Thirty years ago, when I went through medical school, we covered nutrition in one single afternoon: “get rid of the darn thing and move on to more important stuff”. I would have hoped things would have gotten better with passing years. They have not. Nutrition (even “useless” main stream nutrition) is paid lip service in medical school. And it is not only medical education: there is a strong feeling among my colleagues that nutrition is a waste of time. I am just finishing a course in tropical medicine and the grain-based diet of many third world countries affects very negatively many diseases because of the massive lack of nutrients of these diets. We were given an excellent lecture about that very subject. It was very badly received and most of the 110 people in the class (I was, as far as I can see, the only exception) bitterly complained about this “useless” course.
This crystallized for me some of the issues that lie behind our current miasmatic state of health. It also made me wonder, first, why should this be the case and second, does it even matter since there is no agreement on what “good nutrition” is? And finally, a third question came to mind: how does this affect the patient who needs help?
The first thing I did was search online and lo and behold a simple query produced a lot of viable hits immediately. It seems that a lot of people are asking my first question.
Right away I found considerable copy which seems to indicate that yes, in fact there is very little time spent on nutrition in medical school. This story says:
Only a quarter of schools have a course dedicated to the subject, and more than half of graduates rate their nutrition knowledge as inadequate.
Nutrition education in U.S. medical schools is lacking, leaving new physicians unprepared to counsel patients about obesity and related health issues, according to a study in the September issue of Academic Medicine.
A steady decline in nutrition instruction is alarming, given rising obesity rates and proven links between dietary habits and chronic disease risk, said Kelly Adams, MPH, one of the study’s authors and an assistant project director of the University of North Carolina at Chapel Hill’s Nutrition in Medicine program.
The Chicago Tribune ran an article which makes a similar point:
On average, doctors receive 19 hours of total nutrition education in medical school; in 2004 the average was 22.3 hours
One survey published in 2003, for example, found that 96 percent of internists and 84 percent of the cardiologists who responded did not know that a low-fat diet, in general, would increase triglycerides in the blood.
“But that’s just a newspaper story,” I thought. What do the people in the profession think? Here is a lengthy thread (15 pages or so) on the subject by educated people in the health care business. What leaps out at me is that there is no consensus at all. There is one person who thinks the subject is woefully lacking in med school, but there is another doctor who feels that doctors’ education is not the issue – obese people are that way because “they just eat too much food that makes them fat”, even going on to say that over-eaters should be taxed because he is having to pay for their healthcare; this is classic blame-the-patient philosophy that certainly doesn’t help and we know now that it doesn’t work at all. A doctor should know better, surely.
I have also read that the American Medical Association has opposed efforts to get more nutrition education into med school, but I cannot find corroboration of that while searching now, and unfortunately, I didn’t bookmark the source at the time; it may have been in print media, anyway. However, I did find evidence of the California Medical Association doing something similar, although it was continuing education, not med school. “Last year, a bill was introduced in California to mandate that physicians get continuing medical education in nutrition (see Nutrition Education Mandate Introduced for Doctors). Unbelievably, physician trade groups such as the California Medical Association came out in opposition to the bill, which would only require doctors to get a measly 7 hours of nutrition training anytime before 2017”
But wait – what if all of this isn’t true? What if doctors are actually taught about nutrition in med school and the rest of us are just behaving like uninformed conspiracy theorists? I found one physician who says that the idea that med students are not given sufficient nutritional education is a myth, that doctors do in fact study a lot of nutrition and are much better informed about it than the rest of us want to believe. (So much for Dr. François in the earlier paragraph!) Of course this doctor is also making a living (probably a rather well paid living at that) doing lap band surgery on obese people, so he may have a somewhat…differently motivated perspective on things. In that article he comes right out and says “Food can kill you, but it can’t cure you,” and he goes on to say “you cannot cure heart disease with diet, nor can you cure cancer with diet, nor can you cure appendicitis with diet, nor can you cleanse the liver, or cleanse the colon.” He cites Steve Jobs as an example of someone who tried to cure cancer via diet and failed, without mentioning that the Ornish diet Jobs went on is probably the worst possible thing someone with pancreatic cancer could try – in other words, there is more than one diet-based approach available for this problem, just as there is to allopaths who try to treat a condition. I don’t think this doctor would be very good at skinning cats, which can be famously skinned in many different ways. I can think of another doctor who tells a very different story; Dr. Terry Wahls seems to have overcome (not “cured”, necessarily) her MS by changing her diet and her now-famous YouTube videos are must-see material if you haven’t already seen them. So here we have two doctors with opposing viewpoints. I know that from my own experience with metabolic syndrome it IS possible to directly affect your medical condition just by changing your diet, but Dr. Wahls has gone way beyond just lowering your blood sugar and triglyceride levels – it’s pretty clear which dog I think is the winner in this fight.
For another opinion I asked a naturopath I know what she thought the reason for the apparent lack of nutritional education in med school was and her response was direct: Simple. Most medical doctors don’t appear to think that food and nutrition have much to do with health. There are some notable exceptions to be sure.
And what about those notable exceptions; if you do find a physician who thinks this is an important subject, how do you evaluate their approach? They are the professional people – we are the autodidacts without formal training; we get things wrong and we don’t agree. But the same thing seems to be true for the professionals. You can find doctors who will tell you to eat vegetarian diets (no thanks, but that’s me – I don’t want to be Steve Jobs), Mediterranean diets, even paleo diets, or (worst of all, but so far the most typical approach) low-fat diets with lots of “healthy whole grains” and lean meat. I say “worst of all” because it seems to me that the ones that espouse this particular dogma are simply reciting rote memorized information and at best they simply have not looked outside of their own spheres of interest for far too long. And because my own particular bias leads me to think that this approach doesn’t work; well, it certainly didn’t work for me.
Thus I discover that my second and third questions are really the same thing. In order to help yourself you have to have some control over the process and you have to try to find a physician you can trust. What a long-winded way to get around to saying what’s obvious to everybody but me, LOL.
There is also the issue of paying for these services. Most of us are not wealthy enough to just go to a doctor and pay her, so we rely on insurance (if we are fortunate enough to have it in America) or we do without. But if you have insurance, unless it is a pretty top-line policy you may not be able to see anyone who is not going to offer up the standard line, which is “Take this medication, don’t eat too many fats, and get some exercise. Next patient!”. So the list of problems continues for a lot of us.
I didn’t expect to truly answer the questions I posed in the beginning of this thing, but I also thought things might be less complicated than they seem to have turned out. I am left with these queries, which are quite different from each other:
1. If med school students receive too little nutritional education, why is that? If it is deemed not important enough to have a place in the curriculum, why is that (and who influences the deeming)?
2. If you have to find a doctor you can work with, how can you best do this? Obviously, a large and separate topic.
3. How in the world can many people in this country hope to do that and pay for it too?
The first two can be approached on an individual level – they are opinions or decisions for you and me to make on our own. The third is a societal question that is beyond the scope of individual action, unfortunately.
And note that I didn’t even bring up the question of hospital food…until now.
Stay young and monstrous.