The title of this post is a quote from Hippocrates, the father of Medicine. In my own life, practice and forays into Functional Medicine, I am increasingly convinced about the wisdom behind those words.
And, both foods and medications are best consumed in stringent moderation; less is usually more.
My 2011 post, “The Virtues of Oligopharmacy”, opens with the above Hippocrates quote, followed by Ben Franklin’s and Sir William Osler’s Words:
“I saw few die of hunger; of eating, a hundred thousand.” (Benjamin Franklin)
“The desire to take medicine is perhaps the greatest feature which distinguishes man from animals”
(William Osler)
I think that sums up where we are today:
There’s a pill for every ill. Eat too much sugar and Farxiga makes you pee it out. But you might get urinary tract infections, kidney failure, bladder cancer or Fournier’s gangrene. And so on.
Drug companies spend unimaginable amounts of money to produce drugs that allow us to have our cakes and eat them too. Most middle aged or older people with diabetes or hypertension are on three or four drugs, but foods, with their natural ingredients and lack of processed, unnatural or artificial ones can take the place of pills in many instances, at lower cost and with lower risk.
I have sometimes fumed about hospitalists suggesting our practice’s patients are on too many medications and then sending them home on magnesium, B12 and all kinds of more or less over the counter type medications. This irks me partly because of the hassle factor of documentation and cluttering up our medication lists. These days we are obligated to list all over the counter medications and supplements our patients are taking, even if our EMRs don’t have them in their data base…
But I guess I should be grateful that they’re not usually starting dangerous medications I wouldn’t agree with. I’ve never heard of anybody dying from low (or high) magnesium, but I guess I shouldn’t worry myself silly over a relatively harmless supplement to treat a laboratory abnormality still more or less looking for a purpose (seldom critical as an isolated finding, if other electrolytes and minerals are normal).
(UpToDate states: ●Hypomagnesemia is a common entity occurring in up to 12 percent of hospitalized patients. The incidence rises to as high as 60 to 65 percent in patients in an intensive care setting.)
But I do think we all, however conventional we may want to be, need to think hard about food:
If the wrong diet can cause kidney stones, migraines, diabetes, pancreatitis or whatever, shouldn’t we be better educated and more vocal about which foods can instead help patients avoid those conditions?
I, like most doctors, didn’t learn much about nutrition in medical school, but I was a squeamish eater, esthetic former and now recovering vegetarian, who (I always shock my patients with this) gained too much weight when I didn’t eat fish, chicken or bacon (I lived on pasta, sandwiches and oatmeal). This journey lead me to read a lot and learn a lot.
I’m not mad at my medical school for not teaching me more back then. Nobody ever suggested I’d be fully prepared for a lifetime of practice the day I graduated. I knew I’d have to keep learning, and that’s what I’m doing now…
Turmeric anyone? Blueberries?
A Country Doctor Writes: 
Moderation in all things including moderation–I still enjoy the infrequent celebration. Blueberries almost every morning. More activity and exercise than as a younger man. Too soon old; too late smart.
Way back in 2012 (Ha!) I accompanied my wife on a visit to her general practitioner. After the med tech took her weight and blood pressure, for not real reason I asked her to take my BP. I’ll admit that right there and then I recognized that my blood pressure was too high even for one of such magnificent rationalization capabilities as I am. I was 68 years old, 5’9″ tall and the scales were telling me that I was pushing the 250 pound mark. I knew that wasn’t great.
After that I decided to make an appointment to see a doctor. It had been a while. I mean in geological terms, not so long, but even I knew that having not darkened a doctor’s door for nineteen years wasn’t a good record. For most of my adult life I had followed a course that kept me at peace with the medical doctors of the world: I didn’t bother them and they didn’t bother me. Maybe then was a time to change, so I went.
The doc didn’t seem overly concerned as he ordered a blood test. He did say I should get a bit more exercise and “drop some weight.” Right. And when the results of the blood test came back, the normal indicators….triglycerides, A1C, LDL etc, etc….about which I knew little were all WRONG. I left the appointment with a follow-up scheduled.
