what about nutrition?

[RySerr21]

this doesnt necessarily have anything to do with DO, but i just like this forum better .

when is nutrition covered during med school? looking at multiple curriculums at both MD and DO....i fail to see it mentioned anywhere. one of the admins from dartmouth came to my school yesterday....i asked her about nutrition and the curriculum and her response "if you want any in depth study of nutrition it will have to be an elective, besides that, bits and pieces will be covered during other core courses..."

seriously? surely we know how much nutrition affects the onset of disease in this country. i am surprised it is not a bigger part of the curriculum. or have i just managed to miss every school that does incorporate nutrition?

it might seem to crazy to add yet another course to med school....but on the flip side it seems even more ridiculous to not include it at all.


how many people even knew there was a specialty in medicine called "preventive medicine"....a specialty im sure deals primarily with nutrition and how it affects our health and the onset of disease. obviously if people are going into that specialty they must have had some exposure to it at some point.....but when? do i really have to wiat til my 3rd/4th year?

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[LauraDO]

I believe that there is another thread that covers this that was discussed a few months ago

 

[MJB]

I believe that there is another thread that covers this that was discussed a few months ago

The lady is absolutely correct. I don't remember if it ended up being locked or not, but I'm quite sure it was not deleted.

To answer the question, we get Nutrition sprinkled in here and there, and had a specific lecture or two on it first semester.

 

[Ki45toryu]

AZCOM's 2nd quarter of Biochem is about half nutrition. So you are looking at almost a 4th of all Biochem taken = nutrition alone.

This is all discounting metabolism, and related nutrition of course.

 

[spicedmanna]

Here is a previous thread that had quite a bit of discussion on the topic:

http://forums.studentdoctor.net/showthread.php?t=480072

 

[RySerr21]

Here is a previous thread that had quite a bit of discussion on the topic:

http://forums.studentdoctor.net/showthread.php?t=480072

my bad! i will admit, i failed to perform a search this time . i typed in the thread title "nutrition" and nothing recent came up (or at least i missed it) so i figured it wasnt recently discussed.

apologies.

 

[whatdapho]

this doesnt necessarily have anything to do with DO, but i just like this forum better .

when is nutrition covered during med school? looking at multiple curriculums at both MD and DO....i fail to see it mentioned anywhere. one of the admins from dartmouth came to my school yesterday....i asked her about nutrition and the curriculum and her response "if you want any in depth study of nutrition it will have to be an elective, besides that, bits and pieces will be covered during other core courses..."

seriously? surely we know how much nutrition affects the onset of disease in this country. i am surprised it is not a bigger part of the curriculum. or have i just managed to miss every school that does incorporate nutrition?

it might seem to crazy to add yet another course to med school....but on the flip side it seems even more ridiculous to not include it at all.


how many people even knew there was a specialty in medicine called "preventive medicine"....a specialty im sure deals primarily with nutrition and how it affects our health and the onset of disease. obviously if people are going into that specialty they must have had some exposure to it at some point.....but when? do i really have to wiat til my 3rd/4th year?

I can't speak for other schools but here at DMU, we take a 2-3 month course on nutrition our second year. We even have lipid panels done prior to school and towards the end of the second year to see where are cholesterol, triglycerides, etc are at. As for the nutrition course, whether its an advocacy for lifestyle changes, i'll have to see but i'm pretty sure it will be in terms of eating habits, exercise, etc.

 

[RySerr21]

I can't speak for other schools but here at DMU, we take a 2-3 month course on nutrition our second year. We even have lipid panels done prior to school and towards the end of the second year to see where are cholesterol, triglycerides, etc are at. As for the nutrition course, whether its an advocacy for lifestyle changes, i'll have to see but i'm pretty sure it will be in terms of eating habits, exercise, etc.

DMU sounds better and better every day

 

[Instatewaiter]

this doesnt necessarily have anything to do with DO, but i just like this forum better .

when is nutrition covered during med school? looking at multiple curriculums at both MD and DO....i fail to see it mentioned anywhere. one of the admins from dartmouth came to my school yesterday....i asked her about nutrition and the curriculum and her response "if you want any in depth study of nutrition it will have to be an elective, besides that, bits and pieces will be covered during other core courses..."

seriously? surely we know how much nutrition affects the onset of disease in this country. i am surprised it is not a bigger part of the curriculum. or have i just managed to miss every school that does incorporate nutrition?

it might seem to crazy to add yet another course to med school....but on the flip side it seems even more ridiculous to not include it at all.


how many people even knew there was a specialty in medicine called "preventive medicine"....a specialty im sure deals primarily with nutrition and how it affects our health and the onset of disease. obviously if people are going into that specialty they must have had some exposure to it at some point.....but when? do i really have to wiat til my 3rd/4th year?

