Diet and nutrition for busy doctors - part two
Q: Can you give an example of a busy professional you've helped, who was able to see real benefits by applying your advice?
A: One person who comes to mind is a senior politician who not only has to travel on a daily basis to work but also has to travel abroad at a moment's notice. He was referred to me from our health-screening unit. He was obese, had high blood pressure, raised fasting blood glucose and raised cholesterol. He also had gout. Needless to say he did no exercise.
The first thing we needed to do was to get him to exercise. We decided the most appropriate time for him was first thing in the morning, before he had his shower or breakfast. He was to fall out of the bed 20 minutes earlier than normal and either go out for a fast walk or use his exercise bike.
Instead of breakfast on the run he was to have a fresh juice and cereal with low fat milk before leaving the house. He was to avoid lunch out as often as possible and opt to meet people for coffee in a local hotel instead. Lunch was to be just a sandwich or a wrap, plus some fruit and a diet mineral. Dinner was nearly always eaten out so he had to reduce his portion size, avoid the extra bread and butter on the table and avoid very high fat foods like chips, cream, cheese and mayonnaise. He was to avoid eating between meals and limit himself to a maximum of 1-2 glasses of wine per day.
After 3 months his bloods were reviewed. He was down in weight by about 18lbs, fasting glucose was within normal range, fasting cholesterol was reduced, and although he had never mentioned it he said his indigestion was gone. He remained on medication for gout and blood pressure. The most amazing bit was the exercise. He really took to the early morning exercise and couldn't believe how much more energy he had. He wasn't feeling tired at all.
Another patient that comes to mind is a millionaire businessman in his middle 60s. Not only was he on the road for business reasons he had an incredible social life mixing with counterparts around the world. He was obese with glucose intolerance and raised fasting cholesterol. Other than that he was perfectly healthy. His main motivation was that he did not want to become diabetic. I advised him that if he followed two simple rules every day of his life then the evidence says he would not become diabetic. Those two rules are:
1. He must walk or exercise every day for a minimum of 20 minutes;
2. He could only eat three times a day - breakfast, lunch and dinner.
In addition, I gave him other advice about foods high in saturated fat and advice on reducing his alcohol consumption.
I knew he was going to find it difficult but I kept stressing the first two rules. I firmly believe any bit of discipline in your eating will improve your chances of preventing diet related diseases. The exercise was the hardest one at the beginning but I kept constant in my advice and eventually he started to walk every day. Over time I recommended him to a personal trainer and he really related to this. Five years later he has lost approx 21lbs, fasting glucose readings are constantly below 6 and fasting cholesterol is normal. The reason why he springs to mind is because if anybody was not going to do it, it was him.
Q: How relevant do you think this example would be for doctors?
A: If a daily exercise regime could be imposed, along with three meals and no snacking, I think this would improve everybody's health. There is no reason why anybody cannot follow these guidelines. If daily exercise looks like being a problem two options which seem manageable are to get up 20 minutes earlier, to free time to exercise, or to walk/cycle to/from work. The exercise needs to be enough to raise the heart rate above normal for 20 minutes.
Q: Is there anything diet can do to help boost our immune system?
A: Unknown to many people is the role that vitamin A plays in our immune system. Mild vitamin A deficiency leads to an increased susceptibility to a variety of infectious diseases. However, because it is a fat-soluble vitamin that can be stored in the body, supplements should be used with caution. It is far better to improve the sources in the diet, such as fortified milk with vitamins A and D added to it.
Liver is such a rich source of vitamin A that pregnant women should actually avoid it. Many margarines have vitamin A added to them. Carotenes, which are precursors of vitamin A are found in green, yellow and red fruits and vegetables, and these are also a great source of antioxidants.
Selenium (a mineral) and also an antioxidant plays a major role in immunity. Selenium deficiency is accompanied by loss of immunocompetence. Covert suboptimal selenium status may be widespread in human populations. However, there is a narrow margin between beneficial and harmful intakes of selenium so be careful of supplements. Brazil nuts are a rich source of selenium. Fish, shellfish, liver and kidney as well as milk and eggs are also good sources of selenium.
Zinc deficiency causes increased susceptibility to infections. Meat, (beef and lamb being higher than pork and chicken) seafood (especially oysters and crab) and liver are the main sources of bioavailable zinc.
Q: For doctors working long hours, do you have any diet tips to help maintain energy?
A: A high carbohydrate diet is the only way to maintain energy levels. It depends where you are. I have to admit that when I'm in the middle of a busy clinic I keep going on my tea with sugar added. I avoid biscuits because of the high calorie and fat content. For immediate energy, that is fat free, go for something that is sugar-based like tea or coffee with two spoons of sugar added or a soft drink or sweets like pastilles or wine gums. This is so much better than eating biscuits, chocolate or crisps, which are all high in fat. If you have time and you can get it, white bread is absorbed the quickest so a bread roll will give you instant energy and is also fat-free. Nutritious energy snacks would include fruit juices, a smoothie, a fruit or wholemeal scone, a wholemeal cereal bar, a piece of fruit or even just a couple of slices of toast.
