Does your doctor really know what you should be eating?

For years, it has been widely known throughout the medical profession that basic education in nutrition for training physicians has simply been ineffective.  And whether this failure was due to a lack of time or simply a failure of emphasis, the point remains that the medical profession in general is woefully inadequate when it comes to a sound knowledge base related to nutrition and its effects on optimal health.  And the sad thing is that we all know it.

As early as the mid-1980’s, the National Academy of Sciences addressed this failure in a landmark report highlighting the lack of adequate nutrition education in medical schools.  And although the authors recommended a minimum of 25 hours of nutrition instruction, since then several studies have identified that as many as three decades later, a majority of medical schools still fail to meet these basic recommendations.

What we eat plays an enormous role in our ability to ward off disease and achieve good health, overall.  In addition, what we eat both before and after surgery can have a dramatic effect on how well we ultimately heal.  As a result, some physicians will check blood protein levels prior to major surgical procedures as a means to predict overall healing.  The less optimal the protein levels are, the greater the potential for delayed wound healing and other related complications.

Our patients are literally hungry for information on what they should and should not eat.  Wondering about the level of interest your patients have?  Then go to your local bookstore and look at the myriad of new diet books.  Along with self-help, books on diets and nutrition are traditionally some of the most popular topics readers are looking for.  And the reason there are so many is that none of them really solve the problem and there is simply no one-size-fits-all approach that works for everyone.

Another issue which has contributed to this illiteracy is the continued focus on nutritional training for generalists.  Although I would agree that family practitioners and internists spend more time discussing general health with their patients, I feel that the specialists are also missing out when they don’t take the opportunity to do the same.  As a plastic surgeon, I feel that it is critical to look at the whole patient and not simply their isolated part.   A landmark study from the UT Southwestern Plastic Surgery Department several years ago identified three key elements in achieving long-lasting results after body contouring and included the following:

  • Choice of surgeon (e.g.:  experience and technical expertise)
  • Overall diet
  • Level of physical activity

The last two elements are within the patient’s control and play a huge role in achieving good results years following their procedure.

Study after study confirms the fact that most patients actually do listen to their doctors and respect their opinion.  That being said, it is critical that we as physicians gain enough knowledge and background to be able to at least initiate an intelligent discussion related to our patient’s daily diet habits and fill the current void with solid evidence-based information.  After all, as specialized or as generalized as we all are, dispensing good information to our patients is simply good medicine.

Gregory A. Buford is a plastic surgeon and blogs at be for living.

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  • http://twitter.com/MaryHartleyRD Mary Hartley RD, MPH

    I couldn’t agree with you more. I’d like to add, though, in addition to it being “critical that physicians gain enough knowledge and background to be able to at least initiate an intelligent discussion related to our patient’s daily diet habits and fill the current void with solid evidence-based information…,” you also know enough to REFER the patient TO a REGISTERED DIETITIAN. RDs specialize in food, nutrition and medical nutrition therapy. They are the specialists trained to help the patients with their diets. RDs have met rigorous training standards.  They are an indispensable part of the medical team. Visit EatRight.org, the website of the American Dietetic Association to learn about the services RDs provide.

    And to keep learning about nutrition, visit my new blog at AskMaryRD.com

    • http://www.facebook.com/people/David-Brown/692744221 David Brown

      Our oldest daughter is a receptionist for a group of dietitians at Massachusetts General Hospital. She was raised on a diet rich in saturated fats and continues to consume plenty, mainly from the animal sources of saturated fats that dietitians eschew due to their training. She says the younger dietitians are not happy with the American Dietetic Association’s anti-saturated fat stance. The Great Saturated Fat Debate Perhaps for some people a low-fat diet is appropriate. However, anyone who can tolerate significant amounts of fat should not be told that saturated fats will clog their arteries. Enjoy Eating Saturated Fats: They’re Good for You. They should, however, be warned to restrict consumption of foods rich in omega-6 industrial seed oils. WellWise Launches Omega 6 Campaign  Sadly, most dietitians have been trained to recommend the opposite from what the scientific data indicate. Healthy Nation Coalition If American physicians had received training in nutrition, thanks to the U.S. Department of Agriculture, they would also be furnishing their patients with bad dietary advice. What has Government Done to our Health? | The Free Press    

      • http://twitter.com/MaryHartleyRD Mary Hartley RD, MPH

        It’s not just the younger dietitians that are not happy with the American Dietetic Association’s anti-saturated fat stance – and their ties to the food industry. The good dietitians are up-to-date and they are there, heart and soul, for the patients.

    • Anonymous

      Mary~
      Great comments, as well.

      As a super-specialist in my field, I am highly trained in a small area and don’t even pretend to be an expert in all areas.  That being said, I know enough about nutrition to educate my patients but always suggest that they see a RD or other expert in the field for more comprehensive guidance. 

      Let the specialists do what the specialists do best.  The field of Health & Wellness is simply getting too big for one person to be an expert in all areas.

  • http://twitter.com/DarrellWhite Darrell White

    Count me in the camp of “no news is good news” since the majority of what is being taught and suggested is still High-carb/low-fat. After 4 decades of that prescription, how’s that going for our patients’ health? Better we tell them nothing. 

    • Anonymous

      Darrell~
      I couldn’t agree with you more.  The problem is that not only are most physicians taught outdated information but we are also passing that erroneous information on to our patients.  There needs to be more emphasis on not only nutritional education for physicians in training, but (more importantly) training in recent advances in nutrition .

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