There are various places that you are going to find nutrition

1) Biochem course- you will probably have at least 2 lectures on nutrition- not including lipid and carbohydrate biochemistry. While this may not seem like a lot, the depth of those lectures usually is more than can be fit into the allotted time (at least in my experience) so there is a good amt of self study. The amt of stuff covered in 1 med school lecture dwarfs what is covered in 1 undergrad lecture

2) Endocrine- you should spend a good amt of time on lipid/carbohydrate annomalies as they related to DM etc

3) GI- should be a bunch here, esp how certain disorders are going to affect nutritional status

4) Womens health- you will cover proper pregnancy nutrition and with that there will be a lot of overlap into proper nutrition in general

5) Heme/onc- a bit here and there based on deficiencies causing various anemias, special diets for coumadin therapy etc

6) Neuro- again here and there based on metabolic causes of neuro dysfunction- B12, B1, DM, etc

7) Cardio- lipid problems (and how carbs relate) with atherosclerosis

So you will understand how nutrition plays into the pathogenesis of various disease. As for telling pts how to eat better, most is intuitive.

 

[RySerr21]

There are various places that you are going to find nutrition

1) Biochem course- you will probably have at least 2 lectures on nutrition- not including lipid and carbohydrate biochemistry. While this may not seem like a lot, the depth of those lectures usually is more than can be fit into the allotted time (at least in my experience) so there is a good amt of self study. The amt of stuff covered in 1 med school lecture dwarfs what is covered in 1 undergrad lecture

2) Endocrine- you should spend a good amt of time on lipid/carbohydrate annomalies as they related to DM etc

3) GI- should be a bunch here, esp how certain disorders are going to affect nutritional status

4) Womens health- you will cover proper pregnancy nutrition and with that there will be a lot of overlap into proper nutrition in general

5) Heme/onc- a bit here and there based on deficiencies causing various anemias, special diets for coumadin therapy etc

6) Neuro- again here and there based on metabolic causes of neuro dysfunction- B12, B1, DM, etc

7) Cardio- lipid problems (and how carbs relate) with atherosclerosis

So you will understand how nutrition plays into the pathogenesis of various disease. As for telling pts how to eat better, most is intuitive.

you'd think.......right?

 

[scpod]

....So you will understand how nutrition plays into the pathogenesis of various disease. As for telling pts how to eat better, most is intuitive.

Unfortunately, that's what a lot of medical people think-- that they know some basic sciences behind it so they ought to be able to use their intuition to tell someone how to eat right. That's BS in my opinion. It's like saying you learn the basic sciences of medicine in your first two years and intuitively treat your patients afterwards. You might have learned some of the basic sciences.... but you've still got alot to learn and have totally left out the clinical aspect of nutrition. I learned more about nutrition in one specific two-hour lecture on it than in all the combined science stuff you mentioned.

Teaching people about nutrition is NOT something intuitive. You have to know so much more about the types of foods on the market, the manufacturing processes, and the way they are prepared for serving.....it's endless. Nutrition is a vastly overlooked part of the population's health. You would be much better off referring your patients to someone who is well versed in nutrition than to try to treat them "intuitively".

 

[J1515]

Plenty of nutrition is taught in biochem and GI. It's also sprinkled in with other systems when applicable.

 

[RySerr21]

Unfortunately, that's what a lot of medical people think-- that they know some basic sciences behind it so they ought to be able to use their intuition to tell someone how to eat right. That's BS in my opinion. It's like saying you learn the basic sciences of medicine in your first two years and intuitively treat your patients afterwards. You might have learned some of the basic sciences.... but you've still got alot to learn and have totally left out the clinical aspect of nutrition. I learned more about nutrition in one specific two-hour lecture on it than in all the combined science stuff you mentioned.

Teaching people about nutrition is NOT something intuitive. You have to know so much more about the types of foods on the market, the manufacturing processes, and the way they are prepared for serving.....it's endless. Nutrition is a vastly overlooked part of the population's health. You would be much better off referring your patients to someone who is well versed in nutrition than to try to treat them "intuitively".

thats pretty much what i was trying to get at w/ my 3 word response..... well articulated.

 

[DragonWell]

Unfortunately, that's what a lot of medical people think-- that they know some basic sciences behind it so they ought to be able to use their intuition to tell someone how to eat right. That's BS in my opinion. It's like saying you learn the basic sciences of medicine in your first two years and intuitively treat your patients afterwards. You might have learned some of the basic sciences.... but you've still got alot to learn and have totally left out the clinical aspect of nutrition. I learned more about nutrition in one specific two-hour lecture on it than in all the combined science stuff you mentioned.

Teaching people about nutrition is NOT something intuitive. You have to know so much more about the types of foods on the market, the manufacturing processes, and the way they are prepared for serving.....it's endless. Nutrition is a vastly overlooked part of the population's health. You would be much better off referring your patients to someone who is well versed in nutrition than to try to treat them "intuitively".

Very well-stated. Maybe indigenous people were able to balance their diets intuitively by seeking out the foods they needed in their environment, and eating what was seasonally available, but this has little bearing on the brave, new world of processed foods that most people are interacting with on a daily basis.

