia.org/wiki/Elliott_P._Joslin
