Patients have come to me with a variety of problems over the past 30 years. I have told my students that I think of patients as books. They come in through the door, share a chapter of their lives with me in confidence, then off they go, out through the door and the chapter closes. Each story is unique and fascinating. What I do enjoy about being a GP is you never know what story you are going to get from one day to the next. What I have noticed most though is the huge rise in autoimmune disease, irritable bowel syndrome, anxiety and depression, allergies, infertility and skin problems. More people seem to have medically unexplained problems too which do not fit into an easy diagnostic category for doctors yet cause horrible symptoms and ill health for the sufferer.
A lot of these patients get referred to many specialist departments and end up on a cocktail of medicines with a list as long as your arm. They frequently end up feeling exasperated as well as unwell.
Since starting at medical school in the 80s I have recognised the value of a holistic approach, looking at mind and stress in the person as well as their physical symptoms. I have studied psychology, acupuncture, looked into reflexology, hypnotherapy and aromatherapy and had amazing success for my own health issues.
I have seen time and time again the beneficial results of complementary therapies in patients as well as for myself. Assessing a patient on an individual basis and finding out what works for them as a unique individual seems to be the best way forwards.
So much is written now about healthy diets in the popular press and patients will often ask me for advice because the information can be confusing. As a doctor in the UK, we get very little training on food at all. So we tend to seek the advice of a dietician. In most cases that I see, referring patients to a dietician in the NHS is usually reserved for the patients with diabetes and weight issues. I have been suspecting that diet is implicated in the majority of ill health that I see for many years. As much as I would like to , it would be impossible for me to refer a patient with fatigue or infertility for dietary advice, yet I have been suspecting that it is often what people could benefit from.
This frustration lead me to study the therapeutic effects of food more in depth by doing the naturopathic nutritional diploma at the College of Naturopathic Medicine in London. The course has taught me what I suspected all along, that food can play a role in health but in a larger role than I even thought possible. The good thing about the course at CNM is that it seeks to critically evaluate the research on nutrition and its role in health. One of the first lectures was spent teaching us how to critically evaluate research papers. Diet and food can help in the prevention of illness as well as in the management of chronic conditions. It can help specific conditions when tailored to the individual.
I have learned that food intolerances, gut infections and the individual’s genetic makeup are so vital to consider in assessing certain conditions. There are many new tests available now and in conjunction with the work being done on the genome, there are some fascinating research areas emerging on the way individuals handle specific nutrients in specific conditions. Enzymes we have for processing foods and the metabolites of foods are absolutely crucial to know about and appreciate. It is not just food itself too. The quality of the food, the effects of the environment and the ways in which food is processed, can have far ranging health effects. The research on the microbiome, the bacterial environment in the gut, is exploding. Our gut is as important as our brain or our heart. The gut influences the levels of many neurotransmitters, chemicals in our brain which can affect mood or behaviour. Amazing! The gut contains the vast majority of our immune system cells. That is why it is such a crucial place to start looking as a health detective when trying to help a patient with autoimmune disease. But the poor digestive tract tends to get relegated down to just a place of digestion and pooing.
If you have a problem with it and we doctors can’t really find anything specifically wrong, we just tend to label it as ‘irritable bowel”. This diagnosis has been bugging me for years. I want to know what is irritating the poor bowel in the first place. I don’t feel it is enough to say it is just irritable and not try to find out why. It would be like leaving your sulking toddler sitting upset in a corner and offering pacifiers (irritable bowel tends to get given the old peppermint water and antispasmodic to try and appease its irritability), but not trying to find out what is causing all the upset in the first place.
As well as studying for my diploma I have also been lucky enough to get to an international symposium looking at all the latest research on the gut biosome. I also went to the ‘Food is Medicine” this year conference run by the College of Medicine in London. This brought together many doctors, from a variety of specialities, who are interested in the role of food in health. They are trying to educate doctors about the importance of understanding the wider effects and benefits of food to help patients. There is such enormous interest now in diet and the digestive system. My conclusion through my practice is that it is a fundamental place to start when considering someone’s wellness.