8 October 2007
Dear Readers: Sincerely,
Dr. Warren hopes to help all who ask his advice and to enlighten all who read Ask Dr. Warren. For your own well being please keep in mind that
advice you read here may not apply exactly to your own situation, and that if you are sick, no information on the web can take the place of a hands on examination by your physican who knows you and cares about you.
Dr. Warren
On the page you refer to a study about sugar, and you write:
Although I can no longer remember where I read the study, a study on the relationship between sugar and hyperactivity found NO EFFECT on hyperactivity levels in children who have ADHD and those who don't.The study you probably have in mind is the Wolraich 1994 study on sugar:
In this study, children whose parents said they were “sugar-sensitive” were tested with a series of 3 diets: One with sugar, one with aspartame, and one with saccharin. None of these sweeteners had an adverse effect on the children’s behavior. Wolraich concluded that the three sweeteners could not all be “equally bad” because the children had improved continuously during the nine weeks of the study.
Note: Since all 3 diets were without artificial food colorings, flavorings, and preservatives, this improvement is not surprising. Most candy and soda contains CORN SYRUP – not table sugar – but this study did not test corn syrup. Nevertheless -- in spite of not even testing the actual "sugar" that the kids were getting, this study is quoted frequently to "prove" that sugar is harmless.
I do hope you agree with me that if you want to test corn syrup, then you must test corn syrup. You cannot test honey ... or sucrose ... or maple sugar ..... or any other sugar and then assume that your results will also apply to corn syrup. That is just plain bad science.
Well, moving on, here, I would like to address your mention of the Feingold diet in the same paragraph.
You write:
The American Academy of Pediatrics has classified the Finegold diet, a popular diet that eliminates food colorings and additives, as ineffective in the management of ADHD.(1) First the smaller error -- the spelling is FEINgold and not FINEgold.
(2) Since it is one sentence before your discussion of sugar, it may give the erroneous impression that the Feingold diet eliminates sugar. However, it does not. Nor are all additives eliminated; just the worst ones.
(3) If you look at the newer AAP policy statements, they say NOTHING about the Feingold Program ...... I believe that is because they no longer are able to say that it "has no effect" and they don't want to say anything else. Why? I'm sure you will find out if you follow the money. Unfortunately, dietary intervention has been under attack by the food additive industry from the beginning. Remember all those studies that were done way back in the 1970's that were supposed to "prove" that the diet didn't work? Do you know who funded them? It was the "Nutrition Foundation" which was (and still is, now called ILSI) an organization of companies that make additives, sugar, MSG, nitrites, sodas, snacks, pesticides, and chemicals. This is sort of like asking the wolf to guard the hen house, right? I will be happy to discuss the individual studies in detail if you wish.
(4) Please do look at the rest of the research ..... NO study since 1987 claims the diet doesn't work -- now that is already 20 years. Please see lots of research at http://www.diet-studies.com/adhd.html
(5) I have almost completed an update of our information booklet, and I will be happy to send it to you if you will give me a mailing address. It contains a whole section on the science, and cites almost 200 studies.
(6) By now perhaps you are wondering if there is any information somewhere about how many children actually do respond to the Feingold Program? After all, the ADHD gurus working with the pharmaceutical companies would like you to believe that only a very few, if any, actually respond to the diet. But it is not so. Here are some of the studies with percentage of children improving:
§ Egger 1985 = 81.6%I hope you will agree that 70% and up is not a "small percentage."Controlled Trial of Oligoantigenic Treatment in the Hyperkinetic Syndrome, J.Egger, P.J.Graham, J.F.Soothill, C.M.Carter, D.Gumley, The Lancet, March 9, 1985§ Swanson 1980 = 85%
62 of 76 selected overactive children (81.6%) improved; other symptoms such as headaches, abdominal pain, and fits, also improved.
http://www.diet-studies.com/PDFstudies/Egger85.pdf = full textFood Dyes Impair Performance of Hyperactive Children on a Laboratory Learning Test, J. Swanson, M.Kinsbourne, Science magazine, March 28, 1980, Vol. 207. pp.1485-7§ Rowe 1988 = 72.7%
"The performance of the hyperactive children on paired-associate learning tests on the day they received the dye blend was impaired relative to their performance after they received the placebo, but the performance of the non-hyperactive group was not affected by the challenge..."
