Doctor Nutrition Deficiency

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“Why don’t doctors know more about nutrition?”

This question was posed by JF from Pursuit of Happiness in a comment on my last post, “Eating Medicine Like It’s Candy“. It was a good question, one that begs to be answered, so I am going to attempt to tackle it here…

I have had this question asked of me repeatedly by different people with different agendas and differing opinions of what “nutrition” means.

For the purpose of this post, I am going to say nutrition means diet. Dietary supplements need their own post and they will not be addressed specifically here. Sorry, folks.

There are actually many answers to the question of doctors and nutrition but I am going to focus on two: The Official Excuse and My Personal Answer.

The Official Excuse goes something like this:

“Nutrition and diet are overrated when we can fix everything with pharmaceuticals.”

Generally, pharmaceuticals are quicker. It is faster for me to write a prescription and do a quick run down of the top three possible side effects than it is to open the can of worms that is someone’s diet. This is much akin to psychiatrists not doing psychotherapy because they are focusing on the pharmaceutical side of things. Anyone who had waded through a pharmacology class in med school can tell you that the pharmacology itself is brutal, particularly with an average of 28 new drugs approved per