It’s always clear to good physicians that diet, ie. your fuel source, is essential for good health.
by Dr. Alan Kadish NMD
So whats the disconnect between medical schools and their teaching no or limited amounts of dietary courses and NO culinary translation ?
There are no lack of reasons given including the exploding amount of information that all physicians need to know, limited time and well there seems to always be more important information to teach. If you considered that most scientific literature suggests that the overwhelming number of our illnesses are connected to lifestyle and especially diet, would you be surprised ? It’s almost too obvious, if poor fuel quality is present your car would not run properly, why should you body ?
In a 2015 study published by the American Medical Association, the author found on average, U.S. medical schools only offer 19.6 hours of nutrition education across four years of medical education, according to the perspective authors. “This corresponds to less than 1 percent of estimated total lecture hours,” however the key is in the details. When we talk about nutritional medicine what’s most important. The author found that, “Moreover, the majority of this educational content relates to biochemistry, not diets or practical, food-related decision making.” So what’s being taught is a whole different subject entirely.
Let’s move forward and consider the study in 2017 by the Society of Teachers of Family Medicine, on the current state of affairs. A telling statement by the medical students is truly revealing. Their comment “…..stating the amount of material (nutrition training) as “almost anecdotal” and would not be helpful in a clinical setting”. This summarizes the students experiences of nutritional information. Once again it’s not the time, but rather the context and materials needed to convey to a patient clear and effective dietary information that’s not present.
What should one conclude ? We need to include much more integration of the basic biochemistry, coupled with the applications (culinary skills) and an understanding of how to integrate this information. This approach should be part of the practitioners lifestyle in order for them to understand and then deliver quality content that is both effective and meaningful to the patients.
If you consider the Naturopathic medical approach, the coursework for nutrition is fully integrated, including the understanding of how lifestyle changes are essential for good health. Not a secondary option to the understanding of just biochemistry, but rather a complete system that allows for lifestyle interventions that really pay dividends. Naturopathic students in U.S. naturopathic medical schools average 150 hours of nutrition training and over 1,330 hours of clinical training. (Source: AANMC Member Survey, 2017). It takes both a good foundation in the biochemistry coupled with the applications and personal utilization to make lifestyle change suggestions that really work.
One of the ongoing evolutions in medical understanding of nutrition, has been the emergence of multiple allopathic medical organizations, training MD/DO’s to focus on lifestyle. A consistent characteristics of many of the organizations is their offerings of lifestyle training as a way to change the income stream from the insurance model to the cash payment patients. Can you really get a good foundation in lifestyle change from a few online or weekend courses and be an expert in the field ?
Nutrition will continue to be a contentious area of medical care as the field is very much in flux. The amount of monies from agribusiness political action committees for 2018 has already topped $13 million dollar…..keep in mind it’s only April….. The level of influence that this has based on the publics perceptions as to government policy alone can not be underestimated. Consider the multimillion dollar move to make cows milk a “healthy choice” . the public’s perception of this campaign alone is amazing. No mention of the antibiotic use leading to more resistance, the farm subsidy or other less attractive aspects of land use when drinking milk are considered. The real cost is so much more and not really understood or factored in to the price of milk, as one example.
The concept of a whole foods plant based diet is going to become a much more known approach, over time. At present it’s still considered a bit fringe and no you don’t have to become a vegan however, it’s starting to look like the literature is well in support of this or a modified WFPB diet for disease interventions.
Stay tuned for a lot more on this subject as your health matters !
We learn nothing about nutrition, claim medical students
Medical students say they currently learn almost nothing about the way diet and lifestyle affect health – and they should be taught more.
They say what they are taught is not practical or relevant to most of the medical problems they see in GP surgeries, clinics and hospitals.
A leading GP estimated that up to 80% of his patients had conditions linked to lifestyle and diet.
These included obesity, type 2 diabetes and depression.
Why does this lack of training matter?
This year the NHS will spend more than £11bn on diabetes alone – social care costs, time off work etc, will almost double that bill.
Type 2 diabetes – the most common kind – is linked to obesity. And right now Britain is the fat man of Europe.
Training too traditional
But doctors are not being trained to deal with what medics call non-communicable diseases – and it’s those kind of illnesses that are threatening to bankrupt our health system, so a new kind of training is crucial.
Speaking to BBC Radio 4’s The Food Programme, Dr Rangan Chatterjee, authorand podcast host, told me: “The health landscape of the UK has dramatically changed over the last 30 or 40 years and I think the bulk of what I see as a GP now – almost 80% – is in some way driven by our collective lifestyles.”
Dr Michael Mosley, presenter of BBC One’s Trust Me I’m A Doctor, said, “Unfortunately it’s not part of the traditional training. At medical school I learnt almost nothing about nutrition. And I have a son at medical school and it’s again not part of his key curriculum.
“So I don’t get the sense that there are lots of doctors out there who feel empowered to tell patients much about nutrition.”
A hotbed of the new revolution is Bristol University where, in 2017, third year medical students Ally Jaffee and Iain Broadley founded Nutritank.
It’s an online organisation created for and by medical students to share nutrition science research and organises events and lectures on campus.
This summer, it will welcome GP, author and podcast host Dr Rupy Aujla to Bristol to lead the first UK course in culinary medicine for medical students.
From one society in Bristol, Nutritank has now spread to 15 other student-led groups at universities across the country.
Ally Jaffee said: “There’s just about a society at medical school in everything from sexual health to orthopaedics to dermatology. But there just wasn’t a nutrition and lifestyle or a preventative medicine society.
“We’re taught about 10 to 24 hours over five to six years in medical school on nutrition.”
This month, the British Medical Journal announced it will launch a journal on the science and politics of nutrition in June 2018.
Dr Fiona Godlee, editor-in-chief of the BMJ, told me, “It’s time we recognised that food and nutrition are core to health. There is a growing body of research out there that needs to be published – and we want to contribute to that effort.”
She said the same levels of quality and scrutiny should be applied to food science that are applied to other areas of health research.
The BMJ’s announcement follows an opinion piece it published in October 2017 written by two University of Cambridge graduate medical students, Kate Womersley and Katherine Ripullone.
Kate said: “I was in an obesity clinic as part of my medical shadowing.
“A patient came in and said very frankly to the doctor, the consultant in charge, ‘Why am I so fat?’.
“The patient was asking a very straightforward question and I think was expecting a straightforward answer. But often that’s a question where doctors seem to clam up a bit.
“We were interested to write this piece for the BMJ, because we didn’t feel prepared to be receiving that question.”
Medical schools in the UK are responsible for setting their own curriculum with guidance and standards published by the General Medical Council.
The GMC is now reviewing that guidance but so far it’s been very general. It told us that it recognises the significance of the impact of diet and nutrition on health and wellbeing and has sought to express this more explicitly in its revised “outcomes” that will be released this summer.
Things are also beginning to change at medical schools. University of Cambridge told us it plans to double the amount of core course content on nutrition and has asked Kate and Katherine to help.
Similarly, Bristol medical school has sought input from students to redesign its curriculum.
Meanwhile, Prof Sumantra Ray of NNedPro Global Centre for Nutrition and Health told us his organisation is involved in rolling out training in diet and nutrition for student doctors by 2020.
Kate said: “Students need to see nutrition as something at the cutting edge of scientific discovery.
“I think there needs to be an image change of how doctors perceive nutrition, but also how it’s presented to students.”
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