Note: Dr. Swanson used 100 mg and 150 mg of mixed food dye in his study. In a phone conversation with this author, he said he had been told that his use of this "toxic dose" had devalued his study. When informed of the amount of food dye per tablespoon in solid bright-colored candies and frosting, green ketchup, and powdered drinks, as measured by students at an Atlanta college, he was astonished. According to his math, students at a birthday party can easily consume 500-600 mg of food dye. If 150 mg is really a "toxic dose," then we need to seriously reconsider what we are allowing in the food sold for children, and we also need to rethink the fact that manufacturers refuse to reveal just how much coloring is actually in any of their products.
http://www.diet-studies.com/PDFstudies/Swanson80.pdf = full textSynthetic Food Colourings and "Hyperactivity": a Double-Blind Crossover Study, K.S.Rowe, Australia Paediatric Journal, April 1988, Vol. 24 (2), pp. 143-7§ Egger 1989 = 80%
40 of 55 children (72.7%) put on a 6-week trial of the Feingold Diet "... demonstrated improved behaviour." 26 of them (47.3%) remained improved following "liberalization" of the diet over a 3-6 month period.
http://www.diet-studies.com/PDFstudies/Rowe88.pdf = full textOligoantigenic diet treatment of children with epilepsy and migraine, Egger J, Carter CM, Soothill JF, Wilson J, Journal of Pediatrics 1989 Jan;114(1):51-8§ Kaplan 1989 = 50%+
Of 45 children with epilepsy and recurrent headaches, abdominal symptoms, or hyperkinetic behavior, 36 [80%] improved on an oligoantigenic diet; 25 [55%] ceased to have seizures and 11 had fewer seizures during diet therapy. "Headaches, abdominal pains, and hyperkinetic behavior ceased in all those whose seizures ceased, and in some of those whose seizures did not cease." ..."Of 24 children with generalized epilepsy, 18 [75%] recovered or improved (including 4 of 7 with myoclonic seizures and all with petit mal), as did 18 of 21 [85%] children with partial epilepsy. In double-blind, placebo-controlled provocation studies, symptoms recurred in 15 of 16 children, including seizures in eight; none recurred when placebo was given. Eighteen other children, who had epilepsy alone, were similarly treated with an oligoantigenic diet; none improved."
http://www.diet-studies.com/PDFstudies/Egger89.pdf = full textDietary Replacement in Preschool-Aged Hyperactive Boys, B.Kaplan, et al, Pediatrics, 1989, Vol. 83, pp. 7-17§ Egger 1992 = 76%
"More than half the subjects exhibited reliable improvement in behavior and negligible placebo effects. In addition, several nonbehavioral variables tended to improve ... particularly halitosis, night awakenings, and latency to sleep onset."
http://www.diet-studies.com/PDFstudies/Kaplan89.pdf = full text(in this one, since all the kids had already improved on the few-foods diet, the question was would enuresis improve -- and it did, in 76% of them; enuresis is one of the symptoms commonly alleviated by the Feingold diet.)§ Carter 1993 = 75.6%
Effect of diet treatment on enuresis in children with migraine or hyperkinetic behavior, Egger J, Carter CH, Soothill JF, Wilson J, Clinical Pediatrics (Phila) 1992 May;31(5):302-7
"Twenty-one children with migraine and/or hyperkinetic behavior disorder which was successfully treated with an oligoantigenic (few-foods) diet also suffered from nocturnal and/or diurnal enuresis. [daytime or nighttime bed wetting] On diet, the enuresis stopped in 12 of these children and improved in an additional four. [76%] ... Enuresis in food-induced migraine and/or behavior disorder seems to respond, in some patients, to avoidance of provoking foods."
