Thoughts on beginning to prioritize nutrition?

[Espressso]

I for one LOVE it.

Do you think as time goes on, more and more medical programs will begin to integrate more nutritional studies into the curriculum?


Here's a good, short read on it:

http://www.npr.org/sections/health-...learned-to-cook-they-might-give-better-advice

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[To be MD]

I for one LOVE it.

Do you think as time goes on, more and more medical programs will begin to integrate more nutritional studies into the curriculum?


Here's a good, short read on it:

http://www.npr.org/sections/health-...learned-to-cook-they-might-give-better-advice

"If doctors learned to cook" (e.g. if they had fun, healthy cooking instruction integrated into their schedules with the added bonus of free food), they would definitely give better advice. There would probably be healthier, happier people at the med school too.

But, from my understanding of how medical school and med students, if you're just planning on taking on another class on top of the already horrific course load about how important it is to eat your fruits & vegetables, there might be a riot. Doctors already know the importance of not smoking, of having a healthy diet, regular cardiovascular exercise, etc.; they just, sometimes, don't do it themselves because of their intense schedule. Changing the doctors' behavior and, hopefully thereafter, their advice to patients is a great idea; I'm just not sure "adding a class" is the right way to go about it.

I'd love to see the former implemented, but I cringe at the idea of the latter unless it was integrated into the material without adding significant bulk. I'm applying to Tulane; I hope to be one of the students in the cooking classes 🙂.

 

[gyngyn]

Cooking is great.
Nutrition science, unfortunately, has lagged so dramatically that it's hard to find reliable, reproducible data that can be taught with a straight face. It's much more scientific to teach nutrition classes on what we don't understand.

 

[oshanimalia]

Cooking is great.
Nutrition science, unfortunately, has lagged so dramatically that it's hard to find reliable, reproducible data that can be taught with a straight face. It's much more scientific to teach nutrition classes on what we don't understand.

Can you elaborate on what you mean by what we "don't understand"? How does one teach something they do not understand?

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[gyngyn]

Can you elaborate on what you mean by what we "don't understand"? How does one teach something they do not understand?

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Nutrition is an important area in which scientific information is lacking, conflicting or obtained by very unreliable methods.

 

[starspells]

.

 

[gyngyn]

Exercise, meditation, mindfulness, sleep hygiene, maintaining/achieving a normal weight and avoiding harmful substances have been shown to promote wellness. The science of what constitutes a healthy diet is full of conflicting studies using unreliable methods, though (patient recall, for example).
I do recommend that you read the references for any course you teach so that you will know where you are on firm ground and where you are making suggestions based on "best available" information.

 

[Mansamusa]

Doctors would have to have more time with patients to actually be able to share their thoughts. This could be a good outreach program where health professionals volunteer, but what hospital gives physicians time to give recipe ideas to patients? That's why doctors often direct patients to other resources

Bad nutrition is largely influenced by industry and the addictive nature of the prossessed food we eat. There have been studies that have shown that education is minimally effective at changing eating habits and that policy regulation is a much more effective route.

There is a lot of disagreement on what constitutes a good diet.

Nutrition needs to be done at a childhood level. It would make more sense to give nutritional info to new parents then train teachers to teach nutrition and sponsor public school programs that get parents involved. And then have rules in school about what to eat and then provide children with those kinds of food. It is incredibly difficult to lose and maintain weight loss as an adult (though even small nutritional changes can help).

Tl;dr: doctors knowing nutrition will not be as beneficial as a ton of other things imo, but could still be cool to learn

Edit: Not to mention that a strong primary care system is needed to actually get this info to patients via doctors. So we need to work on that

 

[Perrotfish]

Can you elaborate on what you mean by what we "don't understand"? How does one teach something they do not understand?

Sent from my SM-G900V using SDN mobile

Its honestly difficult to give good advice concerning nutrition when you start digging into the data. You'll find compelling arguments for high and low fat diets, high and low cholesterol diets, yes fruits, no fruits, yes grains, no grains, yes but only whole grains, and strong arguments for both eating and not eating every part of an egg.

Reading through the data the only things that everyone seems to be certain about:
1) Sugar is bad, and the right amount is none
2) Liquid sugars (soda and juice) are especially bad
3) Green, leafy, calorie free, crunchy vegetables are good.

