drlowe.com---letter to Gov. Bush---fibromyalgia, hypothyroidism, thyroid hormone resistance

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New Book
The Metabolic Treatment
of Fibromyalgia

The Fibromyalgia Research Foundation
A Non-Profit Organization for Research and Education
Dr. John C. Lowe, Director of Research
Post Office Box 271722 Houston, Texas 77277-1722 USA

June 9, 1999

RE: Veto of SB1525

The Honorable George W. Bush
Governor, State of Texas
Post Office Box 12428
Austin, Texas 78711

Dear Governor Bush:

I am writing to you as a clinician and scientist dedicated to helping patients with a disease called fibromyalgia. I firmly believe that passage of SB1525 will adversely affect many of these patients in Texas. In that 2% of the U.S. population have fibromyalgia, the number of patients whom passage of SB1525 might affect is considerable. My purpose is not to malign licensed dietitians. I comment on them herein for only one reason—I'm convinced that passage of the bill will lower the quality of health of Texas health care consumers.

My background in clinical nutrition is pertinent to this letter, so I'll provide a brief summary. I have twenty-five published scientific and professional papers in the field of clinical nutrition. In 1977, I received the Annual Scientific Paper Award from the American Chiropractic Association for my paper "The Nutritional Treatment of Arthritic Diseases." I formerly taught clinical nutrition in the Clinical Sciences Division of the Texas Chiropractic College. Moreover, I'm the principal investigator of the multidisciplinary medical research team that developed the only treatment that enables many fibromyalgia patients to recover. The treatment, called "metabolic rehabilitation," includes certain dietary and nutritional practices; without these features of the regimen, most fibromyalgia patients don't improve or recover.

My experience with dietitians in Texas is extensive. Through that experience, I've learned a disturbing fact about the professional conduct of dietitians: Typically, they counsel fibromyalgia patients not to adopt the very dietary and nutritional practices that our research shows are indispensable to the patients' recovery. Dietitians as a group have distinguished themselves by their pejorative opinions of many dietary and nutritional practices that are essential for good health for most people. In addition, they attempt to indoctrinate their patients with two particular beliefs about diet and nutrition that are unequivocally false: (1) the typical American diet is nutritious enough to maintain good health, and (2) nutritional supplements (except for calcium) are a waste of money because the typical American diet provides enough nutrients to maintain good health. These beliefs are contrary to overwhelming scientific evidence. Despite this, nearly all dietitians I've known have dogmatically clung to these unscientific beliefs; they've done so despite my providing ample scientific evidence against the beliefs. I hastily add that I've known a few dietitians who were exemplary exceptions to these general statements. From long experience, however, I believe these statements are an accurate characterization of the profession at-large.

Fortunately, we have credible evidence of some outcomes of the professional performance of dietitians. I’ve included below the references to a few studies from the medical literature. The results of these studies suggest that the beliefs and practices of dietitians are harmful to hospitalized patents. The studies I’ve listed are only representative; many more are in the medical literature, and their conclusions are consistent with those I cite. Studies show that up to 50% of hospitalized patients are malnourished, and many of these patients suffer adverse medical consequences related to their malnourishment. These findings are directly relevant to the consideration of dietitians’ professional abilities, for dietitians largely determine what hospitalized patients consume. I’ll mention a few of the findings because they bear on issues raised by SB1525.

• Baxter [see ref. 1] noted that the dietitian is particularly important to evaluating the nutritional status of hospitalized patients and for determining their nutritional needs. Surveys have shown that 20% to 50% of patients admitted to hospitals suffer from nutritional depletion. However, Baxter also pointed out that there is a failure in hospitals to recognize the nutritional depletion and its significance.

•Potter and Luxton [see ref. 2] wrote that 24% of hospitalized patients had at least mild protein/calorie malnutrition. Only 42% of these patients received nutritional supplementation. The researchers concluded that the malnutrition results in increased lengths of stay in hospitals and an increased death rate.

• Tobias et al. [see ref. 3] reported that 91% of 67 patients in a New York City teaching hospital had overt or potential nutritional problems of clinical significance. Patients’ nutritional needs were not given attention on a par with other matters of patient care. The researchers wrote: "Major examples of nutritional neglect included failure to: Obtain a dietary history when indicated; record body weight on admission and at appropriate intervals thereafter, ascertain ‘relative weight’or some similar measure of deviation from a desirable standard; provide appropriate dietary management, including nutrient supplements; and furnish nutritional counseling. At no time was a dietary history obtained by a dietitian, and no plans were made at discharge for follow-up nutritional care."

• Vinciguerra et al. [see ref. 4] found that comprehensive home care for terminal cancer patients is an effective alternative to hospitalization. One reason for the comparative effectiveness of home care was "improved measurements of fat stores for female patients." By comparison, hospitalized female patients had poorer measures of fat stores—an index of the inadequacy of nourishment determined by hospital dietitians.

• Zawada [see ref. 5] wrote: "Malnutrition is a common finding in elderly patients, especially at hospitalization. In those whose nutritional status is borderline, the stress of illness may bring about deficiency. Failure to correct malnutrition delays recovery and prolongs hospital stay."

• Weber (see ref. 6) recently reported a poor outcome for hospitalized brain-damaged children. The poor outcome was related in part to nutritional deficits. Before surgery, 82% of the children had less than 90% of ideal body weight, and 50% had a nutritional risk index of less than 90 (normal = 100). The low level of albumin in the children was associated with prolonged hospitalization. These findings indicate that the nutritional needs of the children were not met.

