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Re: Nutrition and Chronic Disease
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Re: Nutrition and Chronic Disease - April 23, 2005 4:10:00 PM
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srcase
Posts: 551
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From: Michigan
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Jason,
Yes, I do give advice to patients on nutrition, but always with the preface that I am not a dietician, and it is only my personal knowledge (not professional recommendation) that I am offering. Usually the topic comes up with female patients who are interested in losing weight, but are eating too few calories, not enough protein, etc. We also offer a fitness program to our patients after rehab, and some of those people ask for advice.
Nutrition is actually one of my other interests, and I have done quite a bit of reading and taken courses in it.
I was asking because a part of me has always felt a little uneasy giving nutritional advice to patients since it is not part of our practice act or education. But I think the CSCS certification covers sports nutrition, so it is a gray area for me. I'd be curious to hear what other PTs do.
Sarah
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Re: Nutrition and Chronic Disease - April 23, 2005 5:04:00 PM
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jma
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From: NY
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There are DPT programs that are giving clinical nutrition as part of the curriulum. If it wasn't before, it is now.
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Re: Nutrition and Chronic Disease - April 24, 2005 2:25:00 AM
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Lukey
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From: Australia
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Diane,
The only reliable source of non-animal (and non-tablet) derived B12 is nutritional yeast. In terms of plants sources the pollen collected by bees is also quite good but some bees lose their legs in the process.
Luke
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Re: Nutrition and Chronic Disease - April 24, 2005 3:03:00 AM
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nari
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From: Australia
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I have followed this thread with interest, as the emphasis on diet and nutrition is big news at present, with Australia almost tied with the USA in terms of obesity incidence.
My daughter became a vegetarian at 17 and gave it up 10 years later. Her sole reason was she hated the idea of eating 'dead cows and sheep'. She took supplements and was fairly careful, but had to give it away as her haemaglobin dropped and she developed lots of colds. Since eating meat and dairy foods, she has been a lot healthier.
I have to agree with Luke - movie stars aside, whom I have never heard of, I have never met a healthy-looking vegan in my life.
I'm sure you are what you eat, but I do not see it as my role to discuss food intake and its constituents with patients. If they raise the issue, I refer them to a dietitian, but they often say: Just eat anything in moderation, and I agree. I think our broad-based problem is not quality, but quantity, and to eat only when hungry. Whether it is meat based or grain, I think this aspect is not important.
My 1.8 cents for the night.
Nari
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Re: Nutrition and Chronic Disease - April 24, 2005 4:02:00 AM
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Lukey
Posts: 180
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From: Australia
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Nari,
I think that the dietitian who says "Just eat anything in moderation" to all patients is lazy and much like PT's who put patients on a standard protocol with no consideration for their individual situation.
Just like a standard protocol may work for some PT patients, this sort of dietary advice works for some but not others. Bodies respond differently to different foods, and many people have sub-allergy sensitivities that must be discovered and eliminated. Some people are less robust and cannot thrive on a diet of "anything", even if it is in moderation. Some people eat certain types of food in moderation and still gain weight but can eat large amounts of other foods and lose it.
However, I agree with you 110% that working all this out with a patient is not the job of an untrained person, especially one with a dogmatic agenda.
Luke
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Re: Nutrition and Chronic Disease - April 24, 2005 5:17:00 AM
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Diane
Posts: 1493
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From: Vancouver, B.C., Canada
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[QUOTE]The only reliable source of non-animal (and non-tablet) derived B12 is nutritional yeast. In terms of plants sources the pollen collected by bees is also quite good but some bees lose their legs in the process[/QUOTE]I didn't used to eat pollen when I was a vegan, but I knew people who wouldn't have because of that reason.. they wouldn't eat honey either because of it being from bees, nor would they wear anything leather.. they stripped out their homes and wardobes of all things animal derived.
Tell me though, Luke, Nari, is vegemite a source of B12? Does it have the nutritional yeast in it you were referring to? I guess vegans would consider these organisms too low on the food chain to worry about consuming.
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Re: Nutrition and Chronic Disease - April 24, 2005 4:33:00 PM
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Lukey
Posts: 180
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From: Australia
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Diane,
If a vegan is going to avoid yeasts then they would have to take out their intestines. Vegimite is made from brewers yeast, which is like a cheap and nasty version of nutritional yeast. Yes, it does have some B12 in it. I prefer miso on my toast.
Luke
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Re: Nutrition and Chronic Disease - April 25, 2005 1:42:00 AM
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nari
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From: Australia
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Luke
I actually meant that the patients often say -eat in moderation - not the dietitians. That wasn't clear in my text; dietitians are very serious about details!