http://www.diet-studies.com/PDFstudies/Egger92.pdf = full textEffects of a Few Foods Diet in Attention Deficit Disorder , C.M. Carter, et al, Archives of Disease in Childhood, November 1993, Vol. 69 (5), pp.564-8§ Rowe 1994 = 75%
59 of 78 children (75.6%) referred for "hyperactive behavior" improved on an open trial of an elimination diet. 19 of them were studied in a placebo-controlled double-blind challenge protocol.
http://www.diet-studies.com/PDFstudies/Carter93.pdf = full textSynthetic Food Coloring and Behavior: A Dose Response Effect in a Double-Blind, Placebo-Controlled, Repeated-Measures Study , K.S.Rowe, K.J.Rowe, Journal of Pediatrics, November 1994, Vol. 135, pp.691-8§ Boris 1994 = 73%
150 of 200 children [75%] improved on an open trial of a diet free of synthetic food coloring, and deteriorated upon introduction of foods containing synthetic colorings.
34 other "clear" or "suspected" reactors plus 20 "controls" were studied in a separate double blind study. 82.5% of the "suspected reactors,", 27% of the "uncertain reactors," and 10% of the "controls" reacted to a mild single-item challenge of tartrazine (Yellow #5). Kind of reaction and length of time the children were affected depended on the dose. Rowe reported that a dose response effect was observed.
http://www.diet-studies.com/PDFstudies/Rowe94.pdf = full textFoods and Additives are Common Causes of the Attention Deficit Hyperactive Disorder in Children, Boris M; Mandel F, Annals of Allergy, May 1994, Vol. 72, pp. 462-8
73% of 26 children with ADHD responded favorably to a diet eliminating reactive foods and artificial colors. 16 of the improved children were given a double blind challenge with 100 mg of mixed food dyes or a food chosen by the parent. ALL of them reacted to the challenge. Placebo effect was ruled out, as the children were as good on placebo days as at baseline (on the diet). "This study demonstrated a beneficial effect of eliminating reactive foods and artificial colors in children with ADHD. Dietary factors may play a significant role in the etiology of the majority of children with ADHD."
http://www.diet-studies.com/PDFstudies/Boris94.pdf = full text
Misinformation on an authoritative site like yours, no matter how well-meaning you are, will hurt the families who read it and believe it. I am not asking you to endorse the diet as a treatment, though that would be nice. But I am asking you to explain that the only way to find out if the additives and/or salicylates are a problem for the child's various symptoms (including ADHD) is to try the diet. And you can give them our web site -- we are the people who make it easy by teaching them how.
I will be happy to answer any questions you may have.
-Shula Edelkind
Feingold Program Research Librarian
http://www.feingold.org
http://www.ADDdiet.com
http://www.school-lunch.org
http://www.diet-studies.com
Dear Ms. Edelkind: I will be happy to publish your informative letter on my website so that all my readers can evaluate the information you have provided about the benefits of the Feingold diet for treating ADHD. Of course, I cannot "correct" what I have already written (except the spelling of Dr. Feingold's name), but I will include a "note to my readers" addendum after the original response which links to this response.
I am not in a position to endorse any treatment outside the realm of standard medical care unless I have personal experience with it, and in spite of the literature you have referred me to, apparently mainstream medicine has not, to the best of my knowledge, embraced the Feingold diet. I don't care to postulate why. I'm not a fan of conspiracy theories. First, all studies have to be paid for by somebody, so it doesn't surprise me when the funding comes from a drug company who will profit from the outcome. That doesn't make the results specious if it's a well designed study. I'd agree that, when reading the results of a study critically, it's wise to know the source of the funding and who will profit from the reported results. I know we've had some drugs and treatments rushed to market too quickly for their purported benefits before all the drawbacks were fully known; nonetheless, the standards applied to scientific studies are such, that I would expect that organizations like the American Academy of Pediatrics, whose goal is to provide quality medical care to all children, would not be bamboozled by a flawed study regardless of the source of funding or their relationships with the companies that have funded the studies. Second, I have seen medications for ADHD work wonders. While they are clearly not the answer for everyone, I don't think the drug companies need to discredit nutritional therapies to find their niche.