At least in my experience, most, if not all, of the teaching about nutrition in med school still concerns frank deficiency states -ie. B12 leading to macrocytic anemia, etc. Even though there is now a lot of evidence supporting the the effects of long-term, suboptimal nutrition on many chronic disease states, this material has not yet been integrated into mainstream medicine. Perhaps that will change in the future, but I think there are a lot of economic, cultural, emotional etc. issues raised by attempting to address a patient's diet that many doctors (and patients) just don't want to deal with.

 

[scpod]

Plenty of nutrition is taught in biochem and GI. It's also sprinkled in with other systems when applicable.

Really? Did they tell you that worldwide 40% of men and 30% of women are now overweight? Or that 24% of men and 27% of women are obese? Did they tell you how obesity leads to sleep apnea, adult onset asthma, hypoxia, osteoarthritis, gout, hernias, low back pain, coronary heart disease, stroke, congestive heart failure, GERD, gall bladder disease, infertlity, polycystic ovary syndrome, pregnancy complications, menstrual irregularity, type 2 diabetes, insulin resistence, dyslipedemia, colon esophageal uterine prostate and lung cancers, depression, increased medical costs, discrimination, low self-esteem and reduced work productivity? Obesity is an epidemic that is raging through the US. Can you really adequately counsel your patients on their dietary needs based on what you learned in biochem and GI?

In your patients with cancer risk can you counsel them on the types of foods that give them detoxification support? What about the foods that contain fiber. folate, lycopene, phytonutrients, pro-biotics, vitamin D and other things that have shown to reduce risk? What about vascular health? Do you know about the foods that are antioxidants, flavanoid rich, contain folate, B2 B6, B12, have plant stanols/sterols, omega 3 fats, or are mineral rich? Can you tell them about the effects of high heat or long cooking times? Do you know what effects cooking containers have or which foods are typically riddled with pesticides? How much do you know about glycemic load and glycemic index? What about refined sugars? Can you tell the patient what to look for on the labels of food to tell if its full of bad stuff? What effect does refining have on grains? Which foods contain soluble and insoluble fibers?

What effect do Omega-6 fatty acid have on LTB-4, TXA-2, and and PGE-2? What about Omega-3 on LTB-5, PGE-3, and PGE-1? Which foods contain them? Which should you avoid? Is there a difference between grass-fed and grain-fed beef? Should you avoid one or the other? Is there a difference in vitamin content or taste?

There are just way too many factors in nutrition to think that your basic sciences curriculum is adequate enough to allow you to treat patients and give them good advice.

 

[RySerr21]

Very well-stated. Maybe indigenous people were able to balance their diets intuitively by seeking out the foods they needed in their environment, and eating what was seasonally available, but this has little bearing on the brave, new world of processed foods that most people are interacting with on a daily basis.

At least in my experience, most, if not all, of the teaching about nutrition in med school still concerns frank deficiency states -ie. B12 leading to macrocytic anemia, etc. Even though there is now a lot of evidence supporting the the effects of long-term, suboptimal nutrition on many chronic disease states, this material has not yet been integrated into mainstream medicine. Perhaps that will change in the future, but I think there are a lot of economic, cultural, emotional etc. issues raised by attempting to address a patient's diet that many doctors (and patients) just don't want to deal with.

so patients would rather die than deal with the fact that they eat unhealthy food? i highly doubt that. as a physician treating someone who has just had a massive heart attack....you tell them "if you completely change your diet, you can prevent and even reverse your heart disease." i'm sure they will find ways to deal with the surprising news that their diet needs some revisions. giving them a pill and a 3rd bypass surgery doesnt seem to cut it.

 

[RySerr21]

Really? Did they tell you that worldwide 40% of men and 30% of women are now overweight? Or that 24% of men and 27% of women are obese? Did they tell you how obesity leads to sleep apnea, adult onset asthma, hypoxia, osteoarthritis, gout, hernias, low back pain, coronary heart disease, stroke, congestive heart failure, GERD, gall bladder disease, infertlity, polycystic ovary syndrome, pregnancy complications, menstrual irregularity, type 2 diabetes, insulin resistence, dyslipedemia, colon esophageal uterine prostate and lung cancers, depression, increased medical costs, discrimination, low self-esteem and reduced work productivity? Obesity is an epidemic that is raging through the US. Can you really adequately counsel your patients on their dietary needs based on what you learned in biochem and GI?

In your patients with cancer risk can you counsel them on the types of foods that give them detoxification support? What about the foods that contain fiber. folate, lycopene, phytonutrients, pro-biotics, vitamin D and other things that have shown to reduce risk? What about vascular health? Do you know about the foods that are antioxidants, flavanoid rich, contain folate, B2 B6, B12, have plant stanols/sterols, omega 3 fats, or are mineral rich? Can you tell them about the effects of high heat or long cooking times? Do you know what effects cooking containers have or which foods are typically riddled with pesticides? How much do you know about glycemic load and glycemic index? What about refined sugars? Can you tell the patient what to look for on the labels of food to tell if its full of bad stuff? What effect does refining have on grains? Which foods contain soluble and insoluble fibers?

