The homeopath who already asked about food, and wanted to measure it

The case sheet already asks what the patient eats

A chronic case in a homeopathy clinic runs forty minutes or more, and a surprising share of it is about food. Not as a diet history, though. As evidence. Does the patient want salt or want sweet. Does milk disagree. Is there thirst, and is it a sip or a tumbler at a time. Does the appetite fail at the sight of a plate or only after two mouthfuls. Is the craving worse in the week before a period. Those answers go into the repertory as rubrics and come back out as a remedy, and no other practitioner in Indian general practice asks them in that detail.

Dr Anirban Ghoshal has kept the same clinic in Howrah for eleven years, two sittings a day with the afternoon empty between them, most of the caseload chronic and most of it returning. The complaints will be familiar to anybody practising in a Bengali town. Acidity that has already survived two courses of a proton pump inhibitor. Loose motions that come and go for years with nothing showing on any report. Eczema in a nine-year-old whose mother has stopped counting the ointments. Allergic rhinitis that arrives with the October air. Polycystic ovary syndrome in women in their late twenties who have been told to reduce weight and not told by how much or from where. Thyroid patients taking thyroxine punctually who want something done about a tiredness the thyroxine did not touch.

The household sitting on the other side of the table

The kitchen behind those cases is consistent enough to describe. Rice at midday and rice again at night, a heavier hand with mustard oil than anyone admits, fish four days a week when the price allows, luchi and aloor dum on a Sunday morning, and a sweet shop three doors from the clinic that every second patient passes on the way in. Puja week undoes a month of anything. A patient who has been advised to cut fried food will cut it faithfully and still take four rosogollas after dinner, because in the way the advice was given, sweets were never mentioned.

So the food questions come back at the end of the consultation, every time, in the same six words: doctor, tell me what to eat. For eleven years the answer was assembled out of good instinct, the pathya a teacher had passed on, and whatever the practitioner had read. It was not careless. It was simply unmeasured.

There is a second reason the question lands here rather than elsewhere. A homeopathy consultation in a small clinic is long, cheap and repeated, which makes it the longest conversation most of these patients will have with any health professional in a year. The physician at the government hospital gave them four minutes and a prescription. The practitioner they pay two hundred rupees to see gives them forty, twice a month, and remembers the name of their daughter. Advice given in that setting is acted on in a way that advice given in a queue is not, which is exactly why giving it badly is a waste of something valuable.

Where homeopathic training stops short of nutrition

There is a dietary tradition inside homeopathy, but it is doing a different job. The instructions around a dose, the avoidance of raw onion, garlic, strong coffee and camphor near the time of taking a remedy, the caution about anything sharply flavoured, all of that is remedy hygiene. It protects the medicine. It says nothing whatever about whether the patient is short of protein, taking eleven teaspoons of sugar a day in tea, or eating an evening meal at half past eleven at night.

The BHMS curriculum covers physiology and biochemistry properly, and it covers hygiene and dietetics as a subject. What it does not build is the applied habit: sitting with a household and reconstructing the last twenty-four hours of eating, item by item and katori by katori, then working out which two changes carry most of the benefit and which forty can be left alone. That is a separate skill and it is not examined anywhere in the degree.

The second gap is the report. Patients in Howrah do not use one system at a time. They arrive with an HbA1c from a chain laboratory, a lipid panel, a thyroid profile, a ferritin done because somebody suggested it, and a strip of metformin they have not mentioned to anyone. Reading that stack fluently is not a compromise of the system a homeopath trained in. It is the minimum condition of practising safely beside it.

The third is that the chronic caseload has moved. A clinic that thirty years ago filled with infective and seasonal illness now fills with metabolic and digestive complaints in which daily eating is a substantial part of what is wrong.

The particular risk of an unmeasured answer

An imprecise dietary instruction is not neutral, and homeopathy attracts a patient who follows instructions unusually faithfully. Told to avoid sour things, a woman will remove curd, lemon and every fruit she was eating, and arrive six weeks later with a narrower diet and the same complaint. Told that ghee is heating, a household will cook in refined oil instead and consider the matter improved. Told to eat light at night, a man who leaves his shop at ten will eat two slices of bread and nothing else, and wonder why the weakness he came about has not shifted.

