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Doctors ≠ Nutrition Experts, But We Keep Asking, and Believing Them

I spent a lot of time late last week and earlier this week digging into more research on medical school curricula so I’d be armed with facts about why it is that you generally should NOT assume that your doctor knows a single actual thing about nutrition. Unfortunately, the many articles I’d saved as placeholders in a first draft of this blog entry somehow got dispersed back out into the ether, so I’m going off the cuff, or I won’t end up posting anything for Food Friday this week and I don’t want to do that, because every time I think about this subject, I get all fired up. If you don’t believe what I’m going to say today, though, just freaking google it, because I promise you, I’m not making this up. Before I bolt ahead, let me throw in this disclaimer: none of this is to say that your specific doctor may not have spent the time and effort to build this knowledge on his or her own, because many have. In the scheme of things, though, IMO, not *nearly* enough of them have done so. Onward.

A few facts:

First: Something like fewer than 20% of medical schools include any requirement in their curricula about food/nutrition. And for those who do, the requirements are almost laughably minimal – essentially one class-worth. I know I’m not the only one who thinks this is insane; several schools are changing the calculus (Tulane is one that sticks in my mind) and adding not only more requirements, but also, importantly, an element of experiential learning, i.e., teaching kitchens, to ensure that the M.D.s minted from their programs will be much more comfortable and conversant with food than most practicing physicians now are. I’m not particularly optimistic, however, that even if or when this changes on a much broader scale, we’re going to start making a dent in this problem, for reasons I’ll expand upon below, but, you gotta start somewhere.

Second: There is no ongoing requirement for nutrition-oriented training in any state’s continuing education mandates for doctors. I actually looked at all of them. What I also discovered in my research is that a couple of states don’t even *have* a continuing education mandate, which is simply mind-blowing. So hold on – let me get this straight: a doctor, who may well have people’s lives in his/her hands, spends countless hours being educated and doing hands-on training for 8 or more years to earn the right to practice, but then, poof! You’re done! No need to keep up with the latest research, techniques, and practices. In those states (o.k. – I broke down and looked it up again, and “those states” are Indiana and Montana), you can just keep going for another 20, 30, 40 years – whatever – with no requirement to stay up-to-date. Your doctor, in whose hands you put your *life,* may be operating (in those states) under assumptions and practices that have been long-outdated, or even proven ineffective. Fab. And under no circumstances are they required to know anything about nutrition, even though they’re asked about it all the time. Okeydokey.

Third: Recall how the medical establishment came to the erroneous collective “understanding” that a low-fat diet was the healthiest diet (see my post “Helicopter Parenting gone Wrong, with our Food, and our Health” from a couple of weeks ago). The “Cliff Notes” version: that belief was cultivated, grown, and pushed into the mainstream by a few overly zealous individuals without any concrete data to back it up as they tried to address a growing epidemic of heart disease. Much of the epidemiological evidence they relied upon (questionably in the first place) for their hypothesis has since been shown to be full of holes itself, with some data and studies even pointing 180 degrees in the other direction. Between the 1950s and the 1990s, the seeming strength of that false belief system resulted in a dearth of support or funding for any studies that could have shown its weaknesses, resulting in a complete “echo chamber” effect that STILL pervades the medical profession, and medical advice about nutrition, to this very day.   

Fourth: Most doctors *still* espouse an overly-simplistic “Calories In, Calories Out” belief system about health and weight-loss. (Read pretty much anything by Dr. Jason Fung for some excellent perspective on this). This gross oversimplification has huffed and puffed right along with us to a place of higher rates of obesity than at any other time in history (and correspondingly higher rates of chronic preventable diseases). It has formed the rich fodder for a terrible environment that not only encourages fat-shaming, but has also launched 1000 fortunes in the processed food industry as companies fall all over themselves to market a bunch of fake-food shit to you under the guise of “low calorie, low fat” benefits.  Many, if not most, of those “low calorie” or “low fat” fake foods contain the processed vegetable or seed oils I talked about in last week’s post, and would be far healthier for you sitting in your trash can than in your body.