Beyond that extrodinarily basic advice its really hard to tell anyone anything helpful

 

[gyngyn]

Its honestly difficult to give good advice concerning nutrition when you start digging into the data. You'll find compelling arguments for high and low fat diets, high and low cholesterol diets, yes fruits, no fruits, yes grains, no grains, yes but only whole grains, and strong arguments for both eating and not eating every part of an egg.

Reading through the data the only thing that everyone seems to be certain about:
1) Sugar is bad, and the right amount is none
2) Liquid sugars (soda and juice) are especially bad
3) Green, leafy, calorie free, crunchy vegetables are good.

Beyond that extrodinarily basic advice its really hard to tell anyone anything helpful

Add legumes and I mostly agree.

 

[Perrotfish]

Add legumes and I mostly agree.

I also forgot black coffee and unsweetened tea.

 

[ace_inhibitor111]

Its honestly difficult to give good advice concerning nutrition when you start digging into the data. You'll find compelling arguments for high and low fat diets, high and low cholesterol diets, yes fruits, no fruits, yes grains, no grains, yes but only whole grains, and strong arguments for both eating and not eating every part of an egg.

Reading through the data the only things that everyone seems to be certain about:
1) Sugar is bad, and the right amount is none
2) Liquid sugars (soda and juice) are especially bad
3) Green, leafy, calorie free, crunchy vegetables are good.

Beyond that extrodinarily basic advice its really hard to tell anyone anything helpful

Even then, there are associations between increased candy intake and reduced cardiovascular disease markers and mortality.

 

[songl4a]

.

 

[Crayola227]

we get a lot of biochemistry learning about vitamin and mineral cofactors

truth is, dieticians and nutrition services can deal with this stuff, there's plenty of other more difficult info to cram into an MD, info that no one else in the med hierarchy can be expected to know

I think docs need to learn carb counting and to be able to teach DM patients about it and how to use a a book or app to help with that in med school, sure enough I was taught this

otherwise, part of being a doctor is educating YOURSELF
it's not hard to learn to read a food label
and we are taught in epi & stats how to critically appraise clinical literature
I had a personal interest in wellness prior to med school that I think I am very self-educated on exercise, musculoskeletal medicine, and nutrition
otherwise, a lot of learning how to counsel on diet I think you can pick up as it pertains to your field and the most common diagnoses you see

e.g. if you are in opthalmology, hopefully you would read the current literature in your field and see that there is data showing omega 3 fatty acids as a good adjunct nutrition therapy for dry eye caused by a number of opthalmological conditions
e.g. one would pick up from whatever exposure to GI as a field that low FODMAP diets are worth trying for a variety of bowel related issues such as IBD/IBS, and even various arthritides that may be affected by gut flora

the curriculum should include more musculoskeletal medicine IMHO, one thing I think is done better in a DO ed vs an MD one

 

[gyngyn]

one thing I think is done better in a DO ed vs an MD one

You need to see our anatomy course!

 

[Mansamusa]

http://www.mayoclinic.org/cholesterol-lowering-supplements/art-20050980
May, may, may, may....

Also associations between reduced cardiovascular disease and alcohol consumption, although no consensus on how much alcohol.

Ah, but then I think those researchers retracted their claims about wine this year (they were just comparing people who normally drink wine to those who don't, which, looking back, they realized that the wine drinkers were normally wealthy and upper class while non wine drinkers were poorer. They didn't control for that confounding variable). It's always changing.

And then there are patients, like my dad, who understand these press releases and then pour olive oil all over their food because "olive oil is good for you." Which is even more reason why nutrition should be a public health issue rather than an individual physician-patient thing. Phyisicians won't have time to cover everything

 

[breezy16]

"If doctors learned to cook" (e.g. if they had fun, healthy cooking instruction integrated into their schedules with the added bonus of free food), they would definitely give better advice. There would probably be healthier, happier people at the med school too.

But, from my understanding of how medical school and med students, if you're just planning on taking on another class on top of the already horrific course load about how important it is to eat your fruits & vegetables, there might be a riot. Doctors already know the importance of not smoking, of having a healthy diet, regular cardiovascular exercise, etc.; they just, sometimes, don't do it themselves because of their intense schedule. Changing the doctors' behavior and, hopefully thereafter, their advice to patients is a great idea; I'm just not sure "adding a class" is the right way to go about it.