None of those patients was disobedient, and none of them was well advised. Each of them took an unquantified direction and applied it with more conviction than it could support, which is a specific hazard of practising in a system patients trust personally rather than institutionally.

What a nutrition qualification changes inside a homeopathy clinic

The history turns into intake

The single largest change was that the food section of the case sheet stopped being one column and became two. On the left, the desires and aversions the remedy selection needs. On the right, an actual recall of what was eaten, with quantities, timings and the things nobody volunteers: the mid-morning tea with biscuits, the fried snack bought at the station, the second helping of rice that is never counted because it went on the plate before anyone sat down. From that, a protein figure, a rough energy figure, a fibre figure, and a clear view of where the sugar is hiding.

Digestive complaints acquire a method

A large part of the practice is gut complaint, and this is where an unmeasured answer does most harm. Told to avoid spicy and oily food, a patient with irritable bowel will strip the diet down to rice and boiled potato, feel briefly better, and arrive two months later thinner, constipated and more restricted than before. Structured study replaces that with a sequence: a symptom and food diary that separates a genuine trigger from a coincidence, a staged reintroduction rather than a permanent ban, attention to the fibre type rather than the fibre slogan, and a fixed point at which the case is sent for investigation instead of being managed for another six weeks.

Reports stop being somebody else's language

Something has to be said plainly at this point, because everything above it depends on the reader knowing where the ceiling is. What NNWA awards is a vocational qualification and not a degree, and it adds nothing at all to what a homeopathic registration permits a practitioner to prescribe. A registered homeopath remains a registered homeopath. The nutrition training changes the quality of the dietary half of the consultation, which was being given anyway, without a method behind it and without a source to point at.

The week after the course

The postgraduate diploma runs a year: six months of live classes and six months of guided practical work, at fifty nine thousand nine hundred and ninety nine rupees, with the short courses bundled alongside. For a clinic with two sittings, the afternoon gap is the obvious study window, and the classes are recorded with lifetime access, so a heavy evening OPD costs the live session and not the teaching.

In practice the week changed in small ways rather than dramatic ones. Chronic cases now get a written diet plan on the second visit rather than a verbal instruction on the first, because the intake recall has to be taken before anything sensible can be written. Review appointments have a second question in them: what changed on the plate, and did it hold through the week. Patients with polycystic ovary syndrome and with fatty liver, the two groups for whom the dietary half is most of the treatment, are seen monthly with weight, waist and a food record rather than seen when the complaint flares.

The clinic also stopped giving the same dietary sheet to a rickshaw puller and a schoolteacher. Anirban's account is that the biggest saving is time: a structured answer takes about two minutes and survives being repeated to a sceptical son-in-law, while an improvised one takes five and ends in hedging that the family reads as uncertainty.

What stays on the other side of the line

Some of it is regulation and some of it is judgement. A homeopathic practitioner is registered under the National Commission for Homoeopathy and practises within that system's scope; a nutrition certificate does not move that boundary a centimetre in either direction. Advertising is worth equal care, because claiming that a diet cures a named disease is a problem under Indian advertising law regardless of which qualification the person holds.

The clinical hand-offs are simpler than practitioners fear. Insulin dose adjustment, a diet in established chronic kidney disease, tube and post-operative feeding, a child not gaining weight for reasons nobody has established, unexplained weight loss, blood in the stool, anaemia deep enough to need investigation rather than iron-rich cooking: those go to the treating physician and the hospital dietitian, and the correct action is to send them, promptly and by name.

Anirban's view after the course is that the line is easier to hold once you know why it sits where it does. Before, it moved depending on how confident he felt that day. Afterwards it stopped moving, and he could explain a referral to the family instead of merely making one, which is the difference between a patient who goes and a patient who says yes and never does.