What effect do Omega-6 fatty acid have on LTB-4, TXA-2, and and PGE-2? What about Omega-3 on LTB-5, PGE-3, and PGE-1? Which foods contain them? Which should you avoid? Is there a difference between grass-fed and grain-fed beef? Should you avoid one or the other? Is there a difference in vitamin content or taste?

There are just way too many factors in nutrition to think that your basic sciences curriculum is adequate enough to allow you to treat patients and give them good advice.

the kines class i took this semster discussed most of what you just talked about...very likely in a lot less detail than you know, but the point is that it was a friken amazing class.

 

[DragonWell]

so patients would rather die than deal with the fact that they eat unhealthy food? i highly doubt that. as a physician treating someone who has just had a massive heart attack....you tell them "if you completely change your diet, you can prevent and even reverse your heart disease." i'm sure they will find ways to deal with the surprising news that their diet needs some revisions. giving them a pill and a 3rd bypass surgery doesnt seem to cut it.

That's a pretty extreme example. I would submit that patients that have just had a near-death experience may have a different level of motivation than "typical" patients. Ideally, nutritional intervention would occur long before the patient was at this stage, making motivation more difficult. (See cartoon below)

I think smoking also illustrates the point I was trying to make: although at this point everyone knows it's harmful health effects, it's also well documented that many physicians do less than they could to help patients quit, and are uneducated about the most recent cessation strategies. Why is this? "Clinicians cited such barriers as time constraints, perceptions about their personal roles in helping smokers quit, inadequate information or training, and reimbursement issues." I suspect many physicians would cite similar reasons for not addressing diet with their patients...http://www.rwjf.org/programareas/resources/grantsreport.jsp?filename=043562.htm&pid=1141

 

[spicedmanna]

Well, I actually don't think you can "teach" someone in a classroom setting how to counsel a patient about nutrition, like you would other basic sciences. You see, I think you need to be healthy yourself and know about it in your own life first. It's the nucleus effect. Knowing about it scientifically, or intellectually is one thing, but unless you are living it and know what it takes to do it, you don't know very much at all. I mean in terms of lifestyle stuff. Then it goes from there. Actions have a way of being much more powerful than mind-fluff.

 

[DragonWell]

Well, I actually don't think you can "teach" someone in a classroom setting how to counsel a patient about nutrition, like you would other basic sciences. You see, I think you need to be healthy yourself and know about it in your own life first. It's the nucleus effect. Knowing about it scientifically, or intellectually is one thing, but unless you are living it and know what it takes to do it, you don't know very much at all. I mean in terms of lifestyle stuff. Then it goes from there. Actions have a way of being much more powerful than mind-fluff.

 

[RySerr21]

That's a pretty extreme example. I would submit that patients that have just had a near-death experience may have a different level of motivation than "typical" patients. Ideally, nutritional intervention would occur long before the patient was at this stage, making motivation more difficult. (See cartoon below)

I think smoking also illustrates the point I was trying to make: although at this point everyone knows it's harmful health effects, it's also well documented that many physicians do less than they could to help patients quit, and are uneducated about the most recent cessation strategies. Why is this? "Clinicians cited such barriers as time constraints, perceptions about their personal roles in helping smokers quit, inadequate information or training, and reimbursement issues." I suspect many physicians would cite similar reasons for not addressing diet with their patients...http://www.rwjf.org/programareas/resources/grantsreport.jsp?filename=043562.htm&pid=1141

agreed, it was an extreme example. my point was that even when we get to that point....nutrition isn't a first option.... and it should be, or at least included in first conversation aboutu "what do we do to solve this problem"

too often when patients do get to that point (which has to happen quite a lot if it is the leading cause of death).... we are too quick to jump to invasive surgeries and/or pill popping habits. a drastic dietary intervention would be less expensive and in way more effective in the long run....... instead we have people getting their 2nd and 3rd bypass or angioplasty.

 

[MJB]

so patients would rather die than deal with the fact that they eat unhealthy food? i highly doubt that. as a physician treating someone who has just had a massive heart attack....you tell them "if you completely change your diet, you can prevent and even reverse your heart disease." i'm sure they will find ways to deal with the surprising news that their diet needs some revisions. giving them a pill and a 3rd bypass surgery doesnt seem to cut it.

In many, many cases....yes. Even those that have had the bypass, etc. Sure, they'll come around and "get serious" about eating more healthy foods for a while, maybe even a few months, but in many cases, they are back to old habits before too long.

I'm guilty of this sort of behavior myself.

 

[DocJulez]

the kines class i took this semster discussed most of what you just talked about...very likely in a lot less detail than you know, but the point is that it was a friken amazing class.