I'd love to see the former implemented, but I cringe at the idea of the latter unless it was integrated into the material without adding significant bulk. I'm applying to Tulane; I hope to be one of the students in the cooking classes 🙂.

I believe LSU or another big southern medical school has began enrolling MS1s in cooking classes (healthy). I remember watching the video and the students were explaining "Hey, if we can't cook or eat healthy, how in the world can I advise my pt?"
I cant find it atm, but I'll keep looking. I think its super important to have these courses.

 

[Mansamusa]

I believe LSU or another big southern medical school has began enrolling MS1s in cooking classes (healthy). I remember watching the video and the students were explaining "Hey, if we can't cook or eat healthy, how in the world can I advise my pt?"
I cant find it atm, but I'll keep looking. I think its super important to have these courses.

That's the link OP posted. Tulane

(As an aside, the course is also only an elective or can be used as part of our required service hours; not a part of the curriculum. I think they are just heavily advertising it to attract investors and funding. Which is good because tuition is way too high and this may allow them to not keep raising it)

 

[breezy16]

That's the link OP posted. Tulane

(As an aside, the course is also only an elective or can be used as part of our required service hours; not a part of the curriculum. I think they are just heavily advertising it to attract investors and funding. Which is good because tuition is way too high and this may allow them to not keep raising it)

My bad, just read the premise of the post and replied on the go 🙂

 

[XxThaDoggxX]

Exercise, meditation, mindfulness, sleep hygiene, maintaining/achieving a normal weight and avoiding harmful substances have been shown to promote wellness. The science of what constitutes a healthy diet is full of conflicting studies using unreliable methods, though (patient recall, for example).
I do recommend that you read the references for any course you teach so that you will know where you are on firm ground and where you are making suggestions based on "best available" information.

Not to mention every time they release the new dietary guidelines every 5 years they contradict major themes of the one released 5 years prior.

Though as a nutrition major I would love to see more of this implemented

 

[njtrimed]

At one of my interviews, we had the opportunity to ask the dean anything we wanted, and one of the students asked if he thinks there is enough emphasis on nutrition. His response was perfect; he basically said it couldn't be less, as it is approximately one three hour lecture, for exactly the reasons @gyngyn outlined. Nutritional studies are dubious at best. Much like studies about exercise, there are a ton of studies with very few reproduceable conclusions.

There are two respectable physicians in my state who have chosen to make nutrition integral to their practices. One has built a small empire on this, and the other is an academic internal medicine physician who bought a farm, hired a nutritionist (who was a lifelong patient of the aformentioned physician) and is devoting the remainder of his career to teaching patients to "live mindfully." There is no real scientific data to support exactly what either of them is doing, but I started following some of the recommendations outlined in a book written by one of them, and so have many of the people close to me. I've seen a few of them come off medications for everything from hypertension and cholesterol to even coming off of methotrexate for rheumatoid arthritis. In my mid-thirties, I stopped tracking calories and kept up my high-intensity triathlon training and I am achieving race times I never thought possible, on much less training time than I ever had before, since I'm a working parent in school full-time.

My stories are purely anecdotal. I can't advise patients based on this or what I've learned from these physicians. And neither of them seems to be publishing anything scientific about their success in private practice, because the funding probably isn't there and they need to survive. Nutrition has to become something important enough to warrant widespread research funding. Regardless of that or the field I choose, I hope to at least educate my patients to consume a mostly plant-based diet with lots of greens and legumes, and limit processed foods to the same extent that alcohol and other chemicals should be limited.

 

[Mansamusa]

See that is one of the biggest problems with nutrition. So much of "good nutrition" information has been heavily influenced by industries and much of the nutrition "research" is really just a way to manipulate people to buy a product and build up a business.

Watching the FDA guidlines be made is like watching a circus. The vegan lobby sues over the cholesterol limit being to high because of the egg lobby, the beef lobby sues because the FDA recommends less red meat, GNC sued because the FDA says to avoid dietary supplements, etc. The wine lobby built up a lawsuit when those researchers realized that wine might not actually have cardiovascular benefits

Who knows how much of those guidelines are based on solid research and how much has been influenced by $ and lawsuits?

