I recently bumped into an acquaintance I hadn't seen in a while. She suffers from chronic reflux disease and it has been affecting her quality of life quite significantly. Not only does she take prescription medications, but she also avoids chocolate, caffeine and a long list of other foods which she believes will worsen her symptoms. A year or two ago, when things started getting really bad, she started making a concerted effort to incorporate more legumes and whole grains into her diet. Her reflux is now so severe that she can't eat after mid-afternoon, and has started discussing the possibility of surgery with her doctor.
When I asked her if she had considered giving up grains, this was a completely novel idea to her. Clearly it wasn't something her doctor had recommended.
I couldn't help wondering how medical specialists can justify discussing surgical options before first suggesting that their patients try a gluten-free diet for a while.
I completely understand that physicians have to be careful not to cross the line into areas beyond their expertise. They are not trained or qualified as nutritionists, so I am aware that they need to tread carefully.
But still, I find it very difficult to understand why a risk averse physician couldn't say something along the lines of, "There is a body of thought that the proteins in wheat are inflammatory and some patients find that their symptoms diminish considerably when they stop consuming grains. Before we talk about surgical options, I wonder if you would consider going on a gluten-free diet for six weeks".
I sincerely hope the reason for this is not that the specialists themselves are completely unaware of the inflammatory effects of gluten. I don't expect our doctors to be totally on the up and up with all the latest nutritional thinking - that is not what they are trained for, after all - but it's not unreasonable for them to be at least somewhat familiar with dietary alternatives that affect their area of expertise.
It doesn't take more than a couple of minutes of internet searching to find plenty of resources and testimonials from others with reflux disease who were able to control or even reverse their symptoms by switching to a Paleo diet. There are even peer-reviewed papers that suggest a relationship between celiac disease and acid reflux.
The risks of surgery to treat a non-acute problem always outweigh the risks that accompany a temporary change in diet involving the avoidance of a particular food that does not provide essential nutritional value. Surgery is always costly, and often cannot be reversed.
Some people are such strong believers in alternative remedies that they avoid potentially life-saving surgery. It has been speculated that Steve Jobs might still be alive today if he had had more faith in traditional medicine. However, we need to distinguish between the need for surgery to fix an acute problem, as opposed to the treatment of a chronic one. When it comes to a chronic disease like reflux oesophagitis, there is more leeway in the treatment options. And it's very hard for me to understand what harm could come of giving up bread, crackers and muffins for a couple of weeks.