Its cuz we Kin's are awesome.

And I totally agree with you. Nutrition needs to be more involved in medicine, esp nowadays. In Canada our overweight/obese numbers arent too far behind u guys. so this is def not just a USA thing. hopefully wherever we go to school prepares us, and if not.....welll seek out a nutritionist i guess......

 

[JWE27]

Unfortunately, that's what a lot of medical people think-- that they know some basic sciences behind it so they ought to be able to use their intuition to tell someone how to eat right. That's BS in my opinion. It's like saying you learn the basic sciences of medicine in your first two years and intuitively treat your patients afterwards. You might have learned some of the basic sciences.... but you've still got alot to learn and have totally left out the clinical aspect of nutrition. I learned more about nutrition in one specific two-hour lecture on it than in all the combined science stuff you mentioned.

Teaching people about nutrition is NOT something intuitive. You have to know so much more about the types of foods on the market, the manufacturing processes, and the way they are prepared for serving.....it's endless. Nutrition is a vastly overlooked part of the population's health. You would be much better off referring your patients to someone who is well versed in nutrition than to try to treat them "intuitively".

Very well said! It's like saying I can become a teacher because I've been a student before...

 

[JWE27]

I think the consensus from the previous thread on this topic was:

Nutrition is extremely important for prevention, treatment of many illnesses, and overall health

Nutrition should not be ignored in the medical treatment of the ill

Nutrition is a scientific specialty/field of its own and would be difficult to fully incorporate into another discipline (e.g., medicine)

In-depth nutrition care should be deferred to those specifically trained in that area (dietitians)

As someone who has been a dietitian for >9yrs, I agree with the above statements. I think the reality is that nutrition simply will not be adequately taught to physicians; but, resources for that information are available for self-study or referral to those who have been trained. Luckily, I'll be able to kill both those birds with one stone (DO, RD - interesting combo! ).

 

[Thantis]

One could always go into Bariatrics, and in addition, later in your life be pro-active in bringing a focus on nutrition into the curriculum of a medical school (or schools).

 

[RySerr21]

In many, many cases....yes. Even those that have had the bypass, etc. Sure, they'll come around and "get serious" about eating more healthy foods for a while, maybe even a few months, but in many cases, they are back to old habits before too long.

I'm guilty of this sort of behavior myself.

how extensive do you think the nutritional guidelines they receive really are?? especially if coming from a physician, whom we have already talked about has really no background in nutrition and its effect on health. its obvious the patients need to eat better. they need to be told EXACTLY how to do it. they need to be monitored and looked after daily. they need to understand that if they follow your nutritional advice (assuming it is adequte), they can completely prevent heart disease. obviously this is a lot of work on the physicians part. but its worth it....because it will save lives. isnt that the whole point of being a physician? heart disease should not exist, and in some places in the world...IT DOESNT. the fact that its the number one killer in america is disheartening to say the least.

what you've described doesnt surprise me in the least. you go in for a 50,000 dollar procedure that basically gives you a set of fresh new arteries, why would you need to worry about what CAUSED your clogged arteries? your doctor tells you to start eating healthier.....okay, ill give it a try. at the same time, does it really matter if i eat this cheeseburger every once in a while? no not really, ill just get anoter bypass if need be. or...hey! i'm taking statins, my cholesterol is significantly lower so it doesnt matter, i can eat like **** and be heart attack free! sorry, it doesnt work like that. but at least the doc will get $$$ for the next round of surgical procedures. you dont see the seriusly flawed logic in the way patients are being treated?

theyve done nutritional studies on pateints with severe heart disease. they convinced them that the nutritional guidelines that they had established would work better than any drug or any procedure they could use. they convinced them that they would be heart attack/heart disease free.......guess what? they listened...and it worked. in 100% of the participants.

 

[scpod]

When you have a guy who's 75 and has clogged his arteries all of his life he doesn't want to give that stuff up; he enjoys it. I used to have breakfast with my dad and his retired friends a couple of times a week. They are mostly in their 60's, 70's, and 80's, and have eaten fried foods for 7 decades now. Every now and then one would drop out for a while and have a CABG or stent put in and would eat right for a few weeks. The had pretty detailed instructions on what they needed to do.....but when everyone around them is easting grits, eggs, bacon and biscuits every morning....for a lot of them they'd rather eat that too and die happy.

Don't you remember the old joke?

A guy walks into the doctor's office for a physical. Learning that he's in fine health, the young man asks, " Doc., what can I do to live longer?"

The doctor replied, "Do you smoke?"

"No."

"Do you drink alcohol?"

"No."

"Do you do drugs?"



"Ummm.. of course not!"

"How often do you have sex?"

"Uhhhh.... never."

After taking some notes, the doctor concluded,"You don't drink, smoke, do drugs, or have sex? Why the heck do you want to live longer?"