I agree that untrained people should not advise on diet, and I would not be interested enough to do any sort of training.
Re vegemite - it is cheap, tasty and very good on fresh hot rolls and tons of butter, Its B12 quality is probably lousy, and it is chock full of salt, so to eat enough to gain nutritional value the kidneys would probably fall apart.
I still like it, though. But I am no gourmet - food to me is something that one eats when hungry to stay awake / alive, and not much more than that!!
Nari
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Re: Nutrition and Chronic Disease - April 25, 2005 11:16:00 AM
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Randy Dixon
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Vegemite tastes good? The first time I tried it I was convinced it had spoiled. The second time I knew it was spoiled but apparently on purpose.
Definitely an acquired taste although I don't know why one would want to acquire it.
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Re: Nutrition and Chronic Disease - April 25, 2005 1:27:00 PM
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nari
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From: Australia
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Randy
I can appreciate your sentiments!
It is a strange Oz icon - but scores of healthy kids have been raised on vegemite sandwiches and little else in the dim past; don't think that happens anymore with the advent of the golden arch...
nari
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Re: Nutrition and Chronic Disease - April 25, 2005 1:39:00 PM
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hmgross
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Nari
I must go home now. Can't get the Men At Work lyrics out of my head!.....
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Holly Gross PT
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Re: Nutrition and Chronic Disease - April 25, 2005 2:51:00 PM
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srcase
Posts: 551
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From: Michigan
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I didn't know that was a real word...vegemite...much less a food substance. I thought Men At Work made that up...love that band!
Sarah
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Re: Nutrition and Chronic Disease - April 25, 2005 6:36:00 PM
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nari
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From: Australia
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Holly and Sarah..
The UK has started stocking vegemite in its supermarkets....what's up with you guys??
However, couldn't find it in Antarctica...
Men At Work is a great band.
nari
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Re: Nutrition and Chronic Disease - April 25, 2005 6:40:00 PM
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Synergy
Posts: 589
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From: Forney, TX
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Wow...and I thought vegemite was one of those cave/cavern projections (kinda like a stalagmite) that hang from the ceiling, except covered with vegetation. Gee...little do I know. :)
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Chris Adams, PT, MPT
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Re: Nutrition and Chronic Disease - April 27, 2005 2:56:00 AM
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JLS_PT_OCS
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Vegan I am, but vegemite I can't do, from taste not health!
God knows there are scores of people in other countries who can't stand the loads of peanut butter we eat in north america, i figure it's the same thing.
Luke-
I hear you there, different strokes for different folks.
Good point on the dogma thing. We definitely shouldn't have anyone with a dogmatic agenda giving nutritional advice. So anyone who recommends dairy foods or meat as being a requirement for health definitely qualifies as dogmatic, since those recommendations are based on culture and (at least in the US) the education of dietitians, which is heavily financed by the meat and dairy industry.
It is unfortunate that there really isn't any unbiased opinion in this area. Even though those supporting plant-based diets do not stand to gain financially from such promotion, the mainstream groups of dairy and meat industries stand to lose significantly, so they do enjoy painting us as wild grass eating pinko hippie types, who wither away without the nutrients we "need" from animal protein.
I think a big part of the problem is that many of those in the vegan community also fit the stereotypes as excessively alternative in their outlook (consuming CAM crap like chiropractic, herbs, reiki, etc with abandon) and often have more activism than sense. That goes a long way to explain some of the "sickly vegan" stereotypes that are so prominent in popular culture.
OK, here we go with some evidence.
This will remind everyone of the manipulation debate a little bit, in that there is no perfect world of blinded, placebo controlled, validated RCTs. However, there is enough evidence, from a statistical standpoint, to consider the health effects of vegan diets stronger than the evidence agaist smoking cigarettes.
Some meat or dairy everyday won't kill you, but then again, neither will a few cigarettes a day.
But I would venture to guess that no one here smokes. :)
First, let me direct you to the division of preventive cardiology at the Cleveland Clinic. They are one of the first major medical centers (internationally known, at that) which is approaching cardiovascular disease (still #1 killer I think) from a prevention standpoint. They do this through exercise, some cholesterol-lowering medication as needed, but most importantly a vegan diet.
Check out their site:
[URL=http://www.vegsource.com/esselstyn/index.htm]www.vegsource.com/esselstyn/index.htm[/URL]
This is hosted on VegSource.
This includes a few longitudinal studies also.
Please also check out [URL=http://www.thechinastudy.com,]www.thechinastudy.com,[/URL] which has several links to the research abstracts and publications.
I'll try to get back later today with some more specific references on B12, and specific impact on some diseases.
