Professor holding an endowed chair in Nutrition and Intestinal Health Transitional Care, Ben Witteman, is saying farewell to WUR after a decade. Witteman, aged 65, earlier resigned from his position as a gastroenterologist at Gelderse Vallei Hospital. Witteman is retiring after an impressive career as a doctor and scientist. Chair holder in Nutrition and Disease, Ellen Kampman, joins Witteman for a reflection as well as looking to the future.
Good implementation of scientific knowledge on healthy eating in healthcare is important but also difficult, explain Kampman and Witteman. Hospital structures are relatively fixed and it is a challenge to really bring dietary insights into the treatment room. Calculating the costs, getting health insurers on board and making sure that doctors have sufficient knowledge of this area all play an important role. This has to be done together with clinicians, nurses, physiotherapists and dieticians, as well as with patients themselves.
Limited attention, not unwillingness
Witteman explains that the sometimes limited attention paid to nutrition does not stem from unwillingness on the part of medics. Medicine used to be a degree in which dietary education was covered extensively. Now, the programme focuses more on medicinal medicine. It is a pity, Witteman believes, if you do not see the patient in their totality. Everyone is more than just an illness or a disease.
Care pathways and multidisciplinarity
For Witteman, a care pathway is successful when it integrates a multidisciplinary approach. In this approach, a patient can express their wishes and goals to the gastroenterologist during their first consultation, when their current lifestyle is also inventarised. In a following multidisciplinary meeting, the gastroenterology nurse and doctor, physiotherapist, dietician, psychologist and somnologist discuss what is going well already and what could be improved for the patient on the basis of their wishes, goals and the completed questionnaire. In a second consultation, the outcomes are discussed with the patient and an achievable treatment plan, with which the patient can identify, is drafted. This plan mainly involves self-treatment but, where desired, the patient may be guided by one or more healthcare professionals from these disciplines.
It is an approach that is still not always broadly supported. But Witteman hopes that more space will be made for such an approach, including by health insurers and the National Health Care Institute. For common diseases in particular, an innovative approach and more attention paid to the causes could offer the necessary improvement.
A good diet improves wellbeing
That brings us back to the role of nutrition. A good diet used to primarily be seen as a way to stay healthy and prevent illness, says Kampman. But this is changing. As chronic diseases are on the rise in the Netherlands, the role of nutrition to prevent a disease from becoming worse or to lighten symptoms has become a point for attention. And this is a good development, according to Kampman and Witteman.
Diet and lifestyle alone aren't enough
Of course, it is important to treat the underlying disease or condition with medicine, as diet and lifestyle alone are not enough. Witteman provides patients with the most suitable medication for their cases, he explains. Still, it would be interesting to conduct more research on whether medicine use could be reduced if a successful dietary adjustment took place. This is already the case for patients with cardiovascular dieases and type 2 diabetes, for instance.
In the future, the number of patients with multiple comorbidities will also increase, says Kampman. Even now, it is becoming more common for patients to have type 2 diabetes as well as bowel cancer or a heart condition. In the future, this could rise to three or more lifestyle-related conditions at the same time. The number of infections is also rising, partly due to climate change and overpopulation. And diet plays a role in all common conditions.
Prevention is better than cure
Up to 90% of type 2 diabetes cases, 70% of cardiovascular disease cases and 50% of bowel cancer cases are preventable, explains Kampman. And even if people do fall ill, they could still benefit from a healthier lifestyle. In addition, a lot can be achieved simply through diet when preparing for and recovering from an operation, chemotherapy or radiotherapy. At the same time, diet cannot be completely separated from other lifestyle factors, such as sleep, movement or stress. Good collaboration with experts in these fields is therefore also very important.
In his career, Witteman focused mainly on intestinal diseases such as Crohn's disease and IBS (irritable bowel syndrome). He explored the role of fibre and the effects of adjusting or avoiding certain food intakes. He observed that many patients with chronic intestinal diseases were also self-motivated to adjust their diets- especially when they realised that the right nutrition eased their symptoms.
Sustainable change remains difficult
Yet human behaviour remains a point for attention. Witteman and Kampman both believe that interventions work, but maintaining them in the long term is a major challenge.
To maintain a dietary change, it must fit with the wishes and abilities of the patient, says Kampman. She emphasises that we still do not fully understand all metabolic differences between people. Why does one person react very well to a certain diet while another does not? Why do some people not lose weight when they adjust their diet?
Personal approach
Witteman agrees, and explains that the Gelderse Vallei Hospital uses a personal approach when making recommendations. What is the person's medical history? Which diseases run in the family? What are the person's goals? You also shouldn't set too many goals at the same time; it is better and more effective to set one goal and focus on it fully. Now that Witteman is retiring, an important pioneer in this approach will be missing, says Kampman. Witteman was close to his patients, communicated clearly and motivated people to change their diet or other lifestyle factors through his knowledge and enthusiasm.
Tjarda van Heek
That is where surgeon Tjarda van Heek can now play a role. This experienced doctor is Head of the Gastroenterology Centre (DarmLevercentrum) in Ede, and is eager to use lifestyle medicine before, during and after treatment. It is a good challenge for a doctor to make lifestyle adjustments part of the treatment process, either themselves or by referring to another expert, reinforces Witteman.
Important task
And this does not end once patients leave the hospital, adds Kampman. As a care provider, you have the incredibly important task of making people aware of the role that a healthy lifestyle has on their wellbeing. Of the significance of this, they are both convinced.
On Thursday, 22 June, the farewell address of Prof. Ben Witteman will be held during the symposium 'An apple a day...! Voeding als hoeksteen van de medische behandeling'. A reception will subsequently be held in the Omnia building on Wageningen Campus.