The problem is that it's more than just changing what they eat. You can't change their nutrition that drastically without changing their entire lifestyle. That's a little unrealistic for the modern primary care practitioner. You don't get paid for taking the extra time to counsel people on the nutritional benefits and follow up with them. Because of declining reimbursements and other finiancial matters, if you spend that much time with them you, and your entire office staff, will soon be out of a job. That's the reality of modern practice. Until the system itself is fixed, most patients won't receive optimal healthcare.

Those patients who are lucky enough to afford physicians with a boutique practice, however, are in pretty good shape. For a significant fee each year, in addition to insurance, they get guaranteed same day visits, 30+ minute office visits, telephone counseling and other benefits. It's kind of a shame, because that's the way I'd picture all healthcare should be.

 

[RySerr21]

When you have a guy who's 75 and has clogged his arteries all of his life he doesn't want to give that stuff up; he enjoys it. I used to have breakfast with my dad and his retired friends a couple of times a week. They are mostly in their 60's, 70's, and 80's, and have eaten fried foods for 7 decades now. Every now and then one would drop out for a while and have a CABG or stent put in and would eat right for a few weeks. The had pretty detailed instructions on what they needed to do.....but when everyone around them is easting grits, eggs, bacon and biscuits every morning....for a lot of them they'd rather eat that too and die happy.

Don't you remember the old joke?

A guy walks into the doctor's office for a physical. Learning that he's in fine health, the young man asks, " Doc., what can I do to live longer?"

The doctor replied, "Do you smoke?"

"No."

"Do you drink alcohol?"

"No."

"Do you do drugs?"



"Ummm.. of course not!"

"How often do you have sex?"

"Uhhhh.... never."

After taking some notes, the doctor concluded,"You don't drink, smoke, do drugs, or have sex? Why the heck do you want to live longer?"

The problem is that it's more than just changing what they eat. You can't change their nutrition that drastically without changing their entire lifestyle. That's a little unrealistic for the modern primary care practitioner. You don't get paid for taking the extra time to counsel people on the nutritional benefits and follow up with them. Because of declining reimbursements and other finiancial matters, if you spend that much time with them you, and your entire office staff, will soon be out of a job. That's the reality of modern practice. Until the system itself is fixed, most patients won't receive optimal healthcare.

Those patients who are lucky enough to afford physicians with a boutique practice, however, are in pretty good shape. For a significant fee each year, in addition to insurance, they get guaranteed same day visits, 30+ minute office visits, telephone counseling and other benefits. It's kind of a shame, because that's the way I'd picture all healthcare should be.

i totally agree. its a dramatic lifestyle change. i totally understand a primary care doc doesnt have the time to do all of the things you mentioned....but i imagine someone in preventive medicine would be able to do the things you mentioned....am i wrong? i would hope not. if i go into this type of thing...thats all i'd be doing....something along the lines of this

http://www.pmri.org/?p=upn

or

http://www.drmcdougall.com/

 

[scpod]

....but i imagine someone in preventive medicine would be able to do the things you mentioned....am i wrong? i would hope not. if i go into this type of thing...thats all i'd be doing....

I actually know a couple of FP docs who are just that sort. They don't have a lot of patients, but the ones they have are healthy. They don't make lots of money or drive nice cars, but they make a good living and their patients love them. I think we need a lot more people who are wiling to practice that way, but the rising costs of tuition and malpractice insurance, and the declining reimbursements, limit just what people can do.

 

[MJB]

how extensive do you think the nutritional guidelines they receive really are?? especially if coming from a physician, whom we have already talked about has really no background in nutrition and its effect on health. its obvious the patients need to eat better. they need to be told EXACTLY how to do it. they need to be monitored and looked after daily. they need to understand that if they follow your nutritional advice (assuming it is adequte), they can completely prevent heart disease. obviously this is a lot of work on the physicians part. but its worth it....because it will save lives. isnt that the whole point of being a physician? heart disease should not exist, and in some places in the world...IT DOESNT. the fact that its the number one killer in america is disheartening to say the least.

what you've described doesnt surprise me in the least. you go in for a 50,000 dollar procedure that basically gives you a set of fresh new arteries, why would you need to worry about what CAUSED your clogged arteries? your doctor tells you to start eating healthier.....okay, ill give it a try. at the same time, does it really matter if i eat this cheeseburger every once in a while? no not really, ill just get anoter bypass if need be. or...hey! i'm taking statins, my cholesterol is significantly lower so it doesnt matter, i can eat like **** and be heart attack free! sorry, it doesnt work like that. but at least the doc will get $$$ for the next round of surgical procedures. you dont see the seriusly flawed logic in the way patients are being treated?

theyve done nutritional studies on pateints with severe heart disease. they convinced them that the nutritional guidelines that they had established would work better than any drug or any procedure they could use. they convinced them that they would be heart attack/heart disease free.......guess what? they listened...and it worked. in 100% of the participants.

You almost act as though I'm disagreeing with you.