But I do think teaching stuff like Dr. Lustig's work could be a good part of the med school curriculum. Even though it still isn't 100% accepted, I think it gives students a lot to think about

Not to mention every time they release the new dietary guidelines every 5 years they contradict major themes of the one released 5 years prior.

Though as a nutrition major I would love to see more of this implemented

 

[Crayola227]

some of it is just picking your battles

most of what lands people at my professional door is lifestyle, sure
they're obese, don't exercise and do drugs in the form of tobacco, booze, street ****, or Pepsi
in some ways I'm off the hook for obsessing about nutrition because I'm just trying to get people to stop killing themselves in all the obvious ways
I guess I'm saying what I said before, MDs usually don't need to get into detail because we have bigger battles to fight

that's what I'm getting at too, is size effect
whatever health benefit someone gets by *only* changing that there's no artificial sweetener in their diet can easily be obscured by a whole host of other factors we already know make a huge difference in health

just the benzene they are breathing in from the concrete jungle maybe?

the truth is that humans are better fed than they've ever been in our history with regards nutritional deficiencies and intake of food necessary for human life
we're getting too much and that worries me more than the exact balance or if there's things they shouldn't be eating at all
the restrictive diets concern me more than any item they may be eating too

I said above there's definitely tweaks that can be made with real value, but last thing MDs need is a cooking class
that's just to provide some elective filler

want to learn to cook? watch the food network, use google, and experiment. learn by doing, learn by doing - Turk
I downloaded Alton Brown's Good Eats, and use a guy named Meathead's website
buy your cooking instruments at Goodwill & Dollar Store to save money

 

[Giovanotto]

Cooking is great.
Nutrition science, unfortunately, has lagged so dramatically that it's hard to find reliable, reproducible data that can be taught with a straight face. It's much more scientific to teach nutrition classes on what we don't understand.

I was initially very gun-ho about being a nutritionist, until I took a few classes in that department. Still enjoy the field though, and it is making some strides recently. It's certainly a science we cannot afford to lose.

 

[NimbleNavigator]

You guys are talking about nutrition as if it's the golden ticket. It's not. Lots of people ingest foods that they already know are terrible for them - soda, french fries, chocolate, alcohol etc. Obviously, "everything in moderation," but if you're drinking a soda a day that's a problem.

IMO more research needs to be done on how to get patient compliance up. Nutrition information would be valuable, but learning how to get patients to actually do what's good for them would be much better.

 

[Mansamusa]

You guys are talking about nutrition as if it's the golden ticket. It's not. Lots of people ingest foods that they already know are terrible for them - soda, french fries, chocolate, alcohol etc. Obviously, "everything in moderation," but if you're drinking a soda a day that's a problem.

IMO more research needs to be done on how to get patient compliance up. Nutrition information would be valuable, but learning how to get patients to actually do what's good for them would be much better.

If you read news sites about anything health/healthcare related, there is always someone in the comments talking about how the problem is "NUTRITION. Med school don't teach any nutrition and this is why our health is getting worse." It's a buzzword, so it may be good to promote stuff like this just for the "branding" purposes of physicians. Showing that we are listening and trying to respond to needs.

But the Mediterranean diet is the big thing to lower heart disease risks. The diet is basically just eating natural, non-industrial made foods. So, yeah, I do agree that a lot of the major premises of nutrition are common sense. It's now just trying to alter those major premises to adjust for the fact that people do and will continue to eat processed foods

 

[mistafab]

I'd like to extend this post a little further by tying our culture's current food habits with the lessons learned decades ago with smoking.

In a pre-policy era, smoking was entrenched in the culture. Once harms were understood, policy changed, and the ability of companies to actively advertise their products in television/media was pulled. This lead to a cascade effect (set in motion in 1964), which in turn has led us to today, where the current smoking in the united states is at 18.8% in men and 14.8% in women (http://www.cdc.gov/tobacco/campaign/tips/resources/data/cigarette-smoking-in-united-states.html). This stands in stark contrast to an era right after the first push against tobacco, where smoking was at 42% prevalence (1965).

