Doctors and Nutrition Advice

4 04 2013

confused_doctorMost advice in life should be taken with a grain of salt. I put out a lot of information on this blog, but I still encourage all of you to do your own research and validate my words before implementing any changes to your lifestyle. Today, I’m going to encourage you to take the same route with any nutrition advice you get from your doctors. Woah, doctors? Yes, doctors. Read on…

Doctors are smart people. They spent years gaining the field-specific knowledge that they have, knowledge that nobody else in the general population can fully understand. I have friends and family who are doctors, and they are intelligent, caring, hard-working people with good intentions. With that being said, they are not experts in nutrition- and the doctors I know all admit this truth. Most doctors have such hectic schedules that they themselves rarely find time to eat properly. An article from the NY Times, written by a young M.D., sums this up nicely:

I soon realized that many questions had nothing to do with medications or operations, or even diseases. With all the newspaper and television reports about newly discovered carcinogens and the latest diets and miracle nutrients, what my friends and acquaintances really wanted to know was just what they should or should not eat.

Years later, as a newly minted doctor on the wards seeing real patients, I found myself in the same position. I was still getting a lot of questions about food and diet. And I was still hesitating when answering. I wasn’t sure I knew that much more after medical school than I did before.

One day I mentioned this uncomfortable situation to another young doctor. “Just consult the dietitians if you have a problem,” she said after listening to my confession. “They’ll take care of it.” She paused for a moment, looked suspiciously around the nursing station, then leaned over and whispered, “I know we’re supposed to know about nutrition and diet, but none of us really does.”

Although closely linked with medicine, nutrition is a completely separate field, and one in which most doctors get very little training. As recently stated by Norman Temple (Professor of Nutrition at Athabasca University in Alberta and recent coeditor of Desktop Nutrition Guide for Physicians): Medical schools concentrate on how to treat disease with drugs and surgery, and doctors are never taught how to properly counsel patients on changes to diet and lifestyle. “The doctor’s office is a pretty lousy place to go for guidance on this. People are badly confused. There is a desperate need for a system of credible sources of good information from credible people. When you go to Chapters, the good books and the bad books are not colour-coded.”

Trust me, I'm a Doctor.

Trust me, I’m a Doctor.

A recent survey of Canadian medical school students revealed that most students are somewhat comfortable in their knowledge of basic nutrition concepts and the role nutrition plays in disease prevention, but that they lack sufficient knowledge about the role nutrition plays in treating diseases, are ill-equipped to counsel patients on their nutrient requirements across all stages of their lives and have trouble identifying credible sources of nutrition information. A quick look at a few other stats:

  • A 1997 report from the American Medical Student Association stated that 62.6% of US medical school students believed they needed more nutrition education.
  • Fewer than half of the US medical schools that participated in a 2006 study required at least 25 hours of nutrition instruction, the minimum standard “recommended” by the National Academy of Sciences
  • 88% of medical instructors who participated in that study said their institutions needed more nutrition instruction.
  • Surveys conducted in many other countries — such as Bangladesh, Saudi Arabia and Turkey — indicated that many doctors are aware only of nutrition information that has appeared in the medical press (this is frightening)
  • A 1999 survey on the nutrition knowledge of Canadian physicians found that doctors had poor knowledge of many important nutrition topics, such as the association between excessive protein intake and calcium loss, and the best type of dietary fibre to lower patients’ blood cholesterol levels

Another compounding issue is the interference of large pharmaceutical companies. The sad truth is that many medical schools are well-funded by large pharma corporations. Is it any wonder that medical school students and young doctors are told of the great benefits of surgery and drugs, but rarely of the simple solution of nutritional intervention? Time magazine exploited this scandal in 2009, most notably throwing Harvard under the bus by revealing that pharma contributed more than $11.5 million to the school annually for research and continuing-education classes, and over 1,600 professors and lecturers at the school admitted that either they or a family member had some kind of business link to drug companies — sometimes worth hundreds of thousands of dollars — that could bias their teaching or research.

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Additionally, the weight of your physician may actually affect the advice he/she passes on to you. According to a study published last year in Obesity magazine:

“Our findings indicate that physicians with normal BMI more frequently reported discussing weight loss with patients than overweight or obese physicians. Physicians with normal BMI also have greater confidence in their ability to provide diet and exercise counseling and perceive their weight loss advice as trustworthy when compared to overweight or obese physicians,” said Sara Bleich, PhD, lead author of the study and an assistant professor with the Bloomberg School’s Department of Health Policy and Management. “In addition, obese physicians had greater confidence in prescribing weight loss medications and were more likely to report success in helping patients lose weight.”

So, overweight doctors are less prone to inform patients that being overweight is an issue, and even if they engage in such conversations, they are more likely to prescribe medication as opposed to nutrition or exercise intervention. Ladies and gentlemen, find yourselves a healthy doctor!!

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The good news is that things might be changing. The link between poor nutrition and chronic health problems is becoming more mainstream by the day, and young doctors here in Canada are beginning to take notice. According to the Canadian Medical Association Journal:

“Canadian medical students are lacking adequate education in nutrition, and they aren’t happy about it, according to a survey distributed to 9 universities across Canada. Of the 933 students who responded to the survey (a 28.6% response rate), which hasn’t been published yet, 87.2% said their undergraduate medical program should dedicate more time to nutrition education.

“Physicians are becoming increasingly aware of their abysmal training in nutrition,” says Dr. Leah Gramlich, president of the Canadian Society for Clinical Nutrition and lead author of the survey. “People still don’t think of nutrition as a science, and doctors aren’t in a position to refute or substantiate nutrition claims.”

It’s not all good news though, as the CMAJ goes on to state that unless Canadian physicians become leaders in nutrition, the lack of nutrition education in medical schools will be a problem that will persist: “Unless there is a push from outside, in the absence of nutrition physician leaders, it’s going to be challenging.” We have awareness, now we need action.

I could go on and on, but my message here is clear: If your doctor informs you of a health problem and advises you to change your diet, please do your due diligence and request that he/she refers you to an expert in the field. Your doctor surely understands your underlying health issue(s), but he/she almost certainly lacks the expertise, or at least the knowledge of recent nutrition research, to properly advise you on any diet-related changes.

Yes, doctors and incredibly important to all of us, but when it comes to nutrition, take their advice with a grain of salt.

For more information, you know how to find me!

- DW








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