Various sources I looked up validate the notion that most physicians, when asked, admit that they really don’t feel that they have a good understanding of nutrition (google it, please, if you don’t believe me). But wait! My cardiologist told me I should be on a low-fat diet! Doesn’t he know what he’s talking about? The short answer: NOPE. The longer and more nuanced answer: he’s in the same rip current that the American Heart Association, the American Medical Association, the USDA, and many other otherwise reputable, seemingly eminently believable, organizations got stuck in with the issues I noted in the “third” fact above.

So what to do?? Does truly sound nutritional advice even exist? If you ask me, that’s highly debatable given that even the Academy of Nutrition and Dietetics (a.k.a. “AND” – the U.S. association that accredits education and training programs for dietetics professionals, who, of anyone, *would* be the people to turn to for sound advice), and those same associations mentioned above (AHA, AMA, etc.), receive a pretty meaningful amount of funding from pharmaceutical and food companies (the original funding for the American Heart Association came from, of all places, Procter & Gamble, makers of Crisco. Just sayin). I do believe sound nutritional advice does exist. Just because “AND” receives a big portion of its funding from big food and pharmaceutical concerns, doesn’t mean that serious individual dieticians (who, by the way, are at least accredited, as opposed to nutritionists – look that up, too) can be swayed by the effects of that funding – possibly biased studies, advertising, etc. But we have to keep in mind the echo chamber effect noted in the third point above.  We all want to think we’re immune to groupthink and the siren-song of advertising. Advertising, though, it is a subtle, subtle art and even if our doctors’ educations aren’t deep in science when it comes to nutrition, you can bet the last dollar in your wallet that advertisers’ educations and techniques *are.*

Back to what to do for sound advice on nutrition:

1) Beware. Of so many things, but primarily, of anyone who tries to sell or push any kind of supplement or “food” that isn’t really food. That includes anything that comes in a bag, box, bottle, or other package that has more than a few discernible, recognizable ingredients on it. And by “recognizable,” I mean by a layperson, not a chemist.

2) Read. Really read – deep – into any article, book, or website telling you something about nutrition. Ask yourself the hard questions when you’re reading beyond the latest nutrition-oriented headline: where is the study/data coming from? How much do I know about the study/data sources or how much can I really find out about them? Are health or nutritional claims being based upon findings that have been manipulated into percentages (or other forms of numbers) that make them look bigger or more important than they really might be?

If those are too hard to answer without hours of effort, then consider the following:

  • For millennia (and until at least 1900), the biggest killers of humans were infectious diseases, such as pneumonia, influenza, and tuberculosis (look it up);
  • In 2017, according to the CDC, the top 10 causes of death were the following: heart disease, cancer, unintentional injuries, chronic lower respiratory diseases, stroke, Alzheimer’s disease, diabetes, influenza and pneumonia, kidney disease, and suicide (look it up). I’ve bolded the ones that have obvious and proven links to diet. Alzheimer’s is up in the air.
  • People until 1900 ate nothing resembling heavily, or even moderately processed food, unless you count milled flour, alcohol, dairy products, fermented foods, or the relatively small amounts of processed sugar that were present in diets then. Different cultures around the world ate *vastly* different diets – animal-based, fish-based, vegetable-based; yet people around the world weren’t dying of those 5 (+) diseases.
  • People until the 20th century, all around the world, didn’t eat Hot Pockets. They didn’t eat Twinkies. They didn’t eat Snackwells, or Oscar Meyer hot dogs. They didn’t drink Coke, or Gatorade, or Diet Pepsi, or even (gasp!) soy milk. They also didn’t eat specifically low-fat diets. They didn’t avoid animal fat because their doctor told them to. And they DIDN’T DIE OF HEART DISEASE, CANCER, DIABETES, and KIDNEY DISEASE in any meaningful numbers. Period.

We have vaccines in most cases to ward off the infectious diseases (a whole other rabbit hole I will NOT be going down, thank you). But we have billions of advertising and influence dollars from food companies telling us that manufactured “food” products are safe, and worse, healthy; and from pharmaceutical companies, tilting the entire medical profession (including research money) towards pharmacological solutions to disease of all kinds – acute or chronic.

Is this really that difficult? I dare say: nope. Just don’t ask your doctor.

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