Book Review: Food and Nutrients in Disease Management, 1st Ed. CRC Press: 2009.- Ingrid Kohlstadt, MD, MPH, FACN (Editor) and Various Chapter Authors

"In recent decades food and medicine have taken divergent paths. Food has become bereft of nutrients, and modern medicine has sought to heal with technical advances that initially seem dazzlingly more powerful than food. Consequently, the healing potential of food is underutilized in modern medicine." Dr. Kohlstadt, Preface

Editor/Author

This 688-page textbook was assembled, edited (and partly authored by) Ingrid Kohlstadt, MD, a highly-esteemed and frequent author and speaker in the nutrition field. She is the Founder and Chief Medical Officer of INGRIDients, Inc (www.ingridients.com), which provides medical nutrition information to colleagues, clients, and consumers. Many reading this review will be very familiar with her and her work.

Audience and Authors

Dr. Kohlstadt's stated goal is to "help physicians reunite food and medicine in clinical practice." The audience is clearly medical doctors, including and perhaps especially those that are primarily allopathic in approach. As she notes in her preface, "Each chapter was written by medical doctors for medical doctors."

Reading the list of chapter authors is like reading a "who's who" of the thought leaders in contemporary nutrition research. There are simply too many powerhouses to list, but suffice it to say it is truly astounding to find so many of the top thinkers and writers in the field having contributed to one textbook.

Approach

Her approach is to address 43 of the most common health conditions, one in each chapter, divided into sections: Disorders of the Ears, Eyes, Nose and Throat; Cardiovascular and Pulmonary Diseases; Gastrointestinal Diseases; Endocrine and Dermatologic Disorders; Renal Diseases; Neurologic and Psychiatric Disorders; Musculoskeletal and Soft Tissue Disorders; Neoplasms; and Reproductive Health. Chapter examples include Osteoarthritis, Pregnancy, Diabetes, GERD, and Cervical Cancer.

Chapter structure varies slightly but typically addresses the condition's Epidemiology; Physiology; Pharmacology or Common Current Treatment; Food/Nutrient-based Treatment Recommendations; and a Summary. Each author gives a biochemical overview of the causes of the condition, and of the rationale and treatment via food and nutrients. Each chapter is squarely based on the science, and is heavily referenced, for instance the Macular Degeneration chapter contains 219 references to the medical literature.

An example is the chapter on Osteoarthritis. Dr. Musnick provides a pithy synopsis its pathophysiology, and notes keys to patient evaluation. He then discusses the allopathic use of NSAIDS and their side effects. He then goes on to discuss 14 nutrients, their impact on pain or inflammation reduction and cartilage regeneration, and their mechanism of action for such. He references studies on each nutrient and gives an overview of the nutrient's merits and uses. It is a clear, concise, well-written summary of the current science on the nutrients and their use for OA, which provides strong backing for the notion of nutrient-based approaches to the condition.
 
Review:

First, what this book is not. This is not a nutrition therapy "cookbook", with "recipes" of foods and nutrients in exact therapeutic quantities for all the conditions listed. Nor does it aspire to be. While extremely useful for others who incorporate nutrition into their practice, such as naturopaths, chiropractors, nutritionists and others, many who use nutrition regularly in practice will know a fair bit of the "answers" (meaning which nutrients are most effective for which conditions) already, but will no doubt learn the biochemistry behind the "answers" at an even deeper level after reading this textbook.

Dr. Kohlstadt has clearly targeted a very different audience. The book does an excellent job of achieving its goal, which (my words) is to educate medical doctors as to the evidence-based, biochemical underpinnings of food and nutrient therapy in addressing common health conditions. The book will be indispensable for medical students, and any allopathic doctor who wants to learn the science behind food as medicine. This will serve as powerful and comprehensive evidence to combat the oft-heard claim that "there isn't any science behind" food and nutrients as therapy.

As with any textbook, its scope must necessarily be limited if it is to achieve anything. Any book with 43 conditions will not be able to comprehensively address each condition. For instance, in the chapter on Alzheimer's Disease, a section on supplements stated: "…Gingko biloba was subjected to two double-blind placebo-controlled studies and failed to show any significant improvement in memory. As such, none of these supplements can be recommended to the general public for delaying onset of AD or for memory loss more broadly." I know from my own secondary research that there have been dozens of studies (most not double-blind, placebo controlled, however) on Gingko biloba for memory loss and dementia, and while results have been mixed, there is certainly some good evidence for its benefit, so the dismissal may have been too quick and too broad.

So if you're looking for a "cookbook" that tells you specific dosages of which nutrient to give a patient, this is not it. And the truth is, sometimes cookbooks like that can be too generalized, and not equip the practitioner with the biochemical insights behind a particular therapy.

If you are looking for the research evidence behind the use of food and nutrients to improve outcomes for major disease states, or to deepen your understanding of the biochemistry thereof, then this is it. And Food and Nutrients in Disease Management is masterful at that task.

Dr. Kohlstadt and her assembled authors have done a huge service to the field of therapeutic nutrition. As Dr. Kohlstadt writes, "Food and nutrients are the original medicine. They are the molecules of biochemistry, physiology, and immunology, and the shoulders on which modern medicine stands." I think this textbook will have a major impact on the way allopathic medicine looks at food and nutrients in clinical care, and it is desperately needed.

I have already begun to put the book to use with my clients. For instance, I used the chapter on migraines to bone up on the subject before working with a client with chronic migraines. I learned a few nuggets I was not aware of, such as the role of glucose dysregulation in triggering migraines. I then dug into the nutrients that are used for migraines, and learned that alpha lipoic acid has some uses for migraines. I've put the client on a prophylactic migraine regimen based on the nutrients described in the chapter: Magnesium, Riboflavin, Co-Q10, Alpha Lipoic Acid, feverfew and butterbur.

As a nutritionist, I found this book to be at a high level of detail, excellent as a biochemistry refresher, and strongly evidence-based. It therefore gives a nutritionist the highest-quality and –level information, while providing the evidentiary backup to give us the confidence to convert the information into action plans for our clients. So while the primary target is physicians, I recommend it highly as well for nutritionists who are serious about improving clients' health.

This textbook will be on my shelf – the one arm's reach from my desk – as I know I will use it time and again to provide my clients the best approaches science has to offer.

Rating: 5 stars out of 5

Audience: 1. Allopathic physicians; 2. Holistic physicians; 3. Other science-based nutrition practitioners

Note: An interview of Dr. Kohlstadt about the textbook, and a link to purchase it are at:

http://www.audio-digest.org/pages/start/cu...iew_series.html

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~Michael