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Functional Medicine & Nutrition in Allopathic Schools

Dr_SuperBloom

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    I will be applying next year, to matriculate fall 2020, and am very interested in both functional medicine and nutrition as part of my medical education. They are obviously things I can self-study/obtain accreditation for after medical school, but I would be very interested to know of any schools that have begun taking meaningful steps towards incorporating “lifestyle” medicine into their curriculum, along with the traditional medical education. Thanks!
     

    gyngyn

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      I will be applying next year, to matriculate fall 2020, and am very interested in both functional medicine and nutrition as part of my medical education. They are obviously things I can self-study/obtain accreditation for after medical school, but I would be very interested to know of any schools that have begun taking meaningful steps towards incorporating “lifestyle” medicine into their curriculum, along with the traditional medical education. Thanks!
      Could you be more specific?
       

      gyngyn

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        Sure. I know that many schools hardly touch on nutrition, but I’ve seen through the experiences of my family members that in some cases, nutrition made much larger changes to their health than the Rx’s they’d been taking for the same conditions. Obviously this is anecdotal, but I’m very interested in having a solid nutritional education to enhance my medical education. I’ve heard of some schools having culinary medicine classes, but often you have to be in a dual enrollment program (ie MD/MPH at GWU) to have access to such programs.

        I mentioned functional medicine because that field generally places a high value on nutrition.
        What is functional medicine?
        Nutrition (and its affect on health) is taught in all the medical schools I'm aware of (at least in CA).
         
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        LizzyM

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          getdown

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            I guess the question I have is how likely are patients going to be able follow this. I see the point and it's all well and good when the patient has the luxury to have access to good nutritional food, access to a gym or live in an area that is not crime riddled. Patients from wealthy neighborhoods and suburbs are always going to be much healthier than low income, working class and inner city patients for this exact reason. I see this every day in patients going into surgery. You compare the average VA patient to a wealthy local private hospital and the ASA status are on opposite sides of the spectrum. It's well-intentioned but implementation is questionable.
             
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            LizzyM

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              I guess the question I have is how likely are patients going to be able follow this. I see the point and it's all well and good when the patient has the luxury to have access to good nutritional food, access to a gym or live in an area that is not crime riddled. Patients from wealthy neighborhoods and suburbs are always going to be much healthier than low income, working class and inner city patients for this exact reason. It's well-intentioned but implementation is questionable.

              Those who have a choice, need help in making good choices. There are too many quacks out there promoting supplements, colon cleanses and other fads. If even only the 1% can afford that, there is a population of >3 million in the US who would be looking for services of this kind. I'd say it is more like 60 million people who can easily adopt this lifestyle. With books, lectures, apps and the rest, the message can reach far more. The whole "food desert" situation is a cop-out; the vast majority of Americans have access to food but they don't always make the best choices. Finding way to make small and permanent changes can eventually make big differences. Take soft drinks, for example. No one needs to drink sugar sweeteded carbonated beverages or the artificially sweetened "diet soda". Water is better for you and cheaper. That $1 for soft drinks can buy a bag of frozen vegetables. It is nonsense to say that most Americans cannot afford a plant-based diet that is low in added sugars and low in saturated fat.
               
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              getdown

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                Those who have a choice, need help in making good choices. There are too many quacks out there promoting supplements, colon cleanses and other fads. If even only the 1% can afford that, there is a population of >3 million in the US who would be looking for services of this kind. I'd say it is more like 60 million people who can easily adopt this lifestyle. With books, lectures, apps and the rest, the message can reach far more. The whole "food desert" situation is a cop-out; the vast majority of Americans have access to food but they don't always make the best choices. Finding way to make small and permanent changes can eventually make big differences. Take soft drinks, for example. No one needs to drink sugar sweeteded carbonated beverages or the artificially sweetened "diet soda". Water is better for you and cheaper. That $1 for soft drinks can buy a bag of frozen vegetables. It is nonsense to say that most Americans cannot afford a plant-based diet that is low in added sugars and low in saturated fat.

