healthy lifestyle or pill

Pill or Lifestyle?


Is the part equal or greater than the whole?  People often hope so.  Not long ago a patient requested I give her a pill that “makes me feel good, causes weight loss, and doesn’t have any side effects.”

No, she wasn’t kidding.  Many others hope for the same.  And they spend lots of money trying to find it.

Life Changes in a Bottle 

Over the last several decades epidemiologists have kept identifying lifestyle issues – like diet, social and physical activity – that lead to longer lives, less disease, and improved psychological and economic function.  Almost without exception someone tries to “drill down” to find the “secret ingredient” that makes good things  happen.  Once they’ve found “the ingredient” that supposedly provides the positive results for something as complicated as a diet, they then try it out on populations.

And the supplement industry’s profits thrive.

We have been treated to soy proteins as the preventer of prostate cancer.  Lycopene, an ingredient of tomatoes, also carried that torch. Supposed “fat busters” or “weight loss agents” like garcinia cambogia to raspberry drops, certainly number in the hundreds.  And then there is one of the granddaddies of the movement, the positive power of omega three fatty acids, advertised on fish packages (“our salmon is better than yours”) to pill bottles across the globe.

Does the stuff really work?  Or is it truly difficult to convert all the health effects of eating fish, for example, into a single pill?

 The Latest

A recent study in   JAMA gave different forms  omega 3 fatty acids to a group of older people and followed them for five years.

The results: no improvement in cognitive abilities.  No improvement in memories.

True, the study was performed late in life and for only five years.  But studies of this sort are difficult and costly.

And as so often the case, the “ingredient”  results don’t add up to what happens from the whole intervention –  in this case, eating wild fish.  Yet the cost of eating sardines periodically, or herring, or other fatty fishes, is in most cases no more a financial burden than slugging down supplements. Besides, there are many reasons why we should prefer the sardines, including:

1. There are real source of nourishment.

2. They include many substances that are probably healthy – and have never been studied individually.

3. We’re adapted to eating them for millions of years – which we can’t say for supplements.

4. They are part of the social rituals of dining that possess their own beneficial physical, social and mental effects.

5. Wild fish accompany various other  foods that make for meals we know to be healthy for us – like the Mediterranean diet.  It may be that the interaction between these thousands of different food ingredients – how they change metabolism and physiology – is the real “secret sauce” of their healthy effects.

So why do we persist in preferring a pill?

Simple Answers to Complex Questions

Pills work.  They work for real in many medical conditions.  Often they succeed as placebos. People think pills are powerful.

And they’re profitable, often extraordinarily profitable.  Turn a food ingredient into a pill – whether it’s omega-3s or caffeine – and you have something lots of people want to buy.

But food is often more powerful than supplements.   Diets include elements from culture to social activity to psychology in ways in ways that engage us far more than pills.

And in most cases, we don’t know what it is about diets that makes us live longer and feel better.  Even if vegetables and most nuts and fruits are thought “healthy,” consider the bitter debate over the merits of red meat and butter.

The effects of foods on us are extraordinarily complicated.  In these complex times, when political and social institutions don’t work the way they should, we prefer simple answers.  Supplement pills provide those answers – even when the vast majority of research studies don’t back up their remarkable claims.

The simplest things do work.  As is the simplest advice – do what your body is built to do.

So when you’re offered a “fabulous discount” on the next group of omega -3 fatty acid  pills, think about saving your money.  For a nice plate of sardines or herring.  And a fine, varied plate of salad.

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