Physicians and nutrition

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BobbyE

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What can an MD do to be qualified and legally protected in giving nutrition advice? Are there any restrictions on an MD's dietary advice? I ask because my biggest interest right now is in the diet's function in hormones and metabolism, and the effect of diet on fat loss, athletes, and anabolism of lean mass. I am a community college student, on my way to undergrad, with a rapidly growing interest in medical school. My first steps into chemical science began this term.

Thanks in advance.
 
I don't think there's really any restrictions other than the fact that it can and most like will be under-emphasized in many fields.
 
Sports nutrition, eh? We share a common interest. Unfortunately, medical professionals have very little formal education in nutrition, and next to none in sports nutrition. I've spent the last 2-3 years researching general nutrition and sports nutrition during my free time.

Check out this certification: http://www.sportsnutritionsociety.org/CISSN.html

You can't really do anything with the certification alone, but it does let people know that you have a background in nutrition. On the downside, it's expensive to take the test (I think it's around $400)
 
Do not do those nutrition certifications online. There is no formal oversight or regulation on being a nutritionist.

You should ask a licensed RD or a few doctors who specialize in nutrition for more information.
 
It seems to me that maybe endocrinology would be ideal. Understanding hormones and metabolism is central to really understanding nutrition.

The two most notable sports doctors that come to my mind are Dr. Mauro Di Pasquale and Dr. Eric Serrano. They don't have any special certs or degrees, but instead just keep up on research.

Mauro Di Pasquale, for instance, is an MD in Canada who advises his patients to go on a low-carb, high-fat, high-protein diet with a weekly phase change of high-carbohydrate, medium-fat, medium-protein days. Because this goes against the conventional grain, could he get into any trouble? What kind of discretion do physicians have?

Please excuse my ignorance...
 
BobbyE said:
It seems to me that maybe endocrinology would be ideal. Understanding hormones and metabolism is central to really understanding nutrition.

The two most notable sports doctors that come to my mind are Dr. Mauro Di Pasquale and Dr. Eric Serrano. They don't have any special certs or degrees, but instead just keep up on research.
Click to expand...

James Andrews is also very well known in the sports world.
 
BobbyE said:
What can an MD do to be qualified and legally protected in giving nutrition advice? Are there any restrictions on an MD's dietary advice? I ask because my biggest interest right now is in the diet's function in hormones and metabolism, and the effect of diet on fat loss, athletes, and anabolism of lean mass. I am a community college student, on my way to undergrad, with a rapidly growing interest in medical school. My first steps into chemical science began this term.

Thanks in advance.
Click to expand...

It's not so much that there are restrictions, but that doctors are completely clueless about anything related to dieting, weight-lifting or nutrition in general, so don't expect to learn anything useful in medical school. For example, lots of doctors still think low-carb diets are all inherently bad for you, or just a "fad" despite all kinds of studies showing many people lost the most fat on long-term low carb groups. Also, a couple years back, my PCP told me that taking 1-1.5 g of protein per pound of bodyweight would essentially damage my kidneys. So you really got to learn about this stuff through other routes.

Some schools let you get a combined MD and MS in nutrition as a 4/5 year degree which could be an option if you have the time and money. IMO a good start to learn about different diets, how they affect metabolism and fat loss/anabolic muscle growth is Lyle McDonald. He really delves into the science behind most of this stuff as well.

http://www.bodyrecomposition.com/
 
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BobbyE said:
It seems to me that maybe endocrinology would be ideal. Understanding hormones and metabolism is central to really understanding nutrition.

The two most notable sports doctors that come to my mind are Dr. Mauro Di Pasquale and Dr. Eric Serrano. They don't have any special certs or degrees, but instead just keep up on research.

Mauro Di Pasquale, for instance, is an MD in Canada who advises his patients to go on a low-carb, high-fat, high-protein diet with a weekly phase change of high-carbohydrate, medium-fat, medium-protein days. Because this goes against the conventional grain, could he get into any trouble? What kind of discretion do physicians have?

Please excuse my ignorance...
Click to expand...
This^

Di Pasquale worked close with Charles Poliquin who has SOLID nutrition advice. Look up his stuff as well as info from others.
 
I've heard good things about Lyle McDonald I'll check that out. And yes, Charles Poliquin is the man. He obviously gets results having coached Olympic medalists in 12 different sports, 900 olympic and professional athletes at total.

So the consensus is basically that a physician, if sure and well-studied, could in legal safety give a patient unconventional dietary guidelines (e.g. low-carb).
 
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BobbyE said:
I've heard good things about Lyle McDonald I'll check that out. And yes, Charles Poliquin is the man. He obviously gets results having coached Olympic medalists in 12 different sports, 900 olympic and professional athletes at total.

