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Why is Nutrition So Disrespected in the Fight Against Chronic Disease?

November 14, 2022

Healthy eating is one of the key means of promoting robust health, wellness, and longevity. The right diet can help prevent, manage, and even reverse many chronic diseases. On the other hand, the all-too-common Western diet — calorie-rich, nutrient-poor, loaded with processed and ultra-processed junk and fast foods, sweets, and liquid carbohydrates — is a key factor contributing to avoidable chronic health issues. Chronic diseases that may result from improper nutrition include the following: metabolic syndrome, diabetes, pre-diabetes, dyslipidemia, cardiovascular diseases, hypertension, and many cancers.


Our diet provides us with fuel and energy as well as the raw materials and nutrients that our body needs to replenish cells and tissues that are constantly turning over. We are literally what we eat and what we eat eats. Healthy eating prioritizes a nutrient dense diet consisting of lean proteins, whole grains, legumes, nuts, fruits, and vegetables and less processed foods. This is a vital component of a healthy lifestyle, the other pieces of which include weight management, ample physical activity, adequate quality and quantity of sleep, stress management, and avoiding tobacco, excessive alcohol, and other toxic and harmful habits.


“Eat food, not too much, mostly plants.”

–Michael Pollen, author of The Omnivore’s Dilemma

In the USA, we largely have an illness-based health care system in which treatment starts at the time of disease recognition, as opposed to a health maintenance system. This is where the importance of a proactive healthy lifestyle is actively promoted, to avoid or minimize the occurrence of illness and disease. Healthy eating is one of the foundational elements of a proactive healthy lifestyle.


It is only the occasional patient who requests nutritional advice, and many physicians are reluctant to offer it. Why is this the case? Many overweight patients accept their overweight status as the norm (as it is in the United States) and many do not realize or, alternatively, deny the role of nutritional issues in the evolution of disease. Some overweight patients have the misconception that going to the gym a few times per week will fully compensate for their overweight status or obesity. Many others are of the mindset that there is a pill for every ill and any consequences that develop as a result of their overweight status can be easily and readily managed. The fact that physicians do not broach the topic of nutrition at the time of an office visit may result in patients falsely concluding that the topic of nutrition is not important.


Another obstacle to the problem of patients not receiving proper nutritional counseling is the overweight physician who sets a poor example and fails to function as a credible source of nutritional guidance. For the physician who is capable of and desires to provide nutritional counseling, other barriers are the time allotted for office visits that do not provide sufficient time for the delivery of nutritional advice, as well as lack of reimbursement. Another barrier is simply that many physicians do not feel that their nutritional advice will be heeded or complied with. Other barriers include physician insecurity about giving nutritional advice because the topic was given such short shrift in their medical training. Many physicians have received their nutritional training through clinical practice or self-directed education.


The bottom line is that virtually 100% of patients would be well served with sound nutritional advice. 75% of American adults are overweight or obese, and even many of those with normal BMIs could be helped with such advice. One reasonable solution to the nutritional advice issues is to refer patients to a nutritionist or other nutritional specialist. Unfortunately, this approach is under-utilized.


A meaningful discussion of nutrition needs to be included in the care of every patient.”

–Stephen Devries, adjunct associate professor, Harvard Chan School of Public Health

We should have at least a baseline of standard nutrition counseling or nutrition assessment for all patients, regardless of weight.”

— Sylvia Bollie, MD, integrative obesity specialist, Silver Spring, Maryland


Those patients who ask me about the best diet to optimize their urological health are told that a urology-healthy diet is no different from a heart-healthy or colon-healthy diet or for that matter “any bodily system”-healthy diet. This diet consists of (mostly) real, natural, wholesome, unprocessed, high fiber nourishment consumed in moderation, emphasizing foods grown in the soil including whole grains, vegetables, fruits, legumes, seeds, nuts, etc., with more fish and less animal and dairy products. Fats derived from vegetables including olives, avocados, nuts, seeds, etc., are preferable to animal and dairy fat. Naturally vibrant colors are clues to foods with high nutrient, fiber, vitamin, mineral, and antioxidant content.

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