Q: Do dietary supplements have any value or is the main benefit from what we eat and drink?
A: The aim should be to get all the nutrients that your body needs from your diet. However, this is not always practical. There is a role for supplements but in special situations, not for the general population.
Women who do not eat dairy products should take a calcium supplement. Vegetarians should take an Iron and vitamin B12 supplement. Vitamin D requirements increase in the elderly so a vitamin D supplement could be necessary here. If someone has been ill then a short course of a vitamin supplement would be useful. Most important of course is folic acid for women who are planning a pregnancy. But for the rest of us, they really are not necessary.
One other point to bear in mind is the value of the sun, within reason, as a source of vitamin D. We are now hearing of an increase in rickets in children, as a result of very high levels of sunscreen use.
Q: The word diet sometimes conjures up the idea of weight loss and every year seems to bring the latest celebrity diet. What would your advice be for someone looking to lose weight?
A: There's no mystery to dieting. It is simply a question of mathematics. Bigger portions contain more calories, which can contribute to weight gain. So to lose weight, or maintain body weight, reduce portion sizes. Don't skip breakfast. Have three regular meals a day - just keep the portion sizes down. If you're eating in, a smaller plate is an easy way of achieving this.
Q: For doctors studying for examinations is there anything they should include in their diet or avoid to help their concentration?
A: The brain is one of the smallest organs in the body yet it uses up 20% of our daily energy. Keeping a constant supply of glucose to the brain will ensure concentration so, again, don't skip breakfast. Lack of glucose will reduce your ability to recall and concentrate. High fire carbohydrate foods will ensure a slow but sustained release of glucose. Foods like high fibre breakfast cereal, brown bread, fruit and vegetables are all recommended.
Q: Would you give different advice to doctors at different stages in their lives and careers? For instance, how might your advice differ, talking to a recently qualified doctor compared with a doctor approaching retirement?
A: The basic nutritional requirements will be pretty much the same throughout your life and career. What is more likely to change is your requirement for energy. There was probably a time when the pace of life earlier in your career was more frantic but changes in the NHS mean you may now be experiencing a hectic pace throughout most of your career. In the past too, many male medical careers were partly built on having a wife at home looking after the home and children and doing the cooking. With both men and women now having careers, pressures outside work may be growing, hence increasing concerns about achieving a work/life balance.
However, physical activity may still be more likely when you are younger, for instance if looking after young children compared with after they have left home. Other factors will also be age related. As we grow older our appetite may be reducing, there may be a slight loss of taste and smell, we may be getting a bit bored with and losing interest in the food we have traditionally eaten. All this suggests the value of planning our diet to ensure we continue to eat regularly and enjoy a varied diet as we grow older. I've already explained the value of higher cereal fibre intake in adults aged 65 years and over. Also, as you grow older, if your weight goes up your blood pressure tends to rise, so the diet and exercise advice I mentioned earlier becomes increasingly important.
Q: Food allergies seem to be an increasing problem. Is there anything we can do, through choice of diet, to reduce the risk of developing food allergies?
A: Food allergy is a reaction by the body to a dietary protein like milk, egg or nut. This allergic response produces a lot of IgE antibodies and will make you ill immediately after eating the food. 1 - 2% of the population is believed to have a food allergy.
Food intolerance causes symptoms hours/days after eating the offending food. This response may or may not involve the immune system. Foods like soya, milk, eggs, and wheat; chocolate, caffeine and wine can all be listed as offenders. There is no scientific test to prove food intolerance. Advice is usually to avoid the offending food. If you think you have a food intolerance seek advice from a registered dietitian.
Q: What would you recommend to doctors interested in finding out more about the health implications of diet?
A: Here are some of the websites they may find helpful. I personally find the American Dietetic Association's site very good, for both health professionals and laymen.
http://www.nutrition.org.uk is a registered charity, supported by the food industry and is a comprehensive and authoritative source of objective information.
http://www.nutsoc.org.uk/ is the Nutrition Societys site and offers many links to other useful sites.
http://www.eatright.org/ is the site of the American Dietetic Association and deals with selected topics
www.ifst.org.uk. Is from the Institute of Food Science and Technology and provides a UK view on a few specific issues like BSE and genetically modified food.
http://www.bda.uk.com/ is the site of the British Dietetic Association
Dr Mary McCreery is a consultant clinical nutritionist and dietitian based at the Blackrock Clinic in Dublin. She has been consultant nutritionist to both the Irish Olympic team and the Irish rugby team and is vice-chair of the scientific committee of the Nutrition and Health Foundation.