                I understand your points. And just like you said, it ultimately comes down to choice. However, I would say if you're in that bracket to be able to do this, most of those people are educated enough and have a pretty good understanding of what good choices are except they like drinking their sodas, hate water, are willing to spend 10 dollars for that venti from Starbucks. Most probably already implement some form of this by eating healthy and exercising without knowing this field exists. So, my point remains that the patients that this concept would make more of an impact on are the patient population least likely to be able to implement it.
                 
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                LizzyM

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                  I understand your points. And just like you said, it ultimately comes down to choice. However, I would say if you're in that bracket to be able to do this, most of those people are educated enough and have a pretty good understanding of what good choices are except they like drinking their sodas, hate water, are willing to spend 10 dollars for that venti from Starbucks. Most probably already implement some form of this by eating healthy and exercising without knowing this field exists. So, my point remains that the patients that this concept would make more of an impact on are the patient population least likely to be able to implement it.

                  I don't understand your point. Many poor people have bad skin but can't afford aesthetic dermatology. Does that mean it should not exist as a medical specialty?
                   
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                  getdown

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                    I don't understand your point. Many poor people have bad skin but can't afford aesthetic dermatology. Does that mean it should not exist as a medical specialty?

                    I didn't say it shouldn't exist. I just think as a field it's usefulness is limited by its inability to reach a population that really could use it.
                     
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                    ADSigMel

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                      I didn't say it shouldn't exist. I just think as a field it's usefulness is limited by its inability to reach a population that really could use it.

                      Everyone who has a PCP should be hearing this information from him or her, whether it’s called “lifestyle medicine” or “how to stay off dialysis” or whatever. The problem is that, while it’s hard for us to imagine, a lot of the people who are most at risk of contracting these super-preventable conditions and diseases are the ones who DON’T have a primary doctor to teach them how not to get Type II diabetes or heart disease or osteoporosis or whatever. And yeah, I know how to Google, “how to prevent hypertension,” but (here’s the kicker), I’m not part of the demographic most at risk of dying from complications of HBP in the first place.

                      OP, I call it regular old “primary care,” not lifestyle Medicine or functional medicine or whatever. But, yeah, it should be a big part of every school’s curriculum. My guess is that, absent an MD/MPH program, you won’t see a whole lot of this in medical school, possibly because so much of it is common knowledge.
                       
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                      gyngyn

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                        :confused: What do you mean? I know a few of the leaders by reputation including Katz and Willett. They are hard core in spreading the gospel of diet/nutrition but not quacks.
                        It has come to have a very different meaning where I work. More like this: Dr Ivan Rusilko, DO
                         

                        OneTwoThreeFour

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                          I don't understand your point. Many poor people have bad skin but can't afford aesthetic dermatology. Does that mean it should not exist as a medical specialty?

                          I think it's an iffy thing to be vocally interested in as a pre-med. Especially with the stigma of 'lifestyle specialty' attached to it. Would take a very compelling story for me to do anything other than assume this person sees medicine as a way to get $$ + prestige.
                           

                          applepie1212

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                            Sorry friend, just graduated with a degree in nutrition and less than 29% of medical schools implement recommended 25 hours of lecture on nutrition. One of the courses I took was condensed into a single powerpoint for the medical students. If you want to be a physician that implements preventative medicine into primary care, then YOU have to put the work in to make nutrition part of the conversation. And if you're interested, the VITAL Trial should be coming out with its results soon. We will officially know if omega-3s (and/or Vitamin D, interesting how they grouped them together) are beneficial for cardiovascular health and cancer prevention!!! :)
                             
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                            Matthew9Thirtyfive

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                              The whole "food desert" situation is a cop-out; the vast majority of Americans have access to food but they don't always make the best choices.

                              I agree with your points, but you’ve clearly never lived in a place like that as a poor person who doesn’t actually have a choice. There is a huge population of people like that, and the food you can afford sucks.
                               