Fortunately, the Feingold diet is available to all without a prescription, with or without their pediatrician's approval, and can even be tried as an adjunct to treatment for those who find medication beneficial. The Feingold diet is a nutritionally sound and safe diet. The only potential drawback is the effort required to keep kids on it, but once everybody learns the parameters and all the food in the house is free of the forbidden colorings and additives, that should not be overwhelming. It's certainly no harder than keeping a diabetic on an appropriate diet, or maintaining a gluten free diet for celiac disease.
Now I'll try to address your other concerns briefly. You've already clarified that the Feingold diet is not sugar free (although I don't think my prior response suggested that it was).
Now with regard to sugar, let me first admit that my response was not pure unemotional science. The writer of the original question wrote to ask about vitamins and quoted a doctor who said "diets high in sugar and processed foods have an adverse effect on ADHD behavior. He goes on to say that a history of antibiotic use for childhood infections could lead to a yeast problem in the digestive tract which can cause some of the hyperactivity as well. The recommendation is for a diet high in fiber and whole grains, while low in sugars and processed foods. He also suggests vitamins." This quoted physician lumped so many things together - sugar, yeasts, vitamins - that I'm sure the Feingold diet isn't anxious to be associated with his theory (and I apologize for putting it there if I did so by implication). It got my hackles up. When a parent throws what I consider a myth - sugar and hyperactivity, milk causing mucus - into a question, especially from a questionable source, I feel obliged to explode that myth. And why bother to argue whether or not sugar aggravates behavior? Because it distracts from what is often the real issues that need to be dealt with in the situations where kids consume excess sugar, namely overstimulation and change from the daily routine - all issues which both children and parents must learn to cope with rather than excusing difficult behavior with the belief that excess sugar made it unavoidable.
You are certainly correct that a study that evaluates sugar cannot claim to be a study of high fructose corn syrup, although, based on their similarities and the way that they are metabolized, I would be surprised if their effects on behavior could be shown to significantly differ.... but maybe I'm just being a pigheaded physician with blinders on who doesn't appreciate the subtleties of the human response to various ingredients. Why belabor the point. My comments were never meant to be a defense of sugar or high fructose corn syrup. High fructose corn syrup was recently recognized to be one of the major contributors to the obesity epidemic gripping this country. I spend a great deal of my time counseling parents of overweight kids in the benefits of eliminating soft drinks from their kids' diets. As far as I'm concerned, we would all do well to read labels and consider the health benefits and risks of everything we eat and drink. And high fructose corn syrup is definitely one of the things we would do well to limit or eliminate.
Finally, lets not forget that ADHD isn't just about hyperactivity. It is also about what a child needs to learn. And I'm not suggesting that Dr. Feingold has forgotten that. I'm just taking advantage of the fact that I'll be posting this to add to the discussion for parents who read it. ADHD isn't all one "disease." Different children will respond best to different treatments. Some children are not hyperactive at all. The inattentive kids who are not behavior problems are far too often overlooked as they fail to concentrate on their work. Regardless of the manifestations and the treatment, many of these children need special accommodations to succeed in school. While parents must never excuse unacceptable behavior regardless of the cause, they must advocate for their children to make sure all necessary evaluations are done to assure an educational placement and individual education plan which aims to maximize their child's educational experience so he can live up to his potential. The longer a child lives in an environment of failure, the harder it will be for him to pull himself out no matter what the treatment.
