EDITORIAL – June 8, 2018
Attentive nutrition guidance needed in BC health model
by Mary P Brooke, B.Sc., Editor, West Shore Voice News
This week it truly was good news to hear the BC Government’s announcement about opening up the first primary care health centre (it’s in Surrey, coming November 2018). A key feature of that first center and others to follow, is the on-site integration of pharmacists into the team. That’s along with physicians, nurse practitioners, occupational therapists, physiotherapists, counsellors and various other disciplines.
But not a mention by Health Minister Adrian Dix about integrating attention to nutritional care in either of his media teleconferences this week (June 5 at UBC’s Pharmaceutical Sciences Building and June 7 at City Centre 2 in Surrey’s Health and Technology District). He shared the June 7 announcement with Premier John Horgan.
So, following up, as media will do, West Shore Voice News has asked the Health Minister’s office about the nutrition factor as a proactive part of multi-disciplinary primary care centers. A response is expected next week.
The entire basis of good health is a well-maintained body, mind and spirit. Taking care of the body does require good food choices. In recent years, people are catching up with the idea that diet is not the same for everyone. Sure, if you have a particular illness like diabetes or a heart condition, there are specific diet regimens that are wise to follow. But for everyone of all ages there are individualized requirements of nutrient intake that serve the specifics of growth phase (age), body type (size, gender, DNA), and most notably the lifecycle phase (infant, child, preteen, child-bearing years, mid-life adult, early senior, aging senior, frail senior).
On top of that there are work/environmental impacts that perhaps deplete certain nutrients, such as exposure to various chemicals or natural contaminants in the workplace or community. A simple one is the need for additional anti-oxidants when living in cities where there is exposure to a higher level of fuel exhaust than you’d be exposed to in rural areas.
This is a degree of attention to nutrition management that is not mentioned in BC health care directions at the present time. Yes, there is the BC Dietician service, which has three distinct target groups which are important but very focussed: pediatric, allergies, and cancer. A 8-1-1 phone number can connect callers with a registered dietician for basic nutrition information, but outcomes depend upon the specific questions and circumstances for calling; generally speaking that’s not proactive nutritional management toward optimal health maintenance. And there’s a policy thrust… did you know that the BC government provides nutrition and food science expertise and consultation to the food and food services industries and health professionals? Key areas of that work include “supporting the implementation of provincial food regulations, policies and best practices related to a healthier food supply and to healthy eating promotion”.
That brings us to the interaction of pharmaceuticals with nutrients and metabolic systems in the body. Minister Dix was very clear this week to outline that now 20% of people over age 70 take at least five medications and that one in six are taking 10 or more. Of those over age 85 (an age group that will double in 20 years) 31% are on at least five drugs, he said. Dix said there is strong evidence that multi-disciplinary intervention will decrease over-prescribing “making people’s lives better”. A factoid repeated by Dix: the number of people over age 75 will increase two-and-a-half times over next 20 years.
Might it be better to take steps to reduce the number of medications taken (especially by seniors), rather than assume that will be the case? With significant bombardment of the body’s basic functions with so much manufactured chemistry, this cries out for an attentive level of nutritional management. Every chemical introduced to the body has to work within the overall body system. In metabolizing each drugs, certain nutrients will be used more readily, or interfered with, or even blocked.
The chemical soup that our bodies are, is a system in delicate balance. Bodies are resilient, but a cocktail of medications intended for treating specific diseases and conditions will have an impact on the baseline of normal body function. Not to mention the various drugs themselves interacting with each other both in process and in their by-product phases, including in post-surgical scenarios and situations of mental health management using drugs. And then there are the cases where there is an overlay of alcohol use. As people age, their ability to absorb nutrients often diminishes, requiring a look at the need for enzymatic support to aid digestion of food so that nutrients can be optimally released.
A heavy intake of pharmaceuticals or other drugs requires a detailed analysis of the accompanying need for vitamin, mineral and protein supplements, just to mention a few components of an optimal-nutrition goal. The general approach to prescribing drugs all these years has been disease-specific, viewing the body is a static vessel that will respond specifically to the drug that is given, without a whole lot of broader view to drug/whole-body interactions.
There is also fluid and electrolyte balance to watch for (especially in seniors and those taking multiple medications), and attention to be given to things like the management of hormone levels, blood sugar levels and bone density. That analysis needs also to be combined with suitable exercise and movement, especially as people age. All of that produces a complex equation.
It sounds like the sort of metabolic counselling that could even begin to address attention to that level of biochemical analysis combined with lifestyle insights is not (yet) on the radar of the BC primary health care model. Standard dietetics is generally not charged with that level of overview or complexity. Some of the new nutrition colleges get into some of these matters, as does the naturopathic discipline.
So while the BC NDP Government is pleased to be providing better access to pharmacists and fully expects more pharmaceuticals to be needed and taken by aging people in the years to come, it would be brilliant to see this government introduce proactive nutritional management into the primary health care model as a counterbalance to more drugs in our bodies. Let’s see where this goes.
This editorial was first published in the June 8, 2018 print/PDF issue of West Shore Voice News, page 2.
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