                              LizzyM

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                                I agree with your points, but you’ve clearly never lived in a place like that as a poor person who doesn’t actually have a choice. There is a huge population of people like that, and the food you can afford sucks.
                                In the past 18 years, about 10-15% of the population has lived below poverty (it varies year by year but within that range). While that is a huge population in terms of the number of people (36-40 million), it also means that there are about 300 million who are not living in poverty and who, we can presume, might choose to make healthy choices with regard to food, sleep, physical activity, etc if they knew what to do and were motivated to do so. That's why I say that pointing to food deserts is a distraction. I'm not denying that some people struggle to find healthy choices. However, when 10% of food stamp (SNAP) spending goes to sweetened beverages, we have a problem crying out to be solved even among those who claim not to have good choices. Some efforts are underway to get more fresh produce into corner stores, for example USDA Publishes Guide to Help Convenience Stores Sell Healthier Foods | Food and Nutrition Service but more needs to be done.

                                From what I know of the people involved with the American College of Lifestyle Medicine, there are academic physicians who are doing research on nutritional epidemiology and population based efforts to motivate the American public to change their ways promote positive health behaviors and prevent illness and injuries.
                                 
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                                theKingLT

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                                  From my limited exposure, it is a blend of endocrinology, nutrition, and a focus on longer appointments (45-60 min) (vs the more common 10-15 min).
                                  Meaning when you're a PCP and someone comes in for their annual wellness check you sit and chat for an hour?! How could you see enough patients that way?

                                  Edit: typo
                                   
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                                  OneTwoThreeFour

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                                    Meaning when you're a PCP and someone comes in for their annual wellness check you sit and chat for an hour?! How could you see enough patients that way?

                                    Edit: typo

                                    You don't take insurance, you charge exorbitantly for "vitamin infusions" you run a whole bunch of unnecessary labwork, you send pts to get a sleep study done by a buddy of yours from med school, etc. It isn't easy to find that niche but if you are charismatic and enterprising enough, there is certainly a business model there.
                                     
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                                    Prometheus123

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                                      I agree that diet and lifestyle interventions are limited by patient compliance, cost, access, etc. I also agree that in many cases those are cop-outs. You don't have to buy local organic veggies from the farmer's market to eat well. You can buy frozen veggies, which are cheap and probably about as nutritious since being shielded from heat and light slows micronutrient break down (e.g. folate).

                                      Meat is generally more expensive than fruits and veggies, and eating too much protein may increase the risk of some diseases. So, you could also save money by eating more plants and less meat.

                                      Personally, I like to focus on diet and lifestyle things that are basically free. For instance, just not eating late at night can have positive effects on some people. Some (but not all) RCTs show only eating during a limited window of time during the day (e.g. 4-12 hours) led to significantly greater weight loss, for instance. (However, only one of them showed 5%+ weight loss, which I believe is part of the FDA's approval criteria for weight loss interventions. That one involved eating only during an 8 hour period per day.)

                                      In practical terms, these time-restricted eating interventions basically come down to eating an early dinner and not eating or drinking anything but water and prescribed medications until breakfast the next day. Anecdotally, this change seems to have decreased a relative's BP and fasting glucose so much that the dosages of their medications have had to be lowered several times. They've also visibly lost weight.

                                      Also, I believe LizzyM mentioned not drinking sugary sodas. That's a great one that actually saves a little money. I'd add to that not drinking sugary fruit juices every day. In the Framingham Heart Study cohort, people who drank one or more fruit juice servings a day tended to have significantly smaller brains that weren't as good at burning sugar for energy. Just a correlational study, but still. Daily fruit juice drinkers also tended to have significantly worse memory of events.

                                      You can also turn off lights at night, which saves money and can increase your body's production of melatonin. Melatonin is one of the only antioxidants that can detoxify hydroxyl radicals, which are one of the most damaging kinds of reactive oxygen species.

                                      Bad diet and lifestyle choices can dramatically increase people's risk for specific chronic diseases. Good diet and lifestyle choices can help prevent chronic diseases or maybe even slow their progression in some cases. However, they are not first line treatment for anything (with a few exceptions involving micronutrient deficiencies). Medicine is.

                                      Sorry for any errors in this message, and for the length. And of course, none of this is advice of any kind. Just trying to show that some of this stuff is accessible to most people.
                                       
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                                      hurtem&healem

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                                        1) there are about 300 million who are not living in poverty and who, we can presume, might choose to make healthy choices with regard to food, sleep, physical activity, etc if they knew what to do and were motivated to do so.