I told my son, an executive in the pharmaceuticals industry about this episode in my life and he recommend I read a book about a medically trained physical training writer named Robb Wolf. I read the easily read and entertaining book he wrote called “The Paleo Solution” and gave it to my wife to read. After reading it she agreed that we should take Wolf” “Paleo Challenge” and proceeded to make the necessary changes in the kitchen to radically change what we ate and as importantly, how that food was prepared. We began to follow Wolf’s instruction and eat like hunter-gatherer cavemen. The results were really interesting.
When I went back to seethe GP a bit more than a month later I had dropped twenty one pounds. But even more interesting the second blood test showed I had dropped 100 points off my triglycerides and my A1c and “good” cholesterol numbers had begun to march in the right direction. “How did you do that?” he asked, his eyebrows raised.
A year later, my weight had dropped almost forty pounds. My wife gave me a membership to the local gym and I went back to restart my old exercise routine….treadmill and free weight. I noticed the power lifting records on the wall and was shocked to see the bench press state record at the time for me my age and weight group. I remember thinking I’d better be better than that! It was 148 pounds.
A year later I weighed around 192 pounds and only my LDL Cholesterol was higher than normal. After less than two years eating like a caveman, my bad numbers were mostly gone. Let me say at this point in my little narrative, I was taking NO medication of any kind, and have never done so to this date.
In 2015, at the age of 71 years, I entered my first ever athletic competition. I entered the New England National power lifting competition of the World Association of Bench Pressers and Dead Lifters in Portland. In that even I set a new state of Maine bench press record for men in the 198 pound class of 187 pounds.
As a result of changing my diet….ONLY fresh vegetables with chicken, fish, pork and a little (VERY little) red beef; NO carbohydrates but a lot of pretein…I had dropped around 50 pounds and pushed away any real concern about cholesterol or diabetes. Of course I had to buy an entire new wardrobe. After the first year eating like a hunter-gatherer caveman, I had dropped nearly 7 inches off my waist line.
My wife has made a considerable study about food and supplements. She does almost all the cooking and really enjoys it. As a result of her work, she has prescribed a fairly large number of supplements for us to take as she has learned the general quality of the food we can buy has deteriorated over the past year. And yes, Turmeric with Curcumin is my “go to” supplement for incidental muscle soreness.
So now I’m 75 and am about to begin a new house building project for my wife and I to retire into. I now believe the necessity of better nutritional counseling for most people and this is something that their health insurance (AND probably Medicare) should provide as a mandatory benefit. As you have pointed out, doctors don’t know a lot about diet and I think there is an awful lot to question about the modern American diet with it’s synthetic substances, high fructose corn syrups and “fast food”.
One thing I wish I could know though, is why my LDL cholesterol is higher than desired. I keep pushing the hospital lab people when I show up for the ordered blood test to MAKE SURE the LDL particle test is given. I always get blank stares. Maybe if I go to Portland for the next blood test!
I call myself a recovering vegetarian, eat zero processed carbs and have had a tiny amount of potato twice in the past year. I’m the weight I was at 25, 160 lbs, 66 years old and feel better than I have in decades.
…and I have no idea what my LDL is; I don’t care…
We eat red-skinned potatoes fairly regularly. They are extremely low in starch and carbs compared to the others. My one great weakness is bread, especially real, French bread. I have fond memories of my mother and my grandmother making fresh bread back in prehistoric times. Of course that was waay before “science” started to manipulate the wheat and filled the soil with pesticides, even impregnating the seeds themselves with all sorts of ugly compounds to insure growth….the seeds being infused with germicide before even being planted. I’d love to bake my own bread even now, and have looked at buying “real” or “unimproved” flour from France. It’s quite expensive and while the idea of recapturing that odor in the kitchen and the flavor of a time long gone is very attractive to me, I’ll pass. That time is gone for me. My body reacts with lightning speed to carbohydrate and I know I just cannot do that anymore.