Dietary advice from doctors

One of the most common complaints I hear from my clients about the various medical professionals they have dealings with is

“My doctor doesn’t seem to know anything about nutrition.”

Over the 20+ years that I’ve been in clinical practice, countless clients with conditions that are definitely diet-responsive, such as inflammatory bowel disease, rheumatoid arthritis, high blood pressure and asthma, have sat in my office and recounted versions of the same story to me: they asked their doctor if there were any changes they could make to their diet that might improve their condition, and the doctor dismissed the idea with complete contempt, telling them “Diet doesn’t make any difference – eat whatever you like.”

Why, they ask me, don’t doctors know what I know: that there is a substantial and rapidly-growing body of evidence, from epidemiological, laboratory and clinical studies, that demonstrates that diet does make a difference – for better or worse – in the vast majority of chronic illnesses that consume the overwhelming majority of our health care expenditure in Australia, and other developed countries.

As Dr Michael Klaper pointed out when he addressed the Nutrition in Healthcare Symposium (at which I also spoke), doctors don’t think nutrition is important because

a) They don’t study it in medical school (as recent medical graduate Dr Juliette Roex confirmed during her address to the symposium, and GP registrar Dr Stephanie Dakin echoed during the panel discussion at the What the Health premiere in Canberra) therefore they don’t develop any sense of its central importance in disease prevention and treatment or health promotion;

b) Largely because of a), medical students and doctors view nutrition as a ‘sissy science’ – the province of dietetics, which they view as inferior to medicine; and

c) They are attached to their own dietary habits (especially once they start making serious money in medical practice and can afford the luxury food and wine that was beyond their budget when they were students!) and don’t wish to change them.

Unfortunately, even when medical students and doctors do have an interest in nutrition and consider that dietary counselling should be an integral part of medical practice, their enthusiasm for the subject often outstrips their competence.

A recent study assessed the nutrition knowledge and attitudes of 1st- and 2nd-year medical students enrolled in osteopathic medicine, and the results were truly worrying.

Whereas in Australia, osteopathy is still seen as somewhat ‘fringe’, in the US osteopathic medicine is a branch of the medical profession, with students studying the same curriculum as in ‘regular’ medical school. Osteopathic physicians are fully licensed physicians, who can prescribe drugs and perform surgery.

However, the roots of osteopathy lie in the philosophy that the body can, given the right circumstances, heal itself, and as a consequence, osteopathic students and doctors tend to have a greater interest in the role of nutrition in health and disease than conventionally-trained medicos.

In fact, 78% of surveyed students thought that nutrition education was an important aspect of health promotion, disease prevention and management and 68% “felt that nutrition counseling and meal planning were the responsibility of the PCP [primary care provider, or GP]”.

But when their actual knowledge of nutrition was put to the test, the results were dismal. Half of the students failed ‘The Nutrition Knowledge Quiz’, a 20-item multiple choice quiz created to measure medical interns’ nutrition knowledge, and which assessed general nutrition knowledge and specific nutrition interventions, including obesity, endocrine nutrition, cardiovascular nutrition, and basic nutrient information.

Shockingly, nearly half of the students did not know the correct answer to the question, “What dietary factor is most responsible for raising serum cholesterol levels?” (The answer, of course, is saturated fat, but 48.2% of students wrongly picked either dietary cholesterol, unsaturated fat or simple sugars.)

Furthermore, a significant proportion of the 56% of students who reported that they felt comfortable counselling patients on nutrition recommendations, and the 34% who reported that they felt comfortable designing a nutrition plan for a patient, failed the test. Confidence without competence is a bit of a worry, to put it mildly!

This recent study echoes the findings of a 2008 study of medical interns (i.e. physicians who have completed medical training but are not yet licensed to practice medicine): the average correct score on a longer version of the same nutrition knowledge quiz administered to osteopathy students was just 66%. As just one example, only 54% of interns knew the correct answer to the question “How many calories are in a gram of protein?” (It’s 4, by the way – and this is about the most basic nutrition question that could be asked.)

Given the lack of nutrition knowledge possessed by most doctors, the terrible dietary advice that’s been issued by some of them should come as no surprise. I’ve lost count of the number of clients I’ve seen who’ve been advised by their doctor to eat a Paleo-style or ketogenic diet to manage their diabetes; told to reduce their intake of healthy carbohydrate-rich foods, low energy-density foods such as sweet potato and brown rice in order to lose weight; or admonished that they should eat meat “because humans have canine teeth” – gotta love that one.

(I wrote an article called “Dumbest Things a Doctor (or Other Health Professional) Has Ever Said To You” which contains a choice selection of this woeful advice.)

Bottom line: The chances are that if you are reading this article, you probably know more about nutrition than your doctor. Unless your doctor has done specific post-graduate training in nutrition (and you should check out the organisation that provided this training, as there are some rather dodgy providers of nutrition education out there – including the food industry itself, which provides webinars to ‘help’ GPs meet their annual Continuing Medical Education requirements), his or her opinion on the subject should be treated with the same degree of scepticism that you would have if a plumber offered advice on building a space shuttle.

My nutrition and health education program, EmpowerEd, is specifically designed to provide you with the skills you need to navigate safely through the barrage of nutrition misinformation that emanates from the Internet, popular books and media and sadly, many health and medical professionals. Your first month of membership is 100% free of charge, and you’ll get instant access to hundreds of hours of nutrition and health content, all referenced from peer-reviewed scientific literature.

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