                                        2) there are academic physicians who are doing research on nutritional epidemiology and population based efforts to motivate the American public to change their ways promote positive health behaviors and prevent illness and injuries.

                                        1) I disagree with this presumption. Even for those in poverty, but especially for the 300M in relative affluence, they know enough of what to do that they are currently making informed decisions to live unhealthy lifestyles. Yes, there is contradictory information out there as to specifics, but not eating garbage and getting a little bit of exercise aren't secrets waiting to get out.

                                        The same goes for motivation. People know they are borderline diabetic, or at high risk of having a stroke or heart attack, etc., yet they actively choose to continue to overeat clearly unhealthy foods, drink Coke, and sit all day.

                                        I don't know what it is which drives the few people who finally do make that break and adopt a healthy lifestyle, but it is not a lack of information. If anything, a psychiatrist is probably their best hope, not a pumped up PCP trying to push their personal diet plans and nutritional supplements.

                                        2) This is the only thing I can possibly see working large scale, and even that I doubt will be very effective. Again, I think the major tenets of a healthy lifestyle and the reasons it's important are common knowledge. There would have to be a societal shift that I don't see coming any time soon, and certainly isn't going to be inspired by a public health campaign.
                                         

                                        theKingLT

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                                          1) I disagree with this presumption. Even for those in poverty, but especially for the 300M in relative affluence, they know enough of what to do that they are currently making informed decisions to live unhealthy lifestyles. Yes, there is contradictory information out there as to specifics, but not eating garbage and getting a little bit of exercise aren't secrets waiting to get out.

                                          The same goes for motivation. People know they are borderline diabetic, or at high risk of having a stroke or heart attack, etc., yet they actively choose to continue to overeat clearly unhealthy foods, drink Coke, and sit all day.

                                          I don't know what it is which drives the few people who finally do make that break and adopt a healthy lifestyle, but it is not a lack of information. If anything, a psychiatrist is probably their best hope, not a pumped up PCP trying to push their personal diet plans and nutritional supplements.

                                          2) This is the only thing I can possibly see working large scale, and even that I doubt will be very effective. Again, I think the major tenets of a healthy lifestyle and the reasons it's important are common knowledge. There would have to be a societal shift that I don't see coming any time soon, and certainly isn't going to be inspired by a public health campaign.
                                          In my n=1 experience the PCP pushing lifestyle advice can still be effective in peds where parents are more likely to force lifestyle changes on their children that they wouldn't follow themselves. As for adults, I agree it's hard to think the information isn't available but I think another voice of promotion can only help
                                           
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                                          LizzyM

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                                            Prometheus123

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                                              1) I disagree with this presumption. Even for those in poverty, but especially for the 300M in relative affluence, they know enough of what to do that they are currently making informed decisions to live unhealthy lifestyles. Yes, there is contradictory information out there as to specifics, but not eating garbage and getting a little bit of exercise aren't secrets waiting to get out.

                                              The same goes for motivation. People know they are borderline diabetic, or at high risk of having a stroke or heart attack, etc., yet they actively choose to continue to overeat clearly unhealthy foods, drink Coke, and sit all day.

                                              I don't know what it is which drives the few people who finally do make that break and adopt a healthy lifestyle, but it is not a lack of information. If anything, a psychiatrist is probably their best hope, not a pumped up PCP trying to push their personal diet plans and nutritional supplements.

                                              2) This is the only thing I can possibly see working large scale, and even that I doubt will be very effective. Again, I think the major tenets of a healthy lifestyle and the reasons it's important are common knowledge. There would have to be a societal shift that I don't see coming any time soon, and certainly isn't going to be inspired by a public health campaign.
                                              That's not to say I disagree with their intentions. It's an important cause and I applaud their effort, I just think it's futile.

                                              But then you find situations like this one where people in an intensive, and cost-effective program in their neighborhood are able to make major changes that reduce their risk of serious illness:
                                              YMCA prediabetes program results in weight loss, lower costs

                                              Most people don't listen, but a few improve their behavior enough to make a difference that's worth working towards.

