Getting your advice on nutrition for optimum health from your doctor’s emergence rooms is not a good idea

With proliferation of health information in the modern day, you might come across information from various sources such as friends, magazines, or the internet suggesting a need to explore nutritional supplements for disease prevention and optimum health. Your doctor’s emergence rooms are not the best place to seek helpful advice. The real reason behind avoiding nutritional consultations in particular from your doctor or  other biomedical trained professionals is often not well presented. It is not only the question of how much education on nutrition the  doctors get during their training, but rather an issue of constraints imposed by the obligation to uphold the professional code of conduct in practicing medicine within the framework of the biomedical model. What this means is that even if your doctor managed to expand her/his nutritional knowledge beyond what they got in medical school, they might not be able to provide you with helpful advice as they are constrained by the dictates of the professional medical code of conduct. Deviations from laid down intervention protocols and standards would be regarded as violations of  the professional code of conduct in the medical practice.

I present this argument using an example of Vitamin B 12. Most cases of Vitamin B12 deficiency manifestations sneak in very slowly, characteristic of chronic illnesses and are also more prevalent in the much older adults. Some of the clinical manifestations include:

· Weakness, tiredness, or lightheadedness.
· Heart palpitations and shortness of breath.
· Pale skin.
· A smooth tongue.
· Constipation, diarrhea, loss of appetite, or gas.
· Nerve problems like numbness or tingling, muscle weakness, and problems walking.
· Vision loss.

Interventions to prevent such chronic conditions is best approached through a regular and continuous  intake of optimum levels of vitamin B12 from food or nutritional supplements.
Here is where the issues of unhelpful advice from your healthcare providers at the emergence rooms. The Food and Nutrition Board (FNB) of the US Institute of Medicine in 1998 revised the RDA of vitamin B12 in adults 51 years and above to 2.4 microgram/day. We also know that the current Dietary Reference Intake (DRI) is 6 microgram/day. However, because vitamin B12 malabsorption and vitamin B12 deficiency are more common in older adults, the Linus Pauling Institute recommends that adults older than 50 years take 100 to 400 μg/day of supplemental vitamin B12.

There is a huge difference between B12 intakes as recognized by the two institutions, and we have to ask: What clinical significance would emerge from this huge difference? It has to be effectiveness. Common sense tells us that if higher intake levels do not lead to toxicity, then we would expect much more effectiveness from the higher than the lower intake levels, especially were issues of availability, absorption, etc., of the nutrients in question are of concern. It is known  that a Tolerable Upper Intake Level (UL) is the maximum daily dose unlikely to cause adverse side effects in the general population.  Current knowledge indicates that there is no upper limit which has been set for vitamin B12, as there is no established toxic level. 

In any case, the point to be clarified on the intake levels is whether the RDAs  (2.4 microgram/day) would have an impact on prevention of health problems associated with vitamin B12 deficiency. From my independent research on vitamin B12 and prevention of associated health problems, the RDA levels of vitamin B12 which might be recommended by your health care provider at the emergency rooms, by far does not appear to have any impact on prevention of  vitamin B12 deficiency associated diseases. The vitamin B12 RDAs need to be increased by 100x or more to have meaningful impact on prevention of the Vit. B12 associated health problems.

The problem with getting your nutritional advice for better health from from the emergency rooms is not really about knowledge deficiencies of the health professionals, but rather the deficiencies from the biomedical model (not ideal for handling complex nutrition-associated health problems), which guides their medical or other healthcare related practices.

Ref

Linus Pauling Institute, Micronutrient Information Centre (2019). Vitamin B12. Available at: https://lpi.oregonstate.edu/mic/vitamins/vitamin-B12 

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