In hospitals, therefore, the beliefs and practices of dietitians don’t serve patients well. It’s noteworthy that the publication dates of these studies range from the mid-1980s to 1999. During this time, the beliefs and practices of dietitians haven’t changed. Some may argue that it’s the job of physicians to decide whether the diets of hospitalized patients are nourishing enough. Ultimately, this is true, and many physicians are negligent in this respect. Nonetheless, dietitians largely determine hospital diets. If these diets provided proper nourishment, hospitalized patients wouldn’t have nutritional deficiencies for physicians to detect. Hospitals are team-oriented facilities. In hospitals, physicians depend heavily on support personnel, such as dietitians, to give them information on the status of patients. Presumably, one job of hospital dietitians is to assess the dietary and nutritional needs of patients. Another is to provide physicians with assessment results so the physicians can use the information to ensure proper patient care. The available evidence, however, suggests that dietitians dreadfully fail in this responsibility. Dieticians do see to it that hospitalized patients eat. The record shows, however, that what hospitalized patients are given to eat—based on the unscientific beliefs of dietitians—leaves a high percentage malnourished.

Evidence also shows that the malnutrition results in longer hospital stays and a higher mortality rate. We don’t have outcome assessments for the performance of health care professionals other than dietitians who provide diet and nutrition counseling. Nonetheless, I can hardly imagine that any other group of professionals could perform more poorly than have licensed dietitians.

In my professional experience, the beliefs and practices of licensed dietitians serve the needs of outpatients just as poorly as they do hospitalized patients. Often, I’ve witnessed the pernicious effects on my patients of the foods imposed on them by dietitians in hospitals. But I’ve also had recovered fibromyalgia outpatients who returned to me with their fibromyalgia reactivated soon after they adopted dietitian-approved diets and ceased taking nutritional supplements. All of these patients again recovered when they resumed the dietary and nutritional practices disapproved by the dietitians.

Despite studies such as those I cited above, dietitians today tenaciously hold to their long-standing unscientific beliefs about diet and nutrition. At the same time, by contrast, other conventional health care practitioners have begun to undergo change. Recently, many traditional medical physicians have begun to prescribe or advocate nutritional treatments—treatments that licensed dietitians on principle oppose and discourage. Reflecting that trend and at the behest of medical physicians, our federal government recently began funding nutritional and herbal studies. To conduct such studies, the research center at Bastyr University recently received a one-million-dollar NIH grant. At Bastyr, naturopathic physicians receive training in nutritional practices that, again, registered dietitians oppose and discourage. Yet nationwide institutions such as Cancer Treatment Centers of America now employ naturopathic physicians to counsel patients on diet and nutrition. The patients dietitians counsel would benefit if the dietitians would follow the lead of progressive medical physicians and institutions. Unfortunately, I have seen no indication that dietitians are doing so.

My request that you veto SB1525 is based only partly on the point I’ve tried to make so far—that the beliefs of licensed dietitians about diet and nutrition almost ensure that their patients will not remain healthy. However, my request is also based on the excellent performance of Texas health care professionals other than dietitians. Over the years, time-and-again, dietitians have militated against the dietary and nutritional practices my patients needed to recover. As a result, I’ve referred patients for dietary and nutritional counseling to professionals other than dietitians. The practitioners have included naturopaths and other individuals with Bachelors, Masters, or Ph.D. degrees in clinical nutrition. I’ve found that most of these other practitioners held beliefs consistent with current scientific thought on diet and nutrition. Moreover, their counseling was scientifically sound. They served well my patients’ needs.

I would consider it a tragedy for Texas health care consumers if these practitioners who are not dietitians were no longer able to provide dietary and nutritional counseling. Yet this will happen if SB1525 becomes law.

(I understand that according to the bill, these practitioners could provide their services free of charge. But I suspect none could afford to do so, and quickly, consumers would be left only with the inferior services of licensed dietitians.)

I am confident that passage of SB1525 will be detrimental to Texas health care consumers. Of particular concern to me is the potential harm to fibromyalgia patients. For these reasons, I will consider your veto of SB1525 a humanitarian action. Thank you in advance for vetoing this unreasonable bill.

Cordially,
Dr. John C. Lowe
Board Certified: American
Academy of Pain Management

References

1. Baxter, J.P.: Problems of nutritional assessment in the acute setting. Proc. Nutr. Soc., 58(1):39-46, 1999. (Department of Digestive Diseases and Clinical Nutrition, Ninewells Hospital and Medical School, Dundee, UK. E-mail: <janetb@dth.nhs.scot.uk>)

2. Potter, M.A. and Luxton, G.: Prealbumin measurement as a screening tool for protein calorie malnutrition in emergency hospital admissions: a pilot study. Clin. Invest. Med., 1999 Apr;22(2):44-52, 1999. (Department of Medical Biochemistry, McMaster University, Hamilton, Ont. E-mail: <mpotter@FHS.mcmaster.ca>)

3. Tobias, A.L. and Van Itallie, T.B.: Nutritional problems of hospitalized patients: a preliminary survey. J. Am. Diet. Assoc., 71(3):253-257, 1977.

4. Vinciguerra, V., Degnan, T.J., Sciortino, A., et al.: A comparative assessment of home versus hospital comprehensive treatment for advanced cancer patients. J. Clin. Oncol., 1986 Oct;4(10):1521-1528, 1986.

5. Zawada, E.T. Jr.: Malnutrition in the elderly. Is it simply a matter of not eating enough? Postgrad. Med., 100(1):207-208, 211-214, 220-222, 1996. (Department of Internal Medicine, University of South Dakota School of Medicine, Sioux Falls 57105, USA.)

6. Weber, T.R.: A prospective analysis of factors influencing outcome after fundoplication. J. Pediatr. Surg., 30(7):1061-1063; discussion 1063-1064, 1995. (Division of Pediatric Surgery, St. Louis University School of Medicine, St. Louis, MO, USA.)