Sincerely,
Dr. Warren
Dear Readers: Ms. Edelkind's response addressed sections of my response (presented above) by quoting the section to which she was responding. To make it easier for you to follow, the part of my response which she is quoting and subsequently responding to is highlighted in blue.Sincerely,
Dr. Warren
| Dear Dr. Warren: I'll insert comments below preceded by what you wrote. |
I will be happy to publish your informative letter on my website so that all my readers can evaluate the information you have provided about the benefits of the Feingold diet for treating ADHD. Of course, I cannot "correct" what I have already written (except the spelling of Dr. Feingold's name), but I will include a "note to my readers" addendum after the original response which links to this response. |
| thank you |
I am not in a position to endorse any treatment outside the realm of standard medical care unless I have personal experience with it, and in spite of the literature you have referred me to, apparently mainstream medicine has not, to the best of my knowledge, embraced the Feingold diet. |
| Indeed this is very true. In fact, medical boards have been known to go after doctors who recommended the Feingold diet and try to take away their license to practice. They used the Feingold Program as a weapon against them. This information is from personal experience, as I was involved as an assistant to the defense attorney for a doctor in just such a case. The doctor won eventually, on appeal; he is featured in the movie The Tomato Effect by Faun Kime. |
I don't care to postulate why. I'm not a fan of conspiracy theories. First, all studies have to be paid for by somebody, so it doesn't surprise me when the funding comes from a drug company who will profit from a the outcome. That doesn't make the results specious if it's a well designed study. I'd agree that, when reading the results of a study critically, it's wise to know the source of the funding and who will profit from the reported results. I know we've had some drugs and treatments rushed to market too quickly for their purported benefits before all the drawbacks were fully known; nonetheless, the standards applied to scientific studies are such, that I would expect that organizations like the American Academy of Pediatrics, whose goal is to provide quality medical care to all children, would not be bamboozled by a flawed study regardless of the source of funding or their relationships with the companies that have funded the studies. Second, I have seen medications for ADHD work wonders. While they are clearly not the answer for everyone, I don't think the drug companies need to discredit nutritional therapies to find their niche. |
| It makes sense; I wish it were true. When, however, I see a study like the Wayne Adams study (Lack of Behavioral Effects from Feingold Diet Violations. 1981) in which the cupcake icing with yellow coloring is identical to the control cupcake icing, without any coloring, you KNOW that they did not put in any significant amount of coloring. When, in the same study, he has a chart that adds up the numbers of mg of coloring in the challenge: 0.3 + 3.0 + 14.7 + .8 and says the total is 26.3 mg .... well I have to wonder how this even got past the peer review. |
| 26.3 mg is just simply not going to do much; look at the most recent study from the UK -- the toddlers reacted to the 20 mg in Mix A but the older children did not. They did, however, react to the 62 mg of Mix B, and even that is not a lot of coloring when you consider how much kids get -- not just in their food, but in their blue toothpaste, green mouthwash, orange shampoo, pink hand lotion, green soap, bright fruit loops, orange drink ... and that's just up to breakfast!! |
| Of course, if the study is well designed, it should not matter who is supporting it. I don't think it is a conspiracy; I think, however, that there is plenty of misinformation, and bias related to money, at all levels. The Nutrition Foundation recommendations are still being quoted as though they came from the government; most people, including scientists, are not aware that this is an industry group made up of companies who make or distribute the additives we eliminate. They do stand to lose big if the Feingold diet is ever accepted. When they suggested researchers use no more than 27 mg coloring on tests, they knew what they were doing. The researchers, however, did not know any better. Then there is the FDA - supposed to be the watchdog of the people. Unfortunately, they get paid for every pound of coloring that they certify ... every pound they certify, not every pound they examine. That does not make me feel very safe. And look who recommends which vaccines to mandate .... it is the vaccine manufacturers themselves. This is not okay, and I don't buy the excuse that there are no independent experts. So let the government hire some experts whose whole business is to worry about safety, not profits. There are no experts? Does that mean that there are also no independent researchers doing studies on vaccines? Then the government should train some experts; why is this so impossible? It seems as though we have accepted a situation in which the fox guards the hen house, and we have forgot that it is precisely our system of checks and balances in government that makes this country great; it should be the same in medicine and every business. |