So the consensus is basically that a physician, if sure and well-studied, could in legal safety give a patient unconventional dietary guidelines (e.g. low-carb).
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Many people can and do give "nutrition" advice, including chiropractors, naturopaths, homeopaths, trainers, health foodies and many similarly unqualified others. There's big money in the diet/sports/nutrition/supplements markets, most of what these people advocate is more BS than science. There should probably be more more government regulation to control the quackery.

The fact that someone is successful with athletes is not an endorsement to me. Don't know how many high level athletes you've known, many of them would hardly be described as intelligent/informed consumers.
 
Musclemass said:
The fact that someone is successful with athletes is not an endorsement to me. Don't know how many high level athletes you've known, many of them would hardly be described as intelligent/informed consumers.
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It is relevant that a trainer has had repeated and consistent success if you are an athlete looking to improve your ability. However, a trainer's success in athletics does not denote success in health care. This much is obvious.
 
BobbyE said:
It is relevant that a trainer has had repeated and consistent success if you are an athlete looking to improve your ability. However, a trainer's success in athletics does not denote success in health care. This much is obvious.
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If you take a look at his website, what IS obvious is that his business is to peddle expensive supplements (most of which broadly are unregulated and unproven) and trainer "credentials" to gullible people.

You might want to buy his $100 jar of Brain Force, which is described as useful to supercharge your brain.
 
Yeah he sells a lot of crap. Maybe you're right, maybe everything he says is worthless 🙂.
 
Don't overlook the placebo effect.

Most nutrition counseling is not reimbursed or it is reimbursed at a low level so it isn't worth a physician's time to do it. It is also not something that is covered extensively in medical school, residency or fellowship so most physicians have only a rudimentary knowledge of nutrition or understand it on the physiologic level but not in relation to the compostion of foods and food preparation methods. Most of the work of translating diet orders into meal patterns and tips for lifestyle changes is in the hands of registered dietitians. (national registry, some are also state licensed -- depends on the state). Most of the research into relationships between food, disease, well being, athletic performance is done by epidemiologists and physiologists (basic scientists).
 
Nutrition is not emphasized in the training of physicians. This is really too bad because when a physician refers a patient to see an RD for medical nutrition therapy, the RD expects the physician to include the basics of what dietary interventions should be made (with the RD essentially refining it). An example of this is the hypertensive or pre-hypertensive patient, in which the physician needs to outline aspects of a DASH (hypertension specific) diet or contraindications of high Potassium intake for example. Physicians that have any working knowledge of nutrition have obtained their knowledge through other sources than medical school (whether it be formal or informal education). Although you still need to be get through undergrad with a great track record to even be thinking about a career in medicine, your best bet would be a combined degree of some sort. An MD/PhD would probably be ideal, but there are a handful of programs that will offer an MD/MS in nutrition.
 
Musclemass said:
Don't know how many high level athletes you've known, many of them would hardly be described as intelligent/informed consumers.
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little jock hate here?

This shows how few "high level athletes" you know.
 
I think if you learn biochemistry, you can also learn some nutrition if you're willing to invest the time.

But the other way around... Learning nutrition without learning biochemistry, it just doesn't work as well.
 
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Well, my undergraduate degree will be in Biochem. If I can't get the best information from my university or graduate studies than I'll get it elsewhere. I'm only first-year first term undergraduate, age 20, and I am shooting for an MSTP. Maybe I'll end up researching something in this area, that'd be sweet.
 
BobbyE said:
Well, my undergraduate degree will be in Biochem. If I can't get the best information from my university or graduate studies than I'll get it elsewhere. I'm only first-year first term undergraduate, age 20, and I am shooting for an MSTP. Maybe I'll end up researching something in this area, that'd be sweet.
Click to expand...

Sounds great. An interesting area is the role of diet on hormone levels and the effect of hormone levels on cancer risk.
 
LizzyM said:
Sounds great. An interesting area is the role of diet on hormone levels and the effect of hormone levels on cancer risk.
Click to expand...

That is interesting, I'll keep an eye out for information and studies about this a long the way. When my biochem/biology is up to par, I'll have to seek out that info.
 
EgotiStick said:
little jock hate here?
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Not at all. Too many gullible people get sucked into the whole supplement thing. Proper nutrition for athletic performance is legitimate and very important. Many of the supplement pushers are charlatans and quacks, but very wealthy ones. They take advantage of many who are sincere in their desire to excel but not smart enough to understand they're being had.


EgotiStick said:
This shows how few "high level athletes" you know.
Click to expand...
You guessed wrong.
 
