Mark Bittman Glimpses a Big Truth: Avoidance of the Obvious by Doctors

Mark Bittman writes about food for the New York Times. If he covered health instead of food, would he have dared to write this?

When I was growing up, drinking milk at every meal, I had a chronic upset stomach. . . . In adolescence, this became chronic heartburn, trendily known as GERD or acid reflux, and that led to . . . an adult dependence on Prevacid, a proton-pump inhibitor. Which, my gastroenterologist assured me, is benign. (Wrong.)

Fortunately my long-term general practitioner, Sidney M. Baker, author of “Detoxification and Healing,” insisted that I make every attempt to break the Prevacid addiction.  Thus followed a seven-year period of trials of various “cures,” including licorice pills, lemon juice, antibiotics, famotidine (Pepcid) and almost anything else that might give my poor, sore esophagus some relief. At some point, Dr. Baker  suggested that despite my omnivorous diet I consider a “vacation” from various foods.

So, three months ago, I decided to give up dairy products as a test. Twenty-four hours later, my heartburn was gone. Never, it seems, to return.

His gastroenterologist (and probably several other doctors) failed to tell him that his digestive problem might be due to eating the wrong foods. It is as if an astronomer fails to understand — or at least tell his students — that the earth is round.

It is equally interesting that someone smart enough to write for the New York Times fails to figure this out for himself. How strange that a food writer would not connect food and health — someone else had to draw his attention to the possibility. Although Bittman praises Dr. Baker, you are not going to figure out what foods are bad by adding things, such as licorice pills, to your diet. Dr. Baker failed to understand this obvious point, which Bittman still fails to see, apparently. Bittman should be utterly astonished by this mountain of avoiding the obvious, including his own.

In a later column he feels “frustration” and begins to notice how big the problem — self-serving avoidance of the obvious by doctors and the rest of mainstream health care — is:

Experiences like mine with dairy . . are more common than unusual [huh?], at least according to the roughly 1,300 comments and e-mails we received since then. In them, people outlined their experiences with dairy and health problems as varied as heartburn, migraines, irritable bowel syndrome, colitis, eczema, acne, hives, asthma (“When I gave up dairy, my asthma went away completely”), gall bladder issues, body aches, ear infections, colic, “seasonal allergies,” rhinitis, chronic sinus infections and more. (One writer mentioned an absence of canker sores after cutting dairy; I realized I hadn’t had a canker sore — which I’ve gotten an average of once a month my whole life — in four months. Something else to think about.)

Although lactose intolerance and its generalized digestive tract problems are well documented, and milk allergies are thought to affect perhaps 1 percent of the American population, the links between milk (or dairy) and such a broad range of ailments has [have] not been well studied, at least by the medical establishment.

Yet if you speak with people who’ve had these kinds of reactive problems, it would appear that the medical establishment is among the last places you’d want to turn for advice. Nearly everyone who complained of heartburn, for example, later resolved by eliminating dairy, had a story of a doctor (usually a gastroenterologist) prescribing a proton pump inhibitor, or P.P.I., a drug (among the most prescribed in the United States) that blocks the production of acid in the stomach.

Finally he turns to emotion:

There is anger as well as surprise, because you’d think that with a grapevine’s worth of anecdotal stories and at least some studies linking dairy to physical problems, few people began this kind of self-testing at the suggestion of their doctor — unless, that is, their doctor was in the “alternative” camp. [he is so angry he gets confused?]

So I got mail saying things like, “When I think back to all the things I’ve missed because I had a migraine, it makes me a little angry that the solution for me was so simple.” When a lifetime of suffering, medical visits and prescription drugs can be resolved with a not especially challenging dietary change — one that, when it works, has rewards well worth the sacrifice — a certain amount of retroactive frustration seems justifiable.

The big trip begins with the small step. Maybe Bittman will begin to wonder at the dystopic miracle of a healthcare system in which respected gastroenterologists fail to grasp that digestive problems are often caused by food. No one else in prestige media has managed to notice this, as far as I can tell.

Thanks to Lisa Wiland.

11 Replies to “Mark Bittman Glimpses a Big Truth: Avoidance of the Obvious by Doctors”

  1. The big truth is these are sub clinical problems, and most doctors don’t have time to deal with them.

    My father is a GI. He had a patient die on him last week during a procedure. When the next patient comes in complaining of an upset tummy — and he is fat, out of shape, and prone to eating a lot of polish sausage, what do you expect any doctor to say? Doctors have real problems to face — not these subclincal ones.

    Yes, after 40 you have to be your own physician. But are these subclinical problems something you can blame the medical establishment for. Take two asprin and call me in the morning….

  2. It’s true that the high and mighty doctors don’t have 2 minutes to explain how to fix these “sub-clinical” problems, but how much more time each day would the doctors have to deal with the “real” problems if they quickly disposed of these easy ones?

    I suspect this is less of an example of doctors having more important stuff to do than it is a case of their ignorance. The learn very little about nutrition in medical school, and we know one thing, doctors NEVER admit their ignorance.

    For a doctor to take a patient’s money, whether the problem is “sub-clinical” or not, he should have a duty to provide decent care and help that patient. If he’s too busy to do a thorough job, then he should not schedule as many patients and take a hit in income.