Fortunately, the Feingold diet is available to all without a prescription, with or without their pediatrician's approval, and can even be tried as an adjunct to treatment for those who find medication beneficial. The Feingold diet is a nutritionally sound and safe diet. The only potential drawback is the effort required to keep kids on it, but once everybody learns the parameters and all the food in the house is free of the forbidden colorings and additives, that should not be overwhelming. It's certainly no harder than keeping a diabetic on an appropriate diet, or maintaining a gluten free diet for celiac disease. |
| Yes. Actually, it is usually much easier, and much less restrictive -- after all, the children can eat anything that is actually FOOD. Even the salicylates are usually tolerated at least in modest amounts. |
Now I'll try to address your other concerns briefly. You've already clarified that the Feingold diet is not sugar free (although I don't think my prior response suggested that it was). |
| Since your sentence about sugar follows directly after your sentence about the Feingold diet, it can be confusing, and for some reason many web sites connect the two concepts. |
Now with regard to sugar, let me first admit that my response was not pure unemotional science. The writer of the original question wrote to ask about vitamins and quoted a doctor who said "diets high in sugar and processed foods have an adverse effect on ADHD behavior. He goes on to say that a history of antibiotic use for childhood infections could lead to a yeast problem in the digestive tract which can cause some of the hyperactivity as well. The recommendation is for a diet high in fiber and whole grains, while low in sugars and processed foods. He also suggests vitamins." This quoted physician lumped so many things together - sugar, yeasts, vitamins - that I'm sure the Feingold diet isn't anxious to be associated with his theory (and I apologize for putting it there if I did so by implication). |
| This is true. While it is possible for a child to have multiple problems, with multiple causes, we prefer to suggest that parents try just the basic diet first -- at that point they will have a cleaner diagnosis and will be more likely to know if symptoms remain to be addressed. And you may have noticed from our website, that we tend to be very mainstream rather than health-nut types. Sometimes nutritionists object because we include hot dogs, ice cream, cookies, etc. in our Foodlists. Sure, the high fiber, no sugar, no egg/milk/citrus rotation diet with only whole grains, etc., is probably a healthy diet, but it is likely to make the parents crazy trying to stick to it even if the kids comply (which they probably won't). No diet is healthy if you don't follow it. |
It got my hackles up. When a parent throws what I consider a myth - sugar and hyperactivity, milk causing mucus - into a question, especially from a questionable source, I feel obliged to explode that myth. |
| Yes, there are too many unsupported ideas floating around out there. |
And why bother to argue whether or not sugar aggravates behavior? Because it distracts from what is often the real issues that need to be dealt with in the situations where kids consume excess sugar, namely overstimulation and change from the daily routine - all issues which both children and parents must learn to cope with rather than excusing difficult behavior with the belief that excess sugar made it unavoidable. |
| There is an interesting study, however, (Inam 2006) in which one group of rats was fed a standard rat diet, while another group was fed a standard diet with 25% table sugar for 5 weeks. Both groups were then tested with a medication that would indicate serotonin response. The study showed that sugar induced a change in the serotonin receptor's ability to receive messages both before and after the synapse. Thus, the child who eats excessive sugar could well be having a biological response, especially if it happens frequently. What astonishes me is how parents get so helpless about it. Part of what we do in teaching the diet is simply teaching parents that they have the job of making good decisions about their children's diet choices - not the kids. |
