How Much Nutrition Education Do Doctors Get?

How Much Nutrition Education Do Doctors Get?.jpeg

In the United States, most deaths are preventable and related to nutrition. Given that the number-one cause of death and the number-one cause of disability in this country is diet, surely nutrition is the number-one subject taught in medical school, right? Sadly, that is not the case.

As shown in my video, Physician's May Be Missing Their Most Important Tool, a group of prominent physicians wrote in 2014 that "nutrition receives little attention in medical practice" and "the reason stems, in large part, from the severe deficiency of nutrition education at all levels of medical training." They note this is particularly shocking since it has been proven that a whole foods, plant-based diet low in animal products and refined carbohydrates can reverse coronary heart disease--our number-one killer--and provide potent protection against other leading causes fof death such as cancer and type 2 diabetes.

So, how has medical education been affected by this knowledge? Medical students are still getting less than 20 hours of nutrition education over 4 years, and even most of that has limited clinical relevance. Thirty years ago, only 37 percent of medical schools had a single course in nutrition. According to the most recent national survey, that number has since dropped to 27 percent. And it gets even worse after students graduate.

According to the official list of all the requirements for those specializing in cardiology, Fellows must perform at least 50 stress tests, participate in at least 100 catheterizations, and so on. But nowhere in the 34-page list of requirements is there any mention of nutrition. Maybe they leave that to the primary care physicians? No. In the official 35-page list of requirements for internal medicine doctors, once again, nutrition doesn't get even a single mention.

There are no requirements for nutrition before medical school either. Instead, aspiring doctors need to take courses like calculus, organic chemistry, and physics. Most of these common pre-med requirements are irrelevant to the practice of medicine and are primarily used to "weed out" students. Shouldn't we be weeding out based on skills a physician actually uses? An important paper published in the Archives of Internal Medicine states: "The pernicious and myopic nature of this process of selection becomes evident when one realizes that those qualities that may lead to success in a premedical organic chemistry course...[like] a brutal competitiveness, an unquestioning, meticulous memorization, are not necessarily the same qualities that are present in a competent clinician."

How about requiring a course in nutrition instead of calculus, or ethics instead of physics?

Despite the neglect of nutrition in medical education, physicians are considered by the public to be among the most trusted sources for information related to nutrition. But if doctors don't know what they're talking about, they could actually be contributing to diet-related disease. If we're going to stop the prevailing trend of chronic illness in the United States, physicians need to become part of the solution.

There's still a lot to learn about the optimal diet, but we don't need a single additional study to take nutrition education seriously right now. It's health care's low-hanging fruit. While we've had the necessary knowledge for some time, what we've been lacking is the will to put that knowledge into practice. If we emphasized the powerful role of nutrition, we could dramatically reduce suffering and needless death.

Take, for example, the "Million Hearts" initiative. More than 2 million Americans have a heart attack or stroke each year. In 2011, U.S. federal, state, and local government agencies launched the Million Hearts initiative to prevent 1 million of the 10 million heart attacks and strokes that will occur in the next 5 years. "But why stop at a million?" a doctor asked in the American Journal of Cardiology. Already, we possess all the information needed to eradicate atherosclerotic disease, which is our number-one killer while being virtually nonexistent in populations who consume plant-based diets. Some of the world's most renowned cardiovascular pathologists have stated we just need to get our cholesterol low enough in order to not only prevent--but also reverse--the disease in more than 80% of patients. We can open up arteries without drugs and surgery, and stabilize or improve blood flow in 99% of those who choose to eat healthily and clean up their bad habits. We can essentially eliminate our risk of having a heart attack even in the most advanced cases of heart disease.

Despite this, medical students aren't even taught these concepts while they're in school. Instead, the focus is on cutting people open, which frequently provides only symptomatic relief because we're not treating the actual cause of the disease. Fixing medical education is the solution to this travesty. Knowledge of nutrition can help doctors eradicate the world's leading killer.

I've previously addressed how Doctors Tend to Know Less Than They Think About Nutrition, which is no surprise given most medical schools in the United States fail to provide even a bare minimum of nutrition training (see Medical School Nutrition Education), with mainstream medical associations even actively lobbying against additional nutrition training.

