Food, drink and the doctor

MEDICINE JOHN ROWAN WILSON

My dog got diarrhoea and I took him to the vet. He gave me some antibiotic tablets and asked me what I was feeding him on. I told him six ounces of raw meat a day mixed with bis- cuit. 'Too much protein,' he said. 'It makes them more susceptible to infection.'

He may be right for all I know, but I have to confess I didn't take the advice too literally. Experience has taught me that it is very difficult for anyone, patient, doctor, or veterinarian, to talk scientifically about the effects of diet. Deep emotional factors seem to be involved, which I will leave it to the psychologists to explain. We are all instinctively drawn towards the primitive proposition that it's what you eat that makes you ill.

Or don't eat, of course. In childhood I re- member being belaboured with such ancient nanny's wisdom as 'feed a cold and starve a fever' or warned that if I didn't eat my semo- lina I should come out in spots. There was talk of the blood being heated up by too much rich food and cooled down again by draughts of lemon barley water or Fenning's Fever Cure. The more mysterious the condition, the more likely its pathology was to be attributed to the effects of food and drink.

Doctors in those days were themselves prone to indulge in dietetic witchcraft. In private prac- tice, it is very difficult to draw a fee for doing absolutely nothing, even if there is nothing use- ful to do. The patient becomes disgruntled and it is bad for his health, as well as for his doctor- patient relationship. If you ask him what be customarily eats and then recommend him to change it, he goes home happy. If nothing more, he has acquired a talking point for his next dinner party.

A person on a diet is not as other men—he has acquired singularity. Pushing platefuls of food aside and demanding something else, pre- ferably something difficult to provide, is almost as much fun as eating. As an attention-getting device, it is out on its own. And it lacks the rather queasy element of much clinical discus- sion. A woman who would be reluctant to talk to strangers about her kidneys or the state of her ovaries feels that she can discuss her diges- tion without embarrassment. A weak stomach, like a tendency to insomnia, can be regarded as a social asset.

Many of the people who complain of dyspep- sia are probably air-swallowers. Quite a num- ber of individuals, either for some psychological

reason or because their swallowing mechanism is lacking in coordination, have a tendency to

swallow air, especially during meals. For most of us, thank God, the business of chewing and swallowing is a pretty crude, rough-and-ready business and goes forward without much ado.

Not so the air-swallower, who often becomes highly aware of complex processes within his oesophagus. He is the kind of man who quotes Mr Gladstone to the effect that one should chew every mouthful thirty-two times. He carefully minces up each piece of meat into a macerated pulp and then washes it down with a globule of air the size of a golf ball. He spends the rest of the evening burping gently and telling you about his weak digestion.

This is not to say that dietetics isn't an im- portant branch of medicine. As we all know, if a patient is chronically undernourished he can suffer from deficiency diseases. There are a variety of serious conditions associated with a lack of calories, or of protein, or of vitamins or essential elements such as calcium and phos- phorus. However, these are not very common nowadays in this country, and it is worth while remembering that if you have enough of the basic nutritional factors, any more isn't going to help and may in some cases even do you harm. For well-fed people to take vitamins 'as a tonic' is simply a waste of time.

A special diet may be valuable in gastric or duodenal ulcer, and is essential in disorders of metabolism like diabetes, where the body can- not cope with some part of a normal diet. It is also necessary in gall bladder disease, where the patient is short of essential substances neces- sary for the digestion of fat.

And, of course, there is the question of over- weight. Most of us eat too much. It is un- doubtedly unhealthy to be too fat, and if we are a stone or more overweight we ought to re- duce our intake and get back to normal. We can make a complicated production out of it if we like, but that is what it really amounts to. We can cut down both on carbohydrates and fats or on either of them alone if we prefer. It doesn't really matter much, since experience shows that if you cut down on one you grad- ually stop eating the other. Nobody likes either bread or butter on its own.

Finally, there is coronary heart disease. Vast sums of money have been spent trying to define what component of diet predisposes western man to this dangerous condition. Surprisingly little has emerged in the way of hard fact, and most of the complicated diets to eliminate specific components which have been thought to cause trouble are unpalatable and hard to stick

'Don't just stand there! Send for Denis Healey!'

to. British physicians are on the whole against making coronary diets into a way of life and testing blood cholesterol levels at regular in- tervals in the way which has become fashion- able across the Atlantic. They reckon that if a coronary patient can reduce his weight to a reasonable level he is doing as much as can be expected of him. Indeed, perhaps the greatest general truth about diets was expressed by the American writer Jean Kerr. After an analysis of a large number of varying diets she con- cluded that 'they all blur together, leaving you with only one definite piece of information: french-fried potatoes are out.'