Doctors need to learn more about nutrition

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In 1903,  Thomas Edison helped  shed light on the doctor of the future, which we have yet to fully realize in our profession. He stated  “The doctor of the future will give no medicine, but will interest his patient in the care of the human frame, in diet and in the cause and prevention of disease.”

Doctors are taught little about nutrition in Medical School.

I was misinformed about medical school.  Growing up, I wanted to help people become healthy.  After four years at The Ohio State University Medical School and three years of a Family Medicine Residency, I still did not know enough to accomplish my  goal.   My training allowed me to become a disease-care expert, not a healthcare specialist.  I was taught little to nothing about nutrition and true disease prevention.  Despite this,  I am not asking for a medical school refund- I  claim full responsibility and then took the necessary steps to learn about health, nutrition and diet so I could help my patients.

Most of us spent at least 7 years of our lives learning how to diagnose, manage, and treat  chronic diseases and their sequela.   Unless dealing with trauma or cutting things out, we have become experts on the management of  chronic conditions such diabetes, hypertension, headaches, cardiovascular disease, auto-immune diseases, and all the complications that occur as a result of these conditions, among many others.

However, when  patients ask us physicians  how  they  can prevent diabetes, hypertension, heart disease, migraines or  reduce risk their of developing cancer, most doctors will have little to no idea how to answer them.  Frequently, we tell our patients, in  a cliché manner,  “Watch your diet and get some exercise”.   We can’t provide  specific diet and nutritional information as we simply don’t know.   We  know little about dietary programs and which are best for our patients.  

We prescribe cholesterol lowering medications and other pharmaceuticals to  help “prevent” diseases.  We prescribe “a pill for every ill”, as Cardiologist and author Dr. Mimi Guarneri  states.  Further, despite the evidence of benefit, we collectively advise patients to eat  a low fat diet.  Most  healthcare providers have a poor understanding of true health, only disease and it’s manifestations. Wellness is not simply the absence of disease.

A 2017 study in the American Journal of  Medicine[i] demonstrated this fact.  930 cardiologists were surveyed.  95% of the cardiologists believe and felt it was their responsibility to teach  their patients at least basic information on nutrition.  However, 90% reported they received no or minimal nutrition education during their cardiology fellowship.   Almost 6 in 10 admitted they received no education training during their internal medicine training and 31% admitted to no nutrition related education in medical school.    Lastly, when asked about their diets, only one in five cardiologists admitted to consuming five or more servings of fruits and vegetables daily.   This level known to provide significant health benefits and help prevent chronic disease.

What is the Best Diet?

This is an evolving field. First, I recommend that my fellow physicians read at least the NY Times bestselling  diet books, as these are  the ones your patients are reading.  In my opinion, this is crucial so we can  have meaningful discussions with our patients and provide solid opinions.   There is no one diet that is best for everyone.  We need to remember this!

To date,  The Mediterranean Diet has the most evidence of heart-health benefit.    This  diet consists of  fish (preferably low in mercury), monounsaturated fats , like those from nuts, seeds and olive oil. It also includes generous servings of  fruits, vegetables, whole grains and  legumes/nuts. The diet also allows alcohol consumption. Men should limit themselves to two servings per day while women, one serving.  If you do not already drink, do not start.

The Ketogenic diet is making a popular comeback.  It consists of a high healthy fat intake (60-75% of calories), moderate protein (15-30% of calories) and low carbohydrates (5% of calories). Originally, this low carbohydrate diet was recommended for medication resistant seizures.  Now, however, when done right, it can be beneficial for weight loss and for the treatment of Type 2 Diabetes. There are even studies suggesting is can help those with  cognitive impairment, such as mild to moderate Alzheimer’s disease.

Another popular diet is the Paleo Diet formulated by Loren Cordain, Ph.D. It is  also commonly known as the “cave man diet”. This diet advises one go back to a diet similar to what our caveman or paleolithic ancestors consumed. The diet allows lean meats, nuts, seeds, fruits and vegetables while prohibiting grains and dairy products.  Numerous studies have shown benefit including a 2017 study which concluded “A Paleolithic diet improves fat mass and metabolic balance including insulin sensitivity, glycemic control, and leptin in subjects with type 2 diabetes. Supervised exercise training may not enhance the effects on these outcomes, but preserves lean mass in men and increases cardiovascular fitness.”

There is the DASH diet, which stands for Dietary Approaches to Stop Hypertension. This diet is promoted by the U.S.-based National Heart, Lung, and Blood Institute to help reduce blood pressure. This diet recommends generous servings of fruits, vegetables, whole grains, and low fat dairy.  It also encourages fish, poultry, lean meat, nuts and seeds. The important part about it is that it recommends avoiding sugary foods and sweetened beverages.

Lastly, for those who want to gain a better understanding of why we gain weight, I recommend The Obesity Code by Dr. Jason Fung. He discusses the role not only diet but also insulin plays. He  demonstrates that the calories in vs. calories out belief is simply a myth and touches upon the  concept of intermittent fasting and how that style of eating, not matter what diet one is on, can assist with weight loss and optimize metabolism. Further, insulin resistance is a risk for cancer so consuming a diet which reduces insulin production is crucial.

Dr. Eric Madrid is a  Family Physician in Menifee, Ca. This article was originally Published on KevinMD.com November 25th, 2018

Doctors need to learn more about nutrition

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