Curing doctors' dangerous lack of nutrition education

Sue LaFortune was in excruciating pain. For more than 20 years, Sue had battled severe migraines. Often, the pain dragged on for days on end. She saw dozens of doctors, tried seemingly endless prescription pills, and had even undergone surgery. But nothing provided relief.

Then, in a clinical study at the Physicians Committee, Sue tried something new: a plant-based diet of fruits, veggies, legumes, and grains. Out with the meat, dairy products, and eggs. She saw an almost immediate difference. Decades of painful migraines came to a stop, and she has been almost completely migraine-free since then.

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Everyone who suffers from a chronic disease—from migraines to type 2 diabetes to heart disease—deserves the relief that lifestyle changes can bring. But most doctors feel ill-equipped to provide it. Doctors learn about prescription drugs and about surgery. But the role of food is underemphasized in medical education.

Currently, most patients who seek doctors’ help for these problems only find a cocktail of drugs or a scalpel—approaches that continually fail to treat or heal. The vast majority of American doctors never learn that dietary approaches exist—so neither do their patients.

In 1985, the National Academies of Science recommended that every aspiring doctor in the United States receive at least 25 hours of nutrition instruction. But the most recent survey of U.S. medical schools offers a harrowing diagnosis: Very few schools meet that recommendation, and only one in four requires even a single course on nutrition. Despite the prevalence of diet-related disease, the number of schools offering the minimum nutrition instruction is declining.

Faculty, medical students, and doctors are conscious of their deficiency. More than three-quarters of medical school instructors admit that students need more nutrition education, and more than half of graduating medical students rate their nutrition knowledge as “inadequate.” A study in the Journal of the American College of Nutrition found that although 94 percent of physicians feel that nutrition counseling should be part of primary care visits, a mere 14 percent feel qualified to offer it.

The only stakeholders not-so-blissfully unaware of this problem, it seems, are the patients: Surveys show that consumers consider physicians credible sources of nutrition information.

Of course, they’re the ones paying the price. Four years ago, diet surpassed smoking as the largest risk factor for disease and death in the U.S. According to the Centers for Disease Control and Prevention, 7 out of every 10 deaths are caused by chronic diseases like heart disease, cancer, and type 2 diabetes that can be prevented and treated through lifestyle changes. Chronic diseases account for a whopping 75 percent of the $2 trillion annual U.S. health care spending.

The evidence to support using diet to prevent, treat, and reverse disease is overwhelming. Plant-based diets have been shown to surpass even the strongest drugs as an effective prevention and treatment strategy for conditions ranging from high cholesterol to even some cancers. Last spring, Kaiser Permanente, the largest HMO in the U.S., urged physicians to “consider recommending a plant-based diet to all their patients, especially those with high blood pressure, diabetes, cardiovascular disease, or obesity.”

Some might argue that dietitians—not doctors—should be responsible for offering advice about diet. But doctors don’t even know enough about nutrition to understand when to refer a patient to these specialists. Instead, they push conventional treatments like drugs and surgery, even when dietary changes could be more effective—and much less dangerous. All the side effects of eating more healthfully are good: weight loss, improved energy, and prevention of other problems from stroke to Alzheimer’s disease.

But two new bills expected to be introduced this week could help doctors learn more about the crucial link between diet and disease. The Education and Training (EAT) for Health Act and the Expanding Nutrition’s Role in Curriculums and Healthcare (ENRICH) Act would boost nutrition education for current and future physicians, respectively. The EAT for Health Act ensures federally employed physicians and nurse practitioners receive continuing medical education in nutrition annually, while the ENRICH Act establishes a grant program to help medical schools incorporate nutrition into school curricula.

Sue’s story is awe-inspiring, but it doesn’t have to be unique. We can win the battle against the epidemic of chronic illnesses if those on the front lines are armed with a strong education in nutrition. The EAT for Health and ENRICH Acts would give doctors the knowledge—and patients the care—they deserve.

Barnard is an adjunct associate professor at the George Washington University School of Medicine, and president of the nonprofit Physicians Committee for Responsible Medicine. He is one of America's leading advocates for health, nutrition, and higher standards in research.

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