The harsh reality is people have bills to pay (thanks to outrageous tuition bills, etc) and can't babysit patients at all times.

People have to take responsibility for THEMSELVES at some point, and Americans have proven over and over that they don't want that responsibility.


For the record, I TOTALLY agree with you that much more emphasis should be put on preventive care, but nothing is going to change until everyone in this country gets behind that philosophy. Do you think the powers that be really want Americans healthy?? In turn, what do you think the politicians want? How about cardiologists? Fast Food? Big Tobacco?

Do you think Joe Six-pack wants to give up his McDonalds or Hardees for breakfast AND lunch? I don't. Not based on the lines I see at those crap factories on a daily basis.

 

[RySerr21]

You almost act as though I'm disagreeing with you.

The harsh reality is people have bills to pay (thanks to outrageous tuition bills, etc) and can't babysit patients at all times.

People have to take responsibility for THEMSELVES at some point, and Americans have proven over and over that they don't want that responsibility.


For the record, I TOTALLY agree with you that much more emphasis should be put on preventive care, but nothing is going to change until everyone in this country gets behind that philosophy. Do you think the powers that be really want Americans healthy?? In turn, what do you think the politicians want? How about cardiologists? Fast Food? Big Tobacco?

Do you think Joe Six-pack wants to give up his McDonalds or Hardees for breakfast AND lunch? I don't. Not based on the lines I see at those crap factories on a daily basis.

i agree. people need to take more responsibility for themselves. 100% true. its just unfortunate the medical community doesnt do more to maximize the probability that people do ending up taking responsibility. they can't take responsibility if they dont know how. and its bigger than the meidcal community...its our society as a whole, just like you said. the politicians, the cardiologists, etc.. there are some serious serious problems that need to be fixed.

how bout the fact that when nutrition education is provided in relation to public health problems, it is often supplied by industries like the Egg Nutrition Board, National Cattlemen's Beef Association, National Dairy Coucnil, Nestle CLinical Nutrition, Bristol-Myers Squibb Company (pharmaceuticals) etc. etc.? i wonder why people are confused and not taking responsibility for themsleves!?

 

[endocardium]

...they can't take responsibility if they dont know how. and its bigger than the meidcal community...

Interesting thought. I agree that it is bigger than the medical community; everyone has to get involved. In my professional experience, it would seem that the willingness to take full responsibility often precedes the knowledge of how to do it. In other words, willingness is what is needed. You may think you know how, but if you aren't willing, your knowledge is utterly inconsequential. So how do we support patients in being willing to take 100% responsibility for their own health and wellbeing? I guess part of that is being willing to be partners with your patient in that regard. I think perhaps it would be good to start sooner in an individual's life, etc. Basically, it isn't just a primary knowledge issue. There's much more at play here.

 

[Pigg-O-Stat]

May you be touched by his noodly appendage.

 

[endocardium]

May you be touched by his noodly appendage.

Whiskey Tango Foxtrot?

 

[JWE27]

May you be touched by his noodly appendage.

RAmen, brother...

 

[J1515]

Really? Did they tell you that worldwide 40% of men and 30% of women are now overweight? Or that 24% of men and 27% of women are obese?

yes

Did they tell you how obesity leads to sleep apnea, adult onset asthma, hypoxia, osteoarthritis, gout, hernias, low back pain, coronary heart disease, stroke, congestive heart failure, GERD, gall bladder disease, infertlity, polycystic ovary syndrome, pregnancy complications, menstrual irregularity, type 2 diabetes, insulin resistence, dyslipedemia, colon esophageal uterine prostate and lung cancers, depression, increased medical costs, discrimination, low self-esteem and reduced work productivity? Obesity is an epidemic that is raging through the US. Can you really adequately counsel your patients on their dietary needs based on what you learned in biochem and GI?

Yes. We not only got lectures specifically on nutrition from nutritionists during GI, but the mechanisms of all of the above were discussed by the "scientists and doctors" as well. Whether or not I remember all of this stuff by the time I get out and practice is a different story.

In your patients with cancer risk can you counsel them on the types of foods that give them detoxification support?

We learned there were certain foods that appeared to decrease certain cancer risks. I memorized them for the test and forgot them.

What about vascular health? Do you know about the foods that are antioxidants, flavanoid rich, contain folate, B2 B6, B12, have plant stanols/sterols, omega 3 fats, or are mineral rich?

Yes. From a nutrition lecture and a lecture specifically on vitamins.

Can you tell them about the effects of high heat or long cooking times? Do you know what effects cooking containers have or which foods are typically riddled with pesticides?

The effects of long cooking times (as well as not enough cooking time) were mentioned. I don't recall hearing about foods riddled with pesticides.

How much do you know about glycemic load and glycemic index? What about refined sugars? Can you tell the patient what to look for on the labels of food to tell if its full of bad stuff? What effect does refining have on grains? Which foods contain soluble and insoluble fibers?

