I attended a recent debate on "High vs. Low Carbohydrate Diets for Cancer Control and Overall Health." The presenters were Dr. T. Colin Campbell, professor emeritus at Cornell University and author of The China Study, who supports a whole-food, plant-based, low protein, low fat diet; and Dr. Eric Westman, associate professor of internal medicine and obesity specialist at Duke University and author of The New Atkins for a New You, who supports a low carbohydrate, higher protein and fat diet. Both very knowledgeable, well-respected in their field, and offering two polar opposite perspectives!
I must say that each presented a very interesting, compelling, and passionate case for his particular viewpoint, and I left somewhat frustrated and even questioning some of the recommendations that I frequently make to patients and the public for cancer prevention and general health. That got me to thinking of how frustrating and upsetting it must be for patients to hear conflicting recommendations from healthcare professionals -- not to mention the information they may receive from well-meaning family and friends, media, Internet, etc.
One physician may recommend chemotherapy and not radiation while another recommends both; one may recommend surgery first then chemotherapy and another the exact opposite. Whom should the patient believe?
Certainly, recommendations change as scientific evidence advances our knowledge. Even over the time frame that I have been a practicing as a registered dietitian (20 years now), there have been changes in general nutrition recommendations for health.
First the focus was on limiting dietary cholesterol to help control hyperlipidemia, then total fat. Now the focus is really on the type of fat -- limiting saturated and transfat but actually including omega 3 fatty acids and monounsaturated fats. Eggs used to be a big no-no for anyone watching their diet because of the cholesterol, but we now know they can be part of a healthy diet and are a great source of protein. I can understand why people get frustrated when they hear one thing one day and later hear that it is not true!
Without questions there would be no progress. If someone didn’t ask questions, perform hypothesis testing, and evaluate treatments and outcomes we wouldn’t be where we are currently in terms of medical and technological advancement. But where does that leave the patient today who is hearing conflicting messages? What practice recommendation changes have occurred since you have been working? What do you say to patients who express frustration when they hear differing recommendations?