  3. I suffered from GERD my entire life, until I went on the Atkins diet. Over the years, I was prescribed various antihistamines to stop my “allergies”, which largely consisted of post-nasal drip (caused by GERD). Eventually, I was prescribed a proton pump inhibitor. By this point, I had developed esophageal ulcers from the frequent vomiting that came with the GERD*. Fortunately, with medical treatment, the ulcers healed. After stumbling on a dietary cure for the GERD, the post-nasal drip and the vomiting also went away.

    I don’t care if the problems were subclinical, they caused me lots of trouble.

    (*The ulcers probably developed while I was on another medication that caused nausea.)

  4. The idea that people should expect doctors to ignore “subclinical” problems is one of the most moronic things I’ve ever heard. As if anyone – including doctors – know what is “subclinical” without investigation!

    The New York Times had two articles in the past two weeks about a 12-year-old boy who went from complete health to dead within two days because of a scraped knee. The doctors missed all the signs of sepsis, no doubt out of their conviction that it was a “subclinical” problem unworthy of their time.

    Back on the topic of Gerd, when I was diagnosed, I didn’t hear a single thing about diet from my gastroenterologist, supposedly one of the best in my state. Just take two Aciphex (proton pump inhibitor) daily, and elevate the head of my bed.

    I got the idea that he thought diet had nothing to do with it.

  5. I was prescribed PPIs once, but I couldn’t understand how they’d provide a cure or justify their side-effects, so I didn’t end up filling the prescription. I suggested to the doctor that my long-standing joint pains could perhaps be related to my long-standing GI complaints, but he didn’t ‘see how that would work.’ Luckily, this was an NHS doctor. If I had a snarky GI taking half a day’s pay off me to waste my time with unscientific anti-treatments, I wouldn’t be so complacent.

    I got relief from GERD when eating a low-carb diet, but it just seems to be a crutch, rather than a real solution, like for diabetes and other things people use them for. It wouldn’t surprise me if some of the people posting in Bittman’s comments had underlying problems that dairy was taking the wrap for, e.g. oestrogen can inhibit lactase enzymes Antibiotic use probably wouldn’t help support the bacteria that help digest lactose either.

  6. Maybe doctor’s would spend time if they were labelled pre-clinical, you know, like pre-hypertension and pre-diabetic and pre-cancerous and pre-obese and other excuses for making patients out of healthy people.

  7. First, systematic academic/scientific fraud. Then, systematic medical malpractice. The only thing missing now is addressing the systematic miscarriage of justice.

  8. To me the whole premise & approach to GERD is backwards. The stomach is SUPPOSED to be Acidic & if you make it less Acidic, OF COURSE you are going to cause problems (C. difficile associated diarrhea, Pneumonia, Fractures, B12 deficiency, Hypomagnesemia, etc.). It seems like such a simple concept, I refuse to believe that intelligent people in Medicine can’t grasp this.

    As far as GERD being sub-clinical, it is until it isn’t. GERD can progress to Barrett’s esophagus, which can in turn progress to Cancer.

  9. I pretty much agree with Javeux, low-carb or avoidance of certain type/class of food can work, but it’s only a band aid.

    And unlike Seth, I am not surprised that doctors and food writers often fail to see the food – gut connection and are not aware of these “easy” fixes. Overall, the Time article looks like a manifestation of the Dunning-Kruger effect – which is when you only know little about something, you easily overestimate your skills or amount of knowledge you possess. Overall, nutrition is in its dark ages compared to other disciplines, e.s. physics

  10. A couple fundamental problems with medicine today.

    1) Western medicine, in most cases, is embarrassingly similar to shamanism.

    Most of the time, doctors have little or no idea as what they’re doing, even though they have great power and prescribe substances with great ceremony with great confidence. We like to laugh at the ignorance of physicians of the 18th century; my guess is that those of the 23rd century will laugh at us.

    Notable exceptions being where cause and effect are visibly obvious. For example, if I get by a car and my bones are broken and I am bleeding severely. In cases, like these, by all means, take me to a emergency room and fix me up with the latest and greatest in medical technology STAT!

    2) Doctors are trained to fix the symptom, not the cause. They are also largely the puppets of Big Pharma. I suffered migraines my whole life until my 30s. I am prescribed meds to help me manage the pain. These meds are better than nothing.

    Then I quit eating grain-based products, no migraines ever.

    (Interesting to note is that I don’t *know* if it is gluten or some other concomitant substance to which I am sensitive.)

  11. I believe that food is the cause and the cure – Let food be your medicine and medicine be your food.

    I suffered from GERD for many years, was a Prilosec addict, then discovered Paleo/Primal/etc. Eliminating grains in effect eliminated the dairy – I didn’t drink milk ala carte and drank my coffee and tea black. No more GERD no more Prilosec.

    I was able, after several months, to add back grass fed cream and butter with no obvious consequences, however, plain milk and yogurt still caused a little heartburn. A few weeks ago I decided to try raw milk and so far all is good. And, the pleasure of a cold glass of milk is under appreciated.

    I have also noticed a small positive change in body comp – lost some stubborn lower (below the navel) belly fat.

    So, when it comes to milk, pasteurization and homogenization, could be the problem – not the milk per se. It would be interesting to see if Mark Bittman would be willing to challenge his biases and give raw milk a try.

    FYI – I am 65 yrs old and probably genetically tolerant of milk (real milk) due to Swiss ancestry.

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