Medical degree = nutrition knowledge??

You are tired of diet contradictions in the media. You have had enough of celebrities who are “half their size! Learn how they did it!”. You have done your own research and now you are going to your family doctor, because you want answers. So, Doctor, is 1.5 g of protein per kilo enough for me if I am doing intervals and strength training 3 times a week? What do you think of Omega-3 composition of grass-fed meat vs grain-fed? How do I reduce my body fat while maintaining muscle mass and strength? You are getting a blank look. The eyes are glazing over. A hesitant hand reaches for a referral pad to a dietician…

Hey, they are doctors! They wear white coats and have stethoscopes around their necks! Don’t they learn this stuff? Let me tell you how much education on nutrition we ACTUALLY get in medical school.

Year 1. The age of innocence
– a lecture on triglycerides in diet. It details the cholesterol transport in all its chemical formulaic glory and exciting medications like statins which we can use to disrupt this process.
– one of the cardiology lectures briefly mentions that saturated fat and cholesterol cause coronary heart disease. A graph from Framingham heart study is flashed on screen. We are assured that it shows a relationship between blood cholesterol levels and heart attacks.

Year 2. Depth of lecture boredom
– endocrinology block introduces hormonal regulation of metabolism. A very dry and boring biochemistry lecture describes the relationship between insulin and glucagon.
– a couple of lectures by an obesity specialist. She talks about different strategies used for obese populations: high vs low carb diets, very low calorie diets, lap band surgery, behavioural strategies, more drugs. At the end she pessimistically concludes that none of the above work in the long term
– a very exciting lecture by Jennie Brand-Miller. She concedes that obesity is probably related to metabolic syndrome, mentions the role of carbs in developing insulin resistance. Then she enthusiastically talks about her research in glycemic index. We are told that to reduce the incidence and severity of diabetes we should recommend low GI diets. The lecture concludes with the slide of her book.
– a few lectures on diabetes management with a focus on medical (=drug) treatment.

Years 3-4 Unleashed onto unsuspecting public
Ahem. Nothing.
Oh, I got presented with a free patient and doctor information booklet on diabetes during my general practice rotation. It is written in a very clear, easy to understand language, colourful pictures, graphs and all. It is written by Pfizer, the pharmaceutical developer of Lipitor, the cholesterol-reducing medication which brought its happy executives $12.2bn in 2005.

 Does anybody else think that this is a bit like a car mechanic who blindly swears that he found a mechanical fault with your car and now you have to pay him $x to fix it? (I normally pay just in case because I don’t understand half of what he is saying and I am a little scared of all this stuff under the bonnet).

 Other than these delightful handouts from pharmaceutical companies, we are encouraged to visit websites like the Heart Foundation, the organisation which has just given its tick of approval to Milo cereal. ‘Nuff said.

Yes, there are others, who study nutrition in order to help their increasing (in size) patient population. But their knowledge is the result of a conscious effort, not an automatic consequence of a medical degree. They are worth their weight in gold when you find them. Because apart from being diet-savvy, they clearly possess humility to acknowledge what they don’t know.

 So what does your doctor know about nutrition?

 Disclaimer: other medical schools might provide more teaching on lifestyle modification. Also, I might have had a microsleep in one of these lectures and missed some pearls of nutritional wisdom. This is not intended as a personal attack on any individual physicians. This is merely an illustration that unless doctors are interested enough to search for truth themselves, you are getting second-hand information.

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16 thoughts on “Medical degree = nutrition knowledge??

  1. Interesting post. I only have to think of my own history with a GP I questioned about nutrition as a young teen. I clearly remember leaving the room thinking that I knew more than he did and I had only looked nutrition up on the net a half dozen times. I aslo have no doubt that the focus is more towards the use of medication to address any health concern under the umbrella of nutrition.
    It also seems from your post that the odd lecture is used as a platform to sell ones published book…….hmmm. Part of a contract I wonder.

    • I always get a feeling that we don’t trust patients to make lifestyle modifications. It’s kind of easier to give a pill because you have more certainty that the patient takes it, plus you can get incentives for prescribing it. Medications are undoubtedly useful, sometimes vital, but you know you have a problem when you dismiss lifestyle changes as too hard and just give a prescription.

      • It’s sad that pharmaceutical companies take away patients’ ownership of their own lives. Just to make a buck, well billions actually. Then patient’s don’t take responsibility for their own actions, although not completely their fault because their GP don’t give them lifesyle changing advise. hello rubber stamp prescription for a tablet from the company who gave me my new BMW woohoo.

        although on a possitive note, there is more push to get people to change their habbits, like the get healthy service hotline NSW Health is running. I am not sure what sort of advise they give people but it’s a start at least. Everyone should have access to nutrition information. Information that is factual not just the tips you get from cleo – “loose two kilos by sticking two fingers down your throat.” Stuff that teaches people how to loose weight the healthy way and keep it off and not loose if for a big event then bugger all after that.

        • Agree, Justin, we need to move away from “tell me what your problem is, I’ll give you a pill for that” mentality. But don’t you get annoyed that government-dispersed lifestyle advice sounds more like lecturing? We are treated like a naughty 5 year old who doesn’t have the willpower to say No to a cookie. What about the load of misinformation that they fed us over the years? Like when they told us that hydrogenated fats are better than butter? And then it turned out that those fake trans fats were worse than anything Nature ever created??? I never heard anybody apologize for that epic fail…

  2. I don’t really have a problem with GP’s not having all the answers about about nutrition and diet, as they don’t have extensively specialised knowledge in a multitude or areas, thus the reason for specialists. But I do have a problem with GP’s prescribing pills to fix lifestyle problems, rather than considering the value of a nutritionists or dietitians advice to a patient that clearly needs help. Referrals, I believe, are an essential part of the process, and GP’s are individuals with their own interests too, which may or may not be about diet. However I acknowledge that you will be one of those rare “worth you weight in gold’ doctors, Anastasia!

