Take two veggies and call me in the morning

A lot of patients ask me to make specific diet recommendations, either to prevent or treat cancer. After all, we eat three times a day, so patients assume doctors know all about the relationship of diet to health and disease.

I'm sorry to say, you could fill an encyclopedia with what we don't know about diet. There is a lot we have left to learn.

In this knowledge vacuum has sprung up a cottage industry of books, websites, and advisors telling you what to eat for better health (you know what they say about nature despising a vacuum!). Usually, these authors and "gurus" have some sort of supplement they are trying to sell you. I had a patient get a dietary consultation at UCLA Medical Center that concluded with a purchase of dietary supplements--I was shocked!

In medical school, they teach you a reductionistic approach to food: everything we eat is some combination of carbohydrate, fat, protein, vitamin, or mineral. Scientists have been trying for at least 100 years to isolate the components of food responsible for good health. This task dates back to the discovery of Vitamin C in the prevention of scurvy, and while there have been many important discoveries along the way, we have yet to distill the natural goodness of vegetables into a pill. I guess if you're going to space and need to save room for oxygen, it makes sense to create freeze-dried ice cream and Tang. For the rest of us, why do we need to do that to ourselves?

Michael Pollan points out in "The Omnivore's Dilemma" that it may very well be impossible to tease out the specific health benefits of particular foods. He suggests that food reductionism is perhaps the wrong approach--rather than trying to isolate the active agent in each food, we should just try for comprehensiveness with a broad variety of foods in our diet. I personally think we should choose variety in our diet, but also continue to isolate active compounds, since this has brought about spectacular successes in antibiotics and chemotherapy.

One thing's certain: when we process food, we remove a lot of these beneficial compounds. The idea that we can add these lost nutrients into food later perhaps is good for the food industry, but maybe not so good for human health. So a box of fruits and veggies gives all the vitamins in the health food stores, plus many others still unknown to science.

Don't even get me started on "antioxidants." I'm not sure what the health benefits of these chemicals are supposed to be. Yet there are many people in the community who slavishly adhere to these, whether in the form of Acai juice, or "Superfoods," or pill supplements.

Pill supplements, for that matter, are suspect in my mind. Vitamins are not regulated by the FDA the same way medicines are, so unless the label says "USP," you can't assume that what's in the bottle is what's on the label. From time to time, you hear stories about supplement pills that contain forbidden substances, as in the famous PC-SPES case, where a prostate cancer supplement contained medicinal blood thinners and hormones! Pill supplements can also be pretty expensive, and do not carry with them the social benefits of food. One could argue that food is the glue that holds civilization together; supplements, not so much.

So probably the best advice comes also from Pollan, "Eat food, not too much, mostly plants." Getting a box full of fresh fruits and vegetables every so often seems like an easy way to follow these reasonable rules.

I have schlepped to the farmer's market, and while it's fun to interact with the people who are growing your food, I never seem to come home with much to eat for $20 or so. Also, there's the crowds, and the time commitment: of course Saturday is for Shabbat, not buying veggies!

While veggies in a pill might not be too far off in the future (a patient actually brought me a bottle of these types of pills!), fruit and vegetable boxes can give you thousands plant nutrients in their most potent form, without even having to get in the car!