Now, to bring it back to our food habits, in the USA the prevalence of Obesity in adults is 34.9% (http://www.cdc.gov/obesity/data/adult.html). At this point in time, we already know the dangers of poor eating habits, but have not made many changes to public policy. Look at any media today and you will find active advertisements of food that could harm people if consumed regularly. I'd like to point out that education on food habits will likely not do much to prevent obesity, like education on smoking doesn't get people to quit. It is my opinion that policy is the best way to address the endemic obesity crisis of our current age, much like policy was the best solution for smoking in the past.

Doctors would have to have more time with patients to actually be able to share their thoughts. This could be a good outreach program where health professionals volunteer, but what hospital gives physicians time to give recipe ideas to patients? That's why doctors often direct patients to other resources

Bad nutrition is largely influenced by industry and the addictive nature of the prossessed food we eat. There have been studies that have shown that education is minimally effective at changing eating habits and that policy regulation is a much more effective route.

There is a lot of disagreement on what constitutes a good diet.

Nutrition needs to be done at a childhood level. It would make more sense to give nutritional info to new parents then train teachers to teach nutrition and sponsor public school programs that get parents involved. And then have rules in school about what to eat and then provide children with those kinds of food. It is incredibly difficult to lose and maintain weight loss as an adult (though even small nutritional changes can help).

Tl;dr: doctors knowing nutrition will not be as beneficial as a ton of other things imo, but could still be cool to learn

Edit: Not to mention that a strong primary care system is needed to actually get this info to patients via doctors. So we need to work on that

 

[Giovanotto]

I'd like to extend this post a little further by tying our culture's current food habits with the lessons learned decades ago with smoking.

In a pre-policy era, smoking was entrenched in the culture. Once harms were understood, policy changed, and the ability of companies to actively advertise their products in television/media was pulled. This lead to a cascade effect (set in motion in 1964), which in turn has led us to today, where the current smoking in the united states is at 18.8% in men and 14.8% in women (http://www.cdc.gov/tobacco/campaign/tips/resources/data/cigarette-smoking-in-united-states.html). This stands in stark contrast to an era right after the first push against tobacco, where smoking was at 42% prevalence (1965).

Now, to bring it back to our food habits, in the USA the prevalence of Obesity in adults is 34.9% (http://www.cdc.gov/obesity/data/adult.html). At this point in time, we already know the dangers of poor eating habits, but have not made many changes to public policy. Look at any media today and you will find active advertisements of food that could harm people if consumed regularly. I'd like to point out that education on food habits will likely not do much to prevent obesity, like education on smoking doesn't get people to quit. It is my opinion that policy is the best way to address the endemic obesity crisis of our current age, much like policy was the best solution for smoking in the past.

Unfortunately, obesity and metabolic syndrome are a socioeconomic problem today. Nothing more. I believe that until the USDA and the FDA start doing their job nothing will change. This is one of those scenarios where I believe the government needs to step up and protect its citizens.

 

[Espressso]

I'd like to extend this post a little further by tying our culture's current food habits with the lessons learned decades ago with smoking.

In a pre-policy era, smoking was entrenched in the culture. Once harms were understood, policy changed, and the ability of companies to actively advertise their products in television/media was pulled. This lead to a cascade effect (set in motion in 1964), which in turn has led us to today, where the current smoking in the united states is at 18.8% in men and 14.8% in women (http://www.cdc.gov/tobacco/campaign/tips/resources/data/cigarette-smoking-in-united-states.html). This stands in stark contrast to an era right after the first push against tobacco, where smoking was at 42% prevalence (1965).

Now, to bring it back to our food habits, in the USA the prevalence of Obesity in adults is 34.9% (http://www.cdc.gov/obesity/data/adult.html). At this point in time, we already know the dangers of poor eating habits, but have not made many changes to public policy. Look at any media today and you will find active advertisements of food that could harm people if consumed regularly. I'd like to point out that education on food habits will likely not do much to prevent obesity, like education on smoking doesn't get people to quit. It is my opinion that policy is the best way to address the endemic obesity crisis of our current age, much like policy was the best solution for smoking in the past.

Unfortunately, obesity and metabolic syndrome are a socioeconomic problem today. Nothing more. I believe that until the USDA and the FDA start doing their job nothing will change. This is one of those scenarios where I believe the government needs to step up and protect its citizens.

Agreed with both these comments. Policy is the most important step.