REPRISE This section of The Journal brings to the attention of our readers vie w po in ts expressed in other publications. The o p inio ns expressed or im p lie d do not necessarily reflect the o p in io n or official policies or position of the A m erican Dental Association. Reader response to the topic is invited.
What do we know about nutrition? Bernard P. Tillis, DDS
D octors don’t know anything about nutrition!” is the recent provocation perpetrated by certain dietary sorcer ers who have gained so much mislead ing attention in the sensation-seeking media. Exploiting half-truths and in sufficiently investigated findings, they d iss e m in ate th e ir p s e u d o scientific dogma by means of fearfully efficient communication devices the civilization has developed. Such self ordained apostles of nutrition have tended to becloud the fundamentals of nutritional science by spreading spe cialized, even mystic rites for human ingestion. Capitalizing on the sad truth that the m alnutrition and its sequelae stemming from disbalanced dietary overabundance has focused at tention on the need for weight reduc tion, purveyors of nutritional gim mickry have offered a confusing, often contradictory variety of dietary distor tions. “Experts” have touted the effi cacy of high protein, or high carbohy drate, or mega-vitamin, or total fruit diets in a succession of ostentatious campaigns attracting millions of con fused and confusing adherents who with evangelical zest attest to the val idity of a particular regimen. In the light of the rampant contradic tions and the exploitation of unre solved scientific investigation, public bewilderment is inevitable. In addi tion, no small part of the widespread confusion can be placed at the door of recent research opinions, pro and con, on the intake of saturated fats and cholesterol and the relation of sodium and / or sugar to heart disease, as well as the limited information on the rol of trace elements. Add to these prob lems the fact that investigators have still to clarify the role of additives, of
enzymes, of the vitamin-hormone rela tionships, plus the fact that, to quote a scientific adage, “ scientific ‘truth’ can change with the morning’s m ail,” and it becomes clear that the role of the doctor in advising a patient is by no means a simple one. Under such cir cumstances, the public confusion, no doubt often shared by the professions, and the susceptibility to various illfounded forms of nutritional hype are perhaps understandable. It may not be inappropriate at this point to indicate that doctors of den tistry, early on, manifested an inten sive interest in nutrition as it deter mined the patient’s oral well-being as well as his or her general health. It was investigating dentists who demon strated that the in tr o d u c tio n of “ civ ilize d ” foods into the diet of “primitive” people resulted in oral disease and in general health deterio ration. In the treatment of periodontal disorders, dentists have for decades, long before current vogue gave the practice a certain chic, stressed the need for dietary analysis and nutri tional understanding as a means of en suring oral health and the general health to which it is related. It may be true that due to their striv ings with exacting restorative proce dures, and because their nutritional and other preventive counseling often has encountered patient apathy, even resistance, dental practitioners have been less than sufficiently emphatic in these educational endeavors. Today, dentists who have become conscious of the rapidly changing vista of dental practice are beginning to adopt coun seling procedures. Witness the in creasing number of continuing educa tion courses replete with opportuni
ties whereby a dentist may equip him self with suitable nutritional lore. The posture that the dentist assumes as he undertakes his duties as nutri tional counselor, as educator, in the highly charged dietary atmosphere, therefore, takes on additional impor tance. The avoidance of ill-founded gimmickry in the face of widespread exploitation is crucial. Time-tested dietary regimens calling for wellbalanced, calorie-controlled meals are still, and apt to be continually, valid. The m odification of deleterious dietary habits is a difficult recom mendation for patients to achieve, yet is undoubtedly a paramount ingre dient of proper nutrition. The altera tion of social and psychological pat terns that such advice entails is, in most cases, so difficult that it repre sents the prime reason for the failure of many dietary disciplines. The process by which a dentist de lineates the nutritional information he conveys to patients, therefore, cannot be simple. He or she needs to cull out the well-founded materials developed according to the scientific method upon w hich his training has been based. Healthy skepticism and in formed selectivity, fundamental to the practice of a profession based on sci ence, may not be relaxed if the high standards the public deserves are to be m ain tain e d . U nder such c irc u m stances, the provocative barbs directed at the conscientious doctor may surely prove to be unsubstantiated canards. This article is reprinted w ith perm ission from N Y State Dent J 47(8):431, 1981.
JADA, Vol. 103, December 1981 ■ 995