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When Doctors Drop the Ball

If a medical condition is largely driven or mitigated by diet and nutrition, why don't doctors refer patients to nutritionists for help? Here's what happens when doctors drop the ball.

 

By
Monica Reinagel, MS, LD/N, CNS
January 21, 2014
Episode #268

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I have great respect for medical doctors -- I don't know what we'd do without them.

But when it comes to nutrition, they sometimes drop the ball.  To be fair, nutrition is typically a very small part of their medical training. That's why health professionals work as a team! Most nutritionists are quick to refer patients to doctors for help with problems that are outside our domain. Why, then, are doctors so slow to refer patients to nutritionists for help with conditions that are largely driven or mitigated by diet and nutrition?

A letter I received this week is a perfect example.

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Felicity saw a gastroenterologist for evaluation of some long-standing digestive issues. After doing an endoscopy and colonoscopy, the doctor told Felicity that she suffered from excess stomach acid, IBS, and diverticulosis.  He then got out his pad and wrote her prescriptions for an acid blocker and an antispasmodic, told her to eat more fiber and to come back in 6 weeks.

Really?

Felicity has been diagnosed with three different conditions for which dietary interventions can be highly effective -- not to mention safer and less costly than drugs. However, coordinating a dietary response to these three issues presents some challenges.  A high-fiber diet, for example, may help with diverticulosis but make IBS worse!  

This doctor may not have had the time -- or the expertise -- to tackle this essential part of Felicity's treatment plan.  But you would hope that a doctor who specializes in digestive diseases would be tuned into the crucial role of diet and nutrition on patient health.  Instead of just throwing drugs at the problem, I wish he'd used that prescription pad to write Felicity a referral to a dietitian or nutritionist.  

What is Diverticulosis?

Diverticulosis is not really a disease; it's a fairly common condition where small pockets or pouches form in the lining of the large intestine.  Many people have diverticulosis without experiencing any symptoms.  The danger is that material can become trapped in these pockets, causing inflammation or infection. This is called diverticulitis and is usually treated with antibiotics. If you know you have diverticulosis, you can take steps to prevent the more dangerous diverticulitis.

Doctors used to tell patients with diverticulosis to avoid nuts, seeds, whole grains, corn, and popcorn, thinking that these foods might be more likely to get lodged in the pouches, or diverticula. However, this quaint notion was finally debunked a few years ago. Although some GI doctors have been late to read the memo, we now know that there is no reason for people with diverticulosis to avoid these foods.

Adding fiber to your diet, however, can help reduce the risk of diverticular disease. In particular, you want insoluble fiber, which is the kind of fiber found in wheat and oat bran. 

See also: What Is the Difference Between Soluble and Insoluble Fiber?

 

But here's where things might get a little complicated for Felicity.....

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