It's important to realize, I think, that a lot of these benefits may be realized by drastically reducing animal protein (cigarette) consumption, without necessarily going 100% vegan (quitting smoking entirely), which is probably unrealistic for most people, from a personal preference and cultural standpoint. But not from a health standpoint.
Thanks.
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Nutrition and Chronic Disease - April 27, 2005 9:23:00 AM
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JLS_PT_OCS
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Some full-text references:
Esselstyn CB Jr, Ellis SG, Medendorp SV, et al. A strategy to arrest and revse coronary artery disease: a 5-year longitudinal study of a single physician's practice. J Fam Prac 1995; 41:560-568
Esselstyn DB, Jr. Updating a 12-year experience with arrest and reversal therapy for coronary heart disease; An overdue requiem for palliative cardiology. Am J Cardiol 1999; 84:339-341
Campbell TC, Parpia B, Chen J. Diet, lifestyle and the etiology of coronary artery disease. The Cornell China Study. Am J. Cardiol 1998; 82(suppl):18T-21T.
Ornish D, Brown SE, Scherwitz LW, et al. Can lifestyle changes reverse coronary artery disease? The Lifestyle Heart Treial. Lancet 1990; 336:129-133
Ornish D, Scherwitz LW, Billings JH, et al. Intensive lifestyle changes for reversal of coronary heart disease. JAMA 1998; 280:2001-2007.
Gould AL, Rossouw JE, Santanello NC, et al. Cholesterol reduction yields clinical benefit. A new look at old data. Circulation 1995; 91:2274-2282.
Resolving the Coronary Artery Disease Epidemic through Plant-Based Nutrition
Preventive Cardiology 2001; 4: 171-177
Good reading.
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Nutrition and Chronic Disease - April 27, 2005 10:24:00 AM
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srcase
Posts: 551
Joined: November 30, 2004
From: Michigan
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Ironically, I am reading all this as I am eating bacon and eggs! Well, at least its turkey bacon :)
Sarah
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Re: Nutrition and Chronic Disease - April 27, 2005 11:09:00 AM
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Diane
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From: Vancouver, B.C., Canada
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Did you know that pork bacon is the belly wall, all the layers of the abdominal muscles including the transversus, of the pig? (One of the weird things you learn from attending a Paul Hodges lecture..)
So, is turkey bacon the abdominal wall of the turkey? (Somehow.. I think not...)
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Re: Nutrition and Chronic Disease - April 27, 2005 4:17:00 PM
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Synergy
Posts: 589
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From: Forney, TX
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Sarah,
Fried, scrambled, or poached? :)
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Chris Adams, PT, MPT
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Re: Nutrition and Chronic Disease - April 28, 2005 12:37:00 AM
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Lukey
Posts: 180
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From: Australia
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Jason,
It is true that meat and dairy are not necessarily requirements for health and my view is more 'Let's see how your body responds with or without them.' As I mentioned, bodies are different and although some research might say veganism is linked with decreased heart disease, what are the effects on other aspects of health. Diane gained weight, which is associated with its own risk factors. I lost 15 kgs (from 63kg); you can't tell me that was good for my health. My wife ended up with a thyroid deficiency and a previous girlfriend completely lost her period. Having said that, I do know a few very healthy long term vegans and I hope you will be among them
As for companies pushing plant-based foods having nothing to gain, H-hmmm - how do you think cereals got onto the base of the food pyramid? Kellog's and the like are very mighty.
Response to any particular diet is something that everyone should be given the encouragment and space to discover for themselves. As you have pointed out, this cannot occur if one is resigned to any culture or theory regarding diet.
Of course, a little education is necessary and (simplistically) this is how I approach it -
Stay away from anything man-made, highly processed, or unnaturally raised (this is actually the hardest part but the most rewarding).
Eat fresh fruit, salad and vegetables every day (you choose which).
Systematically eliminate each of the grain, dairy and meat groups for a month or so and see how you feel, also noting how you feel when it is recommenced and how much you can tolerate (for example, I worked out that all grains except for rice and quinoa - and even that when too often - were the cause of the persistant GERD I suffered since about 12 / imagine how I suffered as a vegan).
Once you have discovered a diet that you feel well on (absence of bloating is an important sign) eat it in moderation, stop worrying and get on with your life.
Since you are doing a lot of reading on diet I thought you might like a look at these -
http://www.second-opinions.co.uk/cholesterol_myth_1.html
http://www.ravnskov.nu/cholesterol.htm
http://www.westonaprice.org/knowyourfats/skinny.html
There is enough references here to keep one busy for a long time.
Luke
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