Yup. All that stuff was covered in a lecture by a nutritionist.

What effect do Omega-6 fatty acid have on LTB-4, TXA-2, and and PGE-2? What about Omega-3 on LTB-5, PGE-3, and PGE-1? Which foods contain them? Which should you avoid? Is there a difference between grass-fed and grain-fed beef? Should you avoid one or the other? Is there a difference in vitamin content or taste?

There are just way too many factors in nutrition to think that your basic sciences curriculum is adequate enough to allow you to treat patients and give them good advice.

At my school we learned not only the stuff you mention but the mechanisms as well. To be honest, I forgot most of it a year later.

 

[J1515]

so patients would rather die than deal with the fact that they eat unhealthy food? i highly doubt that. as a physician treating someone who has just had a massive heart attack....you tell them "if you completely change your diet, you can prevent and even reverse your heart disease." i'm sure they will find ways to deal with the surprising news that their diet needs some revisions. giving them a pill and a 3rd bypass surgery doesnt seem to cut it.

Your view on people will change when you get to rotations. You will have patients coming to the hospital with crushing chest pain and as you are waiting for their blood work to come back they will ask you if it's alright if they go outside to smoke a cigarette. You really have no idea the kind of frustration you are in for (I'm not trying to be mean).

 

[fabu1ous]

When my sister was in the hospital getting chemo, she wanted to know what type of diet she should eat while getting treatments. Her oncologist didn't have advice, so we asked to see the nutritionist.

The nutritionist came in, and when my sister asked what would be the best foods for her to eat, the nutritionist asked her, "What diet did your doctor tell you to eat?"

After glancing at me and shaking her head, my sister purposely dropped her pen on the floor so the nutritionist would be of some use (she picked it up).

Nutrition is very important and it's a shame that it's not taught as it should be at med school.

 

[RySerr21]

When my sister was in the hospital getting chemo, she wanted to know what type of diet she should eat while getting treatments. Her oncologist didn't have advice, so we asked to see the nutritionist.

The nutritionist came in, and when my sister asked what would be the best foods for her to eat, the nutritionist asked her, "What diet did your doctor tell you to eat?"

After glancing at me and shaking her head, my sister purposely dropped her pen on the floor so the nutritionist would be of some use (she picked it up).

Nutrition is very important and it's a shame that it's not taught as it should be at med school.

wow. by now the doctor not knowing any thing to say isnt surprising....but the nutritionist? seriously?

 

[RySerr21]

Your view on people will change when you get to rotations. You will have patients coming to the hospital with crushing chest pain and as you are waiting for their blood work to come back they will ask you if it's alright if they go outside to smoke a cigarette. You really have no idea the kind of frustration you are in for (I'm not trying to be mean).

i know you are not being mean. and i also realize i have no idea what i am in for, which is kind of exciting.

 

[JWE27]

When my sister was in the hospital getting chemo, she wanted to know what type of diet she should eat while getting treatments. Her oncologist didn't have advice, so we asked to see the nutritionist.

The nutritionist came in, and when my sister asked what would be the best foods for her to eat, the nutritionist asked her, "What diet did your doctor tell you to eat?"

After glancing at me and shaking her head, my sister purposely dropped her pen on the floor so the nutritionist would be of some use (she picked it up).

Nutrition is very important and it's a shame that it's not taught as it should be at med school.

That's one of the major problems with nutrition-education programs. They're not all created equal. Also, many dietitians I meet are frankly lazy (which sounds like the case with your sister, versus lack of knowledge). Hence, me going into medicine and not exclusively practicing nutrition, anymore! I'm tired of being the exception!

 

[fabu1ous]

That's one of the major problems with nutrition-education programs. They're not all created equal. Also, many dietitians I meet are frankly lazy (which sounds like the case with your sister, versus lack of knowledge). Hence, me going into medicine and not exclusively practicing nutrition, anymore! I'm tired of being the exception!

I think your background knowledge of nutrition will be of such a benefit to your patients. I think you will contiinue to be an exception though, because all of us will not have the advantage of your expertise! It's all good though, exceptions can rock.

 

[JWE27]

I think your background knowledge of nutrition will be of such a benefit to your patients. I think you will contiinue to be an exception though, because all of us will not have the advantage of your expertise! It's all good though, exceptions can rock.

I guess I never thought of it like that...maybe I will always be an exception. I'm just glad I will be able to do more for patients once through medical school (from prevention/health promotion, to treatment, to maintenance/management of good health).

Thanks for the reinforcement and encouragement!

T minus 63 days and counting...

 

[RySerr21]

Hi guys! That’s a great forum that you guys have, with some useful information on diet. I also want to share something with you on how I got rid of 10 pounds with in few weeks. Few weeks ago I was looking for some specific diets that can help me during weight loss process and then I found Lunch Box Diet by Simon Lovell. He is an expert nutritionist and had been helping people in their weight loss process for years. Please have look at it and let me know.

give me a break duuude.