Search for diet, stone info reveals a tangled Web

November 1, 2006

Cleveland-Dean G. Assimos, MD, professor of urology at the Wake Forest School of Medicine, Winston-Salem, NC, asked a simple question here at the World Congress of Endourology: "Is the Internet a reliable source of information for dietary recommendations for stone formers?"

The short answer is no.

"I had queried 50 consecutive patients who were calcium stone formers, and 44 of them told me that they had a computer at home and used it to get medical information. That is what prompted this study," Dr. Assimos told Urology Times.

"What we found was that the best sites, the ones that noted all four recommendations, were urology sites, followed by nephrology sites," Dr. Assimos reported.

This finding does not necessarily give urologists and nephrologists much to brag about. Only 50% of the 20 urology sites and 40% of the 10 nephrology sites noted all four dietary recommendations, although this performance was much better than that seen in some of the other categories.

At best, only 17% of the remaining categories of web sites mentioned all four recommendations. The sites that performed the worst were MD/DO sites. Only 13% of the 23 MD/DO web sites analyzed described the four dietary recommendations.

The worst web sites appeared to be nutritional sites. While 17% of these sites mentioned the four recommendations, 83% presented erroneous information.

"The most common error involved calcium. A lot of these sites were recommending low calcium consumption," Dr. Assimos told Urology Times. "My interest is oxalate. We also looked at 100 sites with regard to oxalate, and found that only about 25% had any oxalate information at all, and some of these were wrong. The dietary levels were inaccurate."

The study may constitute the first step toward establishing a web site at Wake Forest that would provide nutritional information for those at risk of forming stones, followed by an interactive component that would allow visitors to type in their diets and receive a report about the quality of the diet with respect to stone risk reduction, Dr. Assimos said.

There is no question that the Internet is a phenomenon with which the medical community will have to contend. According to the Internet World Stats web site, more than 1.04 billion people were using the Internet as of June 2006. The largest percentage of these individuals were in the United States, where some 161 million personal computers are in use-about one for every other resident. Almost 70% of the nation's population has access to the Internet and uses it. Use has grown by 112% over the past 6 years.

The Wake Forest study suggests that although there is a plethora of information on the Internet about diet and stone disease, at best only half of it is complete and accurate. The challenge for patients and physicians alike is determining which half.