BobbyE said:
What can an MD do to be qualified and legally protected in giving nutrition advice? Are there any restrictions on an MD's dietary advice? I ask because my biggest interest right now is in the diet's function in hormones and metabolism, and the effect of diet on fat loss, athletes, and anabolism of lean mass. I am a community college student, on my way to undergrad, with a rapidly growing interest in medical school. My first steps into chemical science began this term.

Thanks in advance.
Click to expand...

I'm a registered dietitian going back to be a physician. I was originally pre-med, but liked nutrition and knew physicians get little to no nutrition education. Since I am very passionate about nutrition I decided to become a dietitian. The classes I took were amazing because they were more biochemistry and less food science (I have a human bio degree and a MS in nutrition and dietetics). Once I got into the clinical setting I realized I still really wanted to be a physician. Nutrition is extremely important so I am very glad I did this route so I have the knowledge/experience. Some physicians in my hospital system do nutrition classes with an NP and RD. They do them in group settings so they can make it worth their time (charging for each person vs just one person). If you are early in your academic career I would consider majoring in nutritional science, if possible. Some nutritional science majors include all of the pre-med classes where others you would need to take them in addition. Go to a school where the program has a strong biochemistry emphasis as it will help in med school (I am pre-med but I have a friend who did nutritional sciences and is a MS4 - she agreed with this). Plus, med schools seem to like when students who don't have the traditional pre-health sciences or biology degree. Get a degree is something you enjoy and then you'll find activities to get involved in that you are passionate about, you'll have something different to talk about at interviews, and you might stand out a little since you will likely be the only one on your interview day that has a nutrition background. Feel free to PM me if you have any questions.
 
I don't pay attention to my diet or to be perfectly in shape, all I do is eat only 3 meals, run/swim just to keep my healthy slim physique. But, of course in practice I'll preach to all patients what they should be doing, etc, even if I tell them big macs are bad, and 5 mins later, I eat one myself 😀

Although...personally I prefer Southern Chicken sandwiches and chicken tenders to big macs...If I wanted a burger I would go somewhere not as greasy and grilled just right!
 
As Atkins proved a few years back, many of the "truisms" within the nutrition field are simply false, and it is a field that has as its foundations a couple of longheld notions that actually have never been proven scientifically. There are some fairly comprehensive studies that show benefits of diametrically opposite diets, which allows for a lot of wiggle room in terms of medical stances. They recently disavowed the "food pyramid" as something not science based. Additionally, supplements are widely used but not regulated or well studied. And most would agree that vitamins are massively overused in the US in terms of need. Bottom line is it's a field that is full of controversy because a lot of the "science' is lacking. Which means if you are research minded it's a ripe field. But not a very highly paying field, unless you put your name on some fad diet.
 
patel2 said:
It's not so much that there are restrictions, but that doctors are completely clueless about anything related to dieting, weight-lifting or nutrition in general, so don't expect to learn anything useful in medical school. For example, lots of doctors still think low-carb diets are all inherently bad for you, or just a "fad" despite all kinds of studies showing many people lost the most fat on long-term low carb groups. Also, a couple years back, my PCP told me that taking 1-1.5 g of protein per pound of bodyweight would essentially damage my kidneys. So you really got to learn about this stuff through other routes.

Some schools let you get a combined MD and MS in nutrition as a 4/5 year degree which could be an option if you have the time and money. IMO a good start to learn about different diets, how they affect metabolism and fat loss/anabolic muscle growth is Lyle McDonald. He really delves into the science behind most of this stuff as well.

http://www.bodyrecomposition.com/
Click to expand...

I'm a graduate student in exercise science (will be a first year medical student this summer). I'm also a huge fan of Lyle McDonald.

In my own experience, I've met dietitians who didn't know what they were talking about either. People like Lyle McDonald (he has the same MS I will have in 4 months) have such an enormous amount of success stories (and not just bodybuilders who are cycling a number of different agents) to back up their approach to dieting, weight loss and exercise that they are really the only people I trust.
 
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cbrons said:
I'm a graduate student in exercise science (will be a first year medical student this summer). I'm also a huge fan of Lyle McDonald.

In my own experience, I've met dietitians who didn't know what they were talking about either. People like Lyle McDonald (he has the same MS I will have in 4 months) have such an enormous amount of success stories (and not just bodybuilders who are cycling a number of different agents) to back up their approach to dieting, weight loss and exercise that they are really the only people I trust.
Click to expand...

But like you said, you are soon to be an "expert" in the field. A layperson would gladly take nutrition advice from a physician.
 
TexasPhysician said:
But like you said, you are soon to be an "expert" in the field. A layperson would gladly take nutrition advice from a physician.
Click to expand...