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Image Credit: Sally Plank

Original Link

How Much Nutrition Education Do Doctors Get?

How Much Nutrition Education Do Doctors Get?.jpeg

In the United States, most deaths are preventable and related to nutrition. Given that the number-one cause of death and the number-one cause of disability in this country is diet, surely nutrition is the number-one subject taught in medical school, right? Sadly, that is not the case.

As shown in my video, Physician's May Be Missing Their Most Important Tool, a group of prominent physicians wrote in 2014 that "nutrition receives little attention in medical practice" and "the reason stems, in large part, from the severe deficiency of nutrition education at all levels of medical training." They note this is particularly shocking since it has been proven that a whole foods, plant-based diet low in animal products and refined carbohydrates can reverse coronary heart disease--our number-one killer--and provide potent protection against other leading causes fof death such as cancer and type 2 diabetes.

So, how has medical education been affected by this knowledge? Medical students are still getting less than 20 hours of nutrition education over 4 years, and even most of that has limited clinical relevance. Thirty years ago, only 37 percent of medical schools had a single course in nutrition. According to the most recent national survey, that number has since dropped to 27 percent. And it gets even worse after students graduate.

According to the official list of all the requirements for those specializing in cardiology, Fellows must perform at least 50 stress tests, participate in at least 100 catheterizations, and so on. But nowhere in the 34-page list of requirements is there any mention of nutrition. Maybe they leave that to the primary care physicians? No. In the official 35-page list of requirements for internal medicine doctors, once again, nutrition doesn't get even a single mention.

There are no requirements for nutrition before medical school either. Instead, aspiring doctors need to take courses like calculus, organic chemistry, and physics. Most of these common pre-med requirements are irrelevant to the practice of medicine and are primarily used to "weed out" students. Shouldn't we be weeding out based on skills a physician actually uses? An important paper published in the Archives of Internal Medicine states: "The pernicious and myopic nature of this process of selection becomes evident when one realizes that those qualities that may lead to success in a premedical organic chemistry course...[like] a brutal competitiveness, an unquestioning, meticulous memorization, are not necessarily the same qualities that are present in a competent clinician."

How about requiring a course in nutrition instead of calculus, or ethics instead of physics?

Despite the neglect of nutrition in medical education, physicians are considered by the public to be among the most trusted sources for information related to nutrition. But if doctors don't know what they're talking about, they could actually be contributing to diet-related disease. If we're going to stop the prevailing trend of chronic illness in the United States, physicians need to become part of the solution.

There's still a lot to learn about the optimal diet, but we don't need a single additional study to take nutrition education seriously right now. It's health care's low-hanging fruit. While we've had the necessary knowledge for some time, what we've been lacking is the will to put that knowledge into practice. If we emphasized the powerful role of nutrition, we could dramatically reduce suffering and needless death.

Take, for example, the "Million Hearts" initiative. More than 2 million Americans have a heart attack or stroke each year. In 2011, U.S. federal, state, and local government agencies launched the Million Hearts initiative to prevent 1 million of the 10 million heart attacks and strokes that will occur in the next 5 years. "But why stop at a million?" a doctor asked in the American Journal of Cardiology. Already, we possess all the information needed to eradicate atherosclerotic disease, which is our number-one killer while being virtually nonexistent in populations who consume plant-based diets. Some of the world's most renowned cardiovascular pathologists have stated we just need to get our cholesterol low enough in order to not only prevent--but also reverse--the disease in more than 80% of patients. We can open up arteries without drugs and surgery, and stabilize or improve blood flow in 99% of those who choose to eat healthily and clean up their bad habits. We can essentially eliminate our risk of having a heart attack even in the most advanced cases of heart disease.

Despite this, medical students aren't even taught these concepts while they're in school. Instead, the focus is on cutting people open, which frequently provides only symptomatic relief because we're not treating the actual cause of the disease. Fixing medical education is the solution to this travesty. Knowledge of nutrition can help doctors eradicate the world's leading killer.

I've previously addressed how Doctors Tend to Know Less Than They Think About Nutrition, which is no surprise given most medical schools in the United States fail to provide even a bare minimum of nutrition training (see Medical School Nutrition Education), with mainstream medical associations even actively lobbying against additional nutrition training.