You are certainly correct that a study that evaluates sugar cannot claim to be a study of high fructose corn syrup, although, based on their similarities and the way that they are metabolized, I would be surprised if their effects on behavior could be shown to significantly differ.... but maybe I'm just being a pigheaded physician with blinders on who doesn't appreciate the subtleties of the human response to various ingredients. Why belabor the point. My comments were never meant to be a defense of sugar or high fructose corn syrup. High fructose corn syrup was recently recognized to be one of the major contributors to the obesity epidemic gripping this country. I spend a great deal of my time counseling parents of overweight kids in the benefits of eliminating soft drinks from their kids' diets. As far as I'm concerned, we would all do well to read labels and consider the health benefits and risks of everything we eat and drink. And high fructose corn syrup is definitely one of the things we would do well to limit or eliminate. |
| You may be interested in the couple of studies of corn syrup I included in our info book at http://diet-studies.com/PDFstudies/BLUE/research.pdf on page 36. |
Finally, lets not forget that ADHD isn't just about hyperactivity. It is also about what a child needs to learn. And I'm not suggesting that Dr. Feingold has forgotten that. I'm just taking advantage of the fact that I'll be posting this to add to the discussion for parents who read it. ADHD isn't all one "disease." Different children will respond best to different treatments. Some children are not hyperactive at all. The inattentive kids who are not behavior problems are far too often overlooked as they fail to concentrate on their work. Regardless of the manifestations and the treatment, many of these children need special accommodations to succeed in school. |
| Indeed, Dr. Feingold talked about this very thing in his book, and we are also very aware of it. You may be interested in reading part of the first chapters of Jane Hersey's book which is on line at http://www.feingold.org/why1.html -- her description of her own child is very much the child who is NOT hyperactive. |
| Also, we agree that many if not most of these children also need accommodations - at least for a while - in school. On the website, there are some articles from our newsletter about suggested accommodations: http://www.feingold.org/PF/pf_teach.html http://www.feingold.org/PF/pf_math.html |
While parents must never excuse unacceptable behavior regardless of the cause, they must advocate for their children to make sure all necessary evaluations are done to assure an educational placement and individual education plan which aims to maximize their child's educational experience so he can live up to his potential. The longer a child lives in an environment of failure, the harder it will be for him to pull himself out no matter what the treatment. |
| Amen to that!! (By the way, one of our oldest new members was in his 70's when he began the diet) |
-Shula Edelkind
Feingold Program
http://www.feingold.org
Dear Readers: The inclusion of this discussion of the Feingold Diet on Ask Dr. Warren does not constitute and endorsement of the Feingold diet or an agreement with any of the information provided by Ms. Edelkind directly or through the links she has provided. You, my dear readers, are intelligent, so you may read the information provided and follow the links to decide for yourselves whether or not the information is useful to you.
Sincerely,
The medical profession has come a long way in its understanding of the nutritional management of disease, especially with regard to the nutritional management of diabetes and food intolerances like gluten sensitivity. On the other hand, while most agree that lowering saturated fat and cholesterol is beneficial in the prevention of cardiovascular disease, not a day goes by where there isn't some controversy about the best way to do it. Just when you think that margarine is the best alternative to butter you find out that trans-fats are the real villains. There's so much more physicians need to learn about diet and cancer prevention. The list of conditions potentially affected by diet, environment, and additives is likely to grow faster than physicians can learn all the answers.
I have always felt that it is reasonable for patients to try alternatives to the mainstream medical approach as long as the alternative is safe. Or, if the alternative is not perfectly safe, as long as the patient has a full understanding of the risks and alternatives and makes an educated decision. Sometimes an alternative approach may interfere with medical treatment, in which case, it is crucial for the patient to decide on treatment based on a comparison of the risks and benefits of the medical treatment with the alternative. Unfortunately, most often patients are forced to choose between conventional medicine and the alternatives because the practitioners won't play nice together. I can certainly chastise my colleagues who make it difficult for their patients who admit to alternative medical care to continue conventional medical care, but I am equally aggravated with alternative practitioners who sell themselves as an antidote to conventional medicine eschewing all forms of medical treatment from immunizations to medications to surgical interventions. The consequences to these patients who adopt an anti-medicine approach can sometimes be disastrous.
Dr. Warren
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