Kelly Dorfman’s recent book What’s Eating Your Child? is an exploration of how food affects the physical and emotion health of children. She uses anecdotal pseudo-case studies to demonstrate how particular children had improvement focusing on particular nutritional changes.
Throughout her book she helps parents and practitioners alike understand better ways to involve their children in meal time decisions and allow them to buy-in on health food choices. Her E.A.T program to make health food changes I think will be particularly helpful in my practice.
I have three main problems with her book. First, each chapter is focused around a particular problem in a child in which the answer is an addition or subtraction of a nutrient. I think the best quote that sums up what is lacking in these chapters is from one of my former residency attendings who said “The eye cannot see what the mind doesn’t know.” Mrs Dorfman’s training lacks the depth and breadth necessary to take into account a fuller understanding of the health of these children. Don’t get me wrong some of the points she makes are very insightful from having investigated many different children but her differential diagnosis only includes food treatable illnesses.
The second point of contention is the use of physician ad hominem arguments throughout. Too many of her chapters base her success on the fact that so many physicians have ‘failed’ before her. If a therapy or treatment is true and right and valid for children it is true and right and valid all the time not just when it helps show the perceived failures of other medical professionals. True medical therapy doesn’t require this type of argument.
The last and most problematic issue of her book is the lack of evidence on which to base her claims. She uses reasoning such as milk produces mucus in the respiratory track. This child doesn’t have a runny nose any more, therefore the mucus must be someone were else like the lungs. There is no commentary on evidence supporting that milk does or does not produce mucus nor that it can change where it produces mucus over time. Likewise there is no evidence to support her therapy options. No trials, no studies, not even a peer reviewed journal in which to point. She uses a long bibliography in the back of the book but never correlates these references to particular points of evidence within the book. For the medical professional this is just unacceptable. I can in no way go to my patients and tell them to pursue a course of therapy where there is no evidence that it is beneficial let alone safe. We need science to lead us to the next step in medical therapies not false logic and trial and error. Let’s take the next step with nutrition therapy and perform blinded trials of nutrient intervention on particular well defined disease states. With that we can then guide our patients into better health with clear evidence.
I listened to the audio version of Wheat Belly in 2011 during my daily commute and walks. I thought I would repost a review I did at that time here on our new website blog.
Dr. Davis lays out an argument against the use of wheat containing products in any of its various forms. He contends that wheat (especially the hybridized form developed for high yield in the 1960’s) is the single source of almost all of the current medical ills. He links wheat intake to the obvious and common problems of Celiac disease, diabetes mellitus, hypertension, elevated cholesterol levels, and metabolic syndrome. He extends the linkage to other disorders such as acne, allopecia areata, and mental disorders such as schizophrenia.
Dr. Davis describes his theory using a few very interesting studies on dietary intervention on biochemical markers such as serum glucose and cholesterol levels. He adds to this a substantial amount of anecdotes, both personal and professional, and never passes up an opportunity to turn a sarcastic phrase to describe the evils of wheat ingestion.
I think Dr. Davis provides some very intriguing ideas concerning the changes in wheat consumption in the modern American diet. His description of the genetic modification that occurred in the 1960’s is compelling as the single factor that changed to spark the growing incidence of Celiac disease and diabetes. He also provides one of the simplest explanations I’ve read about the connection between a high carbohydrate diet and the biochemical changes in the cholesterol metabolism pathway.
In the end though Dr. Davis is simply promoting his own hybridization of a low carbohydrate diet and a paleolithic diet. He advocates to avoid all wheat products given their reported disastrous effects on the human body but in practice he recommends a low carbohydrate diet of at most 100gm/day and for many he recommends 50gm/day as the maximum. He argues that the pancreas has been so abused over the years from a high wheat (read: carbohydrate) diet that it can no longer tolerate a higher carbohydrate diet. For all intents and purposes, a low carbohydrate diet reduces or eliminates the majority of wheat consumption anyway.
Overall I thought the book was only okay even though I agree with most of what he said. From a scientific stand point I wish there were more references to studies and actual evidence as wheat as the culprit. I think the evidence for his low carbohydrate intake is sound although he doesn’t necessarily prove that in his book. I wish too that he had toned down his use of anecdotes. One of my favorite medical cynics, Mark Crislip, MD is often heard saying “The plural of anecdote is anecdotes, not data.” Telling compelling stories about successes on a wheat free, low carb diet are good to hear and we want to rejoice with the individuals who now have better health but they don’t provide much in the way guiding public health.
Lastly, I’ve taken some time and looked through his two websites www.wheatbellyblog.com and www.trackyourplaque.com. In several of his blogs he expounds on a style that is much more subtle in the book. He often describes the average working physician as someone rather uneducated about the higher matters of science. He comments frequently on how hard it is to find a physician who actually knows any of the ‘real’ medical facts. I think most of us who are actually seeing patients hurting and suffering from modern diseases are desperately trying therapies to help them. We want facts though, not stories. We want to be able to tell our patients more than the traveling snake doctor would tell his customers. “Come try this tonic! Why, a man down the road used it and it cured his ills!”
I’ve often said that difference between alternative medicine and true medicine is the fact that alternative medicine by definition lacks evidence. Once an alternative therapy has been studied it moves out of the alternative medicine realm into the tool box of true medicine useful in treating patients.
Robert Lustig, MD’s book Fat Chance is a quick, well referenced follow-up to his wildly popular YouTube video “Sugar: The Bitter Truth”. In this book he lays out the clear physiological pathway in which excess sugar (specifically fructose) is the key toxin causing so much obesity and metabolic disease. The twin cofactors of our lack of fiber (to blunt the rate of sugar absorption) and our lack of exercise (to increase our per minute use of glucose) play a role as well.
In this paradigm change is necessary for all of us we hope to avoid certain metabolic catastrophe. He lays our several key elements necessary for our health. Including reducing sugar consumption, increase real/whole food consumption, and in reducing the overly processed packaged food dependency we have as a nation. He outlines why this is both behavioral (we choose the wrong foods) and physiologic (our bodies push us to choose the wrong foods) and how to address both. In the end he even outlines his argument for governmental policy to help us change.
I was very pleased to read this book. I was very glad to realize that 90% of the points he makes in this book we already teach through the practice’s nutritional counseling program. I was even pleased to read him talk about ‘real food spoils.’ It does by the way.
I would highly encourage everyone interested in true health and the physiology that regulates it to read this book. I borrowed mine from the county library but like it so much I’ll order a copy to own.
In that vein we will be using a simple recommendation scale for our book reviews. We will recommend one of the following actions for each book:
Skip It for those books you needn’t bother exploring. You only have so many books you’ll read in your lifetime and we don’t want you to waste it on one like this.
Skim It for those books that deserve some consideration. Maybe use a highlighted copy and read the yellow parts or even run by the bookstore and just browse the chapter headings. There are a few useful tidbits in these books but not a many.
Borrow It is for books that you really ought to read fully. Once you’ve read them, send them packing so they don’t clutter up your life. You may not need them again, ever.
Buy It are books you need to own. These books need a place on your shelves either in hardcopy or electronic. They are books you’ll think about and lend out. Books you’ll look back on and be glad you own.
Study It are books that need a physical presence in your life and something close at hand. They are books you’ll review over and again. You’ll be reading your own highlighting and think “That’s a great point!” all over again. Few books deserve this level of consideration and fewer still will hold this level of recommendation over the course of your lifetime.
For Robert Lustig, MD’s book Fat Chance I give it a Buy It rating.