                                              Knowing the right information isn't the same as putting it into practice. It's helpful to have coaches (e.g. physicians and allied providers, mentors, etc.) reminding you of what you already know, providing social support, caring, and nudging you towards doing what you know is good for you. Social support from communities of people making the same changes is also very powerful, as in that program that you linked to, @LizzyM.

                                              Trying to help patients with chronic diseases in general is a bit of a lost cause, but it's a noble one that's worth fighting for. Most patients get worse over time, even most of the ones who do their best to live a reasonably healthy lifestyle. At least, that's my impression from shadowing. If you want to work with patients with chronic diseases especially, I think it's important to be ok with that. I think it's important to judge ourselves not based on what patients choose to do, but rather on whether we did everything we could within reason, the limits of current medical knowledge, ethics, etc. to increase the probability of a good outcome. It's also important to be open to feedback from various sources and to use that feedback judiciously to improve ourselves so that we can increase the probability of good outcomes even further.
                                               
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                                              Med Ed

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                                                That's not to say I disagree with their intentions. It's an important cause and I applaud their effort, I just think it's futile.

                                                It certainly is with that attitude.

                                                If you do not already have one, I suggest picking up a copy of Motivational Interviewing in Health Care. How to actually alter patient behavior is an area that has been studied quite a bit over the years, although application in practice is, shall we say, uneven.

                                                hurtem&healem said:
                                                I disagree with this presumption. Even for those in poverty, but especially for the 300M in relative affluence, they know enough of what to do that they are currently making informed decisions to live unhealthy lifestyles

                                                It is certainly easy to assume that, until you meet patient after patient who has never once read a food label, or who think that it's okay to sit in a chair for 9 continuous hours a day (minus bathroom breaks). It's not about turning people into Crossfit Paleovegans, it's about making people more cognizant of decisions they have usually been making mindlessly for their whole lives. Do that and you can get better decisions at least some of the time.

                                                Meaning when you're a PCP and someone comes in for their annual wellness check you sit and chat for an hour?!

                                                Your snark aside, an hour of time with a patient lets you give him/her something they are completely unaccustomed to in healthcare: the chance to have a meaningful interaction with a physician.
                                                 
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                                                ithrowtofu

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                                                  I will be applying next year, to matriculate fall 2020, and am very interested in both functional medicine and nutrition as part of my medical education. They are obviously things I can self-study/obtain accreditation for after medical school, but I would be very interested to know of any schools that have begun taking meaningful steps towards incorporating “lifestyle” medicine into their curriculum, along with the traditional medical education. Thanks!

                                                  Feinberg School of Medicine at Northwestern includes Lifestyle Medicine in its curriculum! Its one of its 5 curricular threads.
                                                   

                                                  ekmf27050

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                                                    Everyone who has a PCP should be hearing this information from him or her, whether it’s called “lifestyle medicine” or “how to stay off dialysis” or whatever. The problem is that, while it’s hard for us to imagine, a lot of the people who are most at risk of contracting these super-preventable conditions and diseases are the ones who DON’T have a primary doctor to teach them how not to get Type II diabetes or heart disease or osteoporosis or whatever. And yeah, I know how to Google, “how to prevent hypertension,” but (here’s the kicker), I’m not part of the demographic most at risk of dying from complications of HBP in the first place.

                                                    OP, I call it regular old “primary care,” not lifestyle Medicine or functional medicine or whatever. But, yeah, it should be a big part of every school’s curriculum. My guess is that, absent an MD/MPH program, you won’t see a whole lot of this in medical school, possibly because so much of it is common knowledge.

                                                    To the above point- i worked for a PCP who does exactly that. She studied/researched functional medicine on her own, mostly, and implemented the solid evidence-based aspects into her practice. This included nutrition, stress management, sleep hygiene, etc. She incorporates pretty extensive wellness counseling into physicals, and fought corporate to keep her appointment lengths longer to allow for this- she's not concierge. She keeps tabs on free or low cost websites, apps, and resources for patients. Sure, not everyone wanted the lifestyle changes. Some view taking statins as easier/better than diet changes no matter what. But seeing her help people get off meds/prevent needing meds/feel better overall was pretty cool.
                                                     
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