    There is obviously a huge gap between what people eat and what people should eat to be healthy, which no doubt is has a correlation with the obesity rates in many developed countries such as Australia and the US. We do however need to take some personal responsibility of our own health. I think of it this way, generations before us lived off the land, they moved and they ate natural food, not the highly processed variants of that we see today aligning the supermarket shelves, such as that shit called margarine!. They also didn’t eat on the run!

    My personal peeve ATM is the push for kids in particular to eat ‘plant sterol’ margarine for the sake of good cholesterol, simply reinforcing the gap; the ‘average joe’ just doesn’t know that you can actually get this good cholesterol from natural, unprocessed food such as avocados, nuts, seeds and vegies? So yes, my 1 & 3 year olds eat nuts as snacks as well as fruits, avocados and lots of veggies. I’m at a loss regarding CSIRO research and their ‘help’ in getting more processed ‘plant sterol’ foods on supermarket shelves (http://www.csiro.au/science/Plant-Sterols-Research.html#2). What happened to just eating the raw foods?

    And then we just eat too much bread as a nation; there was a teeny little article in the Daily Telegraph today (can’t find it in the online version, yes I was reading the actual paper) about the increase in bread revenue over the last 12 months in Aust, partly due to the shift to grain and vitamin enriched breads. WTF, as a nation we simply don’t need $21 billions worth of processed carbs!

    There is a balance. Eat more natural stuff and eat less processed stuff. If something makes you feel bloated, (eg. highly refined breads bloat me) work out what it is, eliminate it or at least reduce it. So no, I won’t be going totally paleo but I will continue with a balance of common sense and fresh meals.

    Now back to my essay on Human Resources…

    • Hooray for personal responsibility! Absolutely nothing wrong with listening to your body and experimenting if it is backed up by science. Unfortunately, we can’t always rely on “feeling”. I “felt” for years that high-carb diet of healthy wholegrains gave me enough energy to do 10+ fitness classes a week. I thought that those pesky digestive problems were just part of my genetic makeup. Not until I stopped eating bread, pasta and cereal, did I realize that these problems were not the normal part of my day, and I must have had malabsorption of vital nutrients for years. Education is what can bridge the gap between self-experimentation and optimal diet for us and our children. The margarine sham is scary. To the list of fantastic foods that you mentioned as good for cholesterol, I would add meat, fish and eggs. Your kids will certainly reap the rewards of your attitude to diet. Others might not be so lucky, the list of diseases in our children is growing: diabetes, asthma, ADHD, autism, schizophrenia, inflammatory bowel disease. Keep it up!

    • It is just as well that more doctors don’t go “er, I know pretty much diddly-squat about nutrition, sorry, here’s a dietician referral,” because the dieticians are WORSE in some ways than the doctors. Here Stateside, at least in the children’s hospital where my daughter was admitted last year, their idea of a daily meal plan for a child who is recovering from illness or injury involves such fun foods as pancakes with corn-syrup based fake maple syrup, fruit juice, bread, all manner of starch, pasta, and sweet desserts. I know it’s helpful to have familiar foods when someone’s sick, but it’s dieticians who design these menus and there’s a fine line between comforting the patient with the familiar, and disrupting the healing process with antinutrients.

      Nutritional knowledge is THE basis of good health. The sad part is we wouldn’t have such a doctor shortage if docs would do right by their patients in this vein because if patients stay healthier, they get to spend less time on their checkups, they need fewer sick appointments, and that means more scheduling slots are opened up for other people to be seen. For some reason, this hasn’t sunk in to the general physician population yet and I’m at a loss to explain why.

      • Dana, I was doing a rotation in a children’s hospital last year and I understand your frustration. It wasn’t just the food for the patients but also for visitors and outpatients. The cafeteria was serving hot chips, pies, chicken nuggets and a “healthy” vegetarian lasagna. Apparently, the Starbucks at the main entrance is the most profitable Starbucks in Australia. Clearly children’s nutrition is not a priority for children’s hospitals anywhere. If my daughter ever had to stay there, I would be bringing all her meals from home.

        • I’m with you! My son recently spent 3 weeks in a brand new children’s hospital in Melbourne. We were from interstate so bringing food from home wasn’t possible, but I had to resort to bringing in boiled eggs and proper butter just to feed him properly. I won’t go into how difficult it was to find real food for myself, but yoghurt, nuts and blueberries (plus boiled eggs) was my staple diet for every meal!!

  3. Great to see another health professional jumping into paleo. Looking forward to reading more posts from you.
    In New Zealand we have the pretty much the same amount of nutrition delivered to our med students.
    My doctor admits as much.

    • Julianne, I think that once your eyes have been opened it is impossible NOT to change your whole outlook on nutrition. You guys are lucky in NZ, you still have well-functioning grass-fed meat industry. And amazing fresh produce. It’s fun to be Paleo there.

  4. I love your disclaimer – yup, you must have done well in Med School. But seriously, thanks for the reaffirming post.

  5. I think health goes beyond medicine. There are so many factors that you need to consider before you can achieve complete health…

  6. Pingback: How to talk to your doc about nutrition | primalmeded

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