Review of Nutritional Medicine

Author: Alan R. Gaby, MD Concord, New Hampshire: Fritz Perlberg Publishing, 2011, 1358pages, ISBN13:978-0-9828850-0-0, $295.

N utritional Medicine, the fruit of over 3 decades of diligent study of clinical nutrition research, is an extensive synthesis of the literature almost up to the moment of publication—January 2011. It is written primarily for clinicians, although interested laypeople are likely to find it of considerable use. The accessibility of Dr. Gaby's butter-smooth writing style makes the use of this tome far less burdensome than is typically the case when reading what can essentially be viewed as a combination textbook and reference work.

Outside the realm of treating nutritional deficiencies, allopathic medicine often views nutritional therapeutics as lacking in scientific support. The findings of thousands of citations discussed in this book, many referencing double-blind randomized trials, turn this prejudicial perspective on its head.

The book is divided into three sections. The first, “Fundamentals of Nutritional Medicine,” covers general topics such as diet fundamentals, the health effects of different forms of cooking, and food allergy. Most of these chapters are written with the same level of depth as is the rest of the book. The “Fundamentals of Diet,” however, is more of a quick summary probably not meant to be read in isolation. Regarding that brief chapter, the author helps fill in some of the blanks by directing the reader to other portions of the text that contain more in-depth discussions.

The second section, “Therapeutic Agents,” has individual chapters on each nutrient. Clinicians are likely to use these chapters as a review when seeking details about side-effects, dosing, laboratory evaluation, and so on. For students, however, this section is a gold mine of succinct information needed not just to pass tests, but also to learn the basics that any doctor who uses nutritional medicine needs to know.

The third section covers nutritional treatments of diseases and, like the long-standing successful Wright-Gaby Seminars, is divided by systems (e.g., “Renal Diseases” and “Endocrine Disorders”) or in some cases, areas of medicine (e.g., “Pediatrics” and “Psychiatry”). This is the section that is most likely to make this book, as Dr. Jonathan Wright says in the forward, “a landmark, a milestone in the history of 21^st century medicine.” These are the pages that will get the most fingerprints and food stains. If section two is a gold mine for students, then section three will be platinum for doctors and students alike who use or intend to use nutritional therapeutics in practice.

Hidden in a page here and there are obscure pieces of information that most doctors who use therapeutic nutrition are unaware of but need to be. These gems alone can affect the clinical practices of virtually every reader. For example, the research showing that non-chloride-containing sodium compounds do not raise blood pressure is discussed (page 323). Knowing that baking soda is not problematic for your hypertensive patients might make their lives much easier.

As another example, while some will view the potential problems that could be associated with several thousand International Units of vitamin D per day with less concern than does Dr. Gaby, his thorough discussion of potential downsides of higher-dose vitamin D therapy will help many practitioners put this issue into better perspective.

Medical texts and reference works are supposed to be devoid of anything bordering on the personal. Although no report can be purely objective and no information goes without some processing by a human, the fantasy of such an approach is almost universally maintained in medical textbooks. Therefore, the willingness of Dr. Gaby to openly share how he sees the findings of research playing out in his own clinical experience is a breath of fresh air separating this book from most others. Who among us has not learned from asking questions of seasoned clinicians—questions for which answers are not found in research articles but rather from the experience of those who have been in the trenches of clinical practice?

No book that tackles the broad subject of nutritional therapeutics can be complete, and therefore no book can be perfect, including this one. As one possible example, in the chapter “Atherosclerosis and Ischemic Heart Disease,” the author emphasizes (some may argue overemphasizes) the evidence that downplays the effects of reducing dietary saturated fat (page 253). In that chapter, Dr. Gaby also describes the Pritikin and Ornish research (page 256). Discussing what to many clinicians may appear to be potential contradictions between those seemingly conflicting data would have been a useful addition. Also, it would have been helpful if that section contained reminders of the foods for which Pritikin/Ornish proscriptions appear to be at odds with the scientific literature (viz., olive oil, fish, and tree nuts).

But such criticisms border on hair-splitting. If we back away from the trees, more than any other currently available book, this volume is a must for all clinicians who use nutritional therapeutics. The book is available only at www.doctorgaby.com or by calling 603-225-0134. The website contains two sample chapters. Its cost must be viewed in context. The target audience is small and the number of pages is large. The professional lifetime of work put into its creation makes the purchase price somewhat of a bargain.