No, actually I never said I am an expert, soon to be or otherwise. That being said, of course most people would take nutrition advice from a physician. But how much of an emphasis is place on nutrition in medical school?
 
cbrons said:
No, actually I never said I am an expert, soon to be or otherwise. That being said, of course most people would take nutrition advice from a physician. But how much of an emphasis is place on nutrition in medical school?
Click to expand...

Very little emphasis is placed on nutrition in medical school. It's been this way for at least 30 years (likely longer).
 
with biochem, you get to learn a lot about mechanisms and regulation. this allows you to actually think through different things that people tell you to do.

just plan diet and exercise based on your situation. a low carb diet will not work if you're active...which by that I mean like 4 or 5 times a week of sprinting or trying to run a 90% mile,2 mile, or 3 mile run... not a 15 minute pace jog around the city...with weight lifting. otherwise, a low carb diet will probably benefit you.
 
Danlee07 said:
a low carb diet will not work if you're active...which by that I mean like 4 or 5 times a week of sprinting or trying to run a 90% mile,2 mile, or 3 mile run... not a 15 minute pace jog around the city...with weight lifting. otherwise, a low carb diet will probably benefit you.
Click to expand...
Yes, it can! I've been on a low carb diet since January, I did a 15 k about a month and a half ago (got almost my same time from a year previous, when I had been eating high carb), do intense lifting 5 times a week, and sprints occasionally. Low carb will only hold you back if you're doing extremely long distance, like marathon and up.

Law2Doc said:
As Atkins proved a few years back, many of the "truisms" within the nutrition field are simply false, and it is a field that has as its foundations a couple of longheld notions that actually have never been proven scientifically. There are some fairly comprehensive studies that show benefits of diametrically opposite diets, which allows for a lot of wiggle room in terms of medical stances. They recently disavowed the "food pyramid" as something not science based. Additionally, supplements are widely used but not regulated or well studied. And most would agree that vitamins are massively overused in the US in terms of need. Bottom line is it's a field that is full of controversy because a lot of the "science' is lacking. Which means if you are research minded it's a ripe field. But not a very highly paying field, unless you put your name on some fad diet.
Click to expand...
Very true...
 
CaptainSSO said:
Yes, it can! I've been on a low carb diet since January, I did a 15 k about a month and a half ago (got almost my same time from a year previous, when I had been eating high carb), do intense lifting 5 times a week, and sprints occasionally. Low carb will only hold you back if you're doing extremely long distance, like marathon and up.


Very true...
Click to expand...
are you a continual runner or do you just train for 15k leading up to the weeks? It's a pretty serious difference in amount of calories. the diet just gives you a better bodily condition to attempt reaching your potential. no, low carb will not hold you back only for extremely long distance. it will hold you back for anything that requires your body to produce more energy than the carbs you ate. if I didn't eat as much, my times would be suffering especially on my meet days.

just an extreme example... Michael Phelps. stick a low carb diet to him and see how healthy and how his times are.
 
cbrons said:
No, actually I never said I am an expert, soon to be or otherwise. That being said, of course most people would take nutrition advice from a physician. But how much of an emphasis is place on nutrition in medical school?
Click to expand...

Exactly -- that's the real question. We're about to be people who are seen as experts in taking care of people's bodies, and nutrition is a big part of that. But it sounds like we won't really know what to tell patients about nutrition, other than what we believe based articles we've read and our personal experiences.
 
patel2 said:
Some schools let you get a combined MD and MS in nutrition as a 4/5 year degree which could be an option if you have the time and money.
Click to expand...

Does anyone know which schools do this?
 
LizzyM said:
Very little emphasis is placed on nutrition in medical school. It's been this way for at least 30 years (likely longer).
Click to expand...

There is also very little emphasis on starting a private practice. Medical school obviously can't teach you everything. There has to be A LOT of self study no matter which school someone attends.

I'm merely argueing that physicians are capable of giving nutrition advice. It might not be the best if you don't study it extensively, but the same goes for any field.
 
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In life all depends on good health. If you have good health then and then you can live your life happily. For that take balanced diet with full of nutrients. Take proper diet. Do exercise regularly. Keep walking. Eat healthy, fresh and hygienic food.
 
There's an upcoming Coursera course on this topic. Kind of amazing how abysmal nutrition education is in medical school given that our nation has eaten itself into disease and borrowed to pay for it. Check it out if you have time; looks awesome.

https://www.coursera.org/course/nutrition

From the website:

"This course covers the basics of normal nutrition for optimal health outcomes and evidence-based diets for a variety of diseases.

Nutrition for Health Promotion and Disease Prevention
Katie Ferraro, MPH, RD, CDE"
 
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