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Image Credit: Sally Plank

Original Link

Why Do Heart Doctors Favor Surgery and Drugs Over Diet?

NF-June2 Fully Consensual Heart Disease Treatment.jpg

When he was a surgeon at the Cleveland Clinic, Dr. Caldwell Esselstyn Jr. published a controversial paper in the American Journal of Cardiology, highlighted in my video, Fully Consensual Heart Disease Treatment, noting that heart bypass operations carry significant risks including the potential to cause further heart damage, stroke, and brain dysfunction. Angioplasty isn't much better, also carrying significant mortality and morbidity, and often doesn't work (in terms of decreasing the risk of subsequent heart attack or death). "So," he writes, "it seems we have an enormous paradox. The disease that is the leading killer of men and women in Western civilization is largely untreated." The benefits of bypass surgery and angioplasty "are at best temporary and erode over time, with most patients eventually succumbing to their disease." In cancer management, we call that palliative care, where we just kind of throw up our hands, throw in the towel, and give up actually trying to treat the disease.

Why does this juggernaut of invasive procedures persist? Well one reason he suggests is that performing surgical interventions has the potential for enormous financial reward. Conversely, lack of adequate return is considered one of the barriers to the practice of preventive cardiology. Diet and lifestyle interventions lose money for the physician.

Another barrier is that doctors don't think patients want it. Physician surveys show that doctors often don't even bring up diet and lifestyle options because they assume that patients would prefer to be on cholesterol-lowering drugs every day for the rest of their lives rather than change their eating habits. That may be true for some, but it's up to the patient, not the doctor, to decide.

According to the official AMA Code of Medical Ethics, physicians are supposed to disclose all relevant medical information to patients. "The patient's right of self-decision can be effectively exercised only if the patient possesses enough information to enable an informed choice. The physician's obligation is to present the medical facts accurately to the patient." For example, before starting someone at moderate risk on a cholesterol-lowering statin drug, a physician might ideally say something like:

"You should know that for folks in your situation, the number of individuals who must be treated with a statin to prevent one death from a cardiovascular event such as a heart attack or stroke is generally between 60 and 100, which means that if I treated 60 people in your situation, 1 would benefit and 59 would not. As these numbers show, it is important for you to know that most of the people who take a statin will not benefit from doing so and, moreover, that statins can have side effects, such as muscle pain, liver damage, and upset stomach, even in people who do not benefit from the medication. I am giving you this information so that you can weigh the risks and benefits of drugs versus diet and then make an informed decision."

Yet, how many physicians have these kinds of frank and open discussions with their patients? Non-disclosure of medical information by doctors--that kind of paternalism is supposed to be a thing of the past. Today's physicians are supposed to honor informed consent under all but a very specific set of conditions (such as the patient is in a coma or it's an emergency). However, too many physicians continue to treat their patients as if they were unconscious.

At the end of this long roundtable discussion on angioplasty and stents, the editor-in-chief of the American Journal of Cardiology reminded us of an important fact to place it all in context. Atherosclerosis is due to high cholesterol, which is due to poor dietary choices, so if we all existed on a plant-based diet, we would not have even needed this discussion.

The lack of nutrition training in medical school is another barrier. See, for example, my videos Doctors' Nutritional Ignorance and Doctors Know Less Than They Think About Nutrition.

Shockingly, mainstream medical associations actively oppose attempts to educate physicians about clinical nutrition. See my 4-part video series:

  1. Nutrition Education Mandate Introduced for Doctors
  2. Medical Associations Oppose Bill to Mandate Nutrition Training
  3. California Medical Association Tries to Kill Nutrition Bill
  4. Nutrition Bill Doctored in the California Senate

For more on why doctors don't make more dietary prescriptions, see my video The Tomato Effect, Lifestyle Medicine: Treating the Cause of Disease, and Convincing Doctors to Embrace Lifestyle Medicine.

Heart disease may be a choice. See Cavities and Coronaries: Our Choice and One in a Thousand: Ending the Heart Disease Epidemic.

-Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live year-in-review presentations Uprooting the Leading Causes of Death, More Than an Apple a Day, and From Table to Able.

Image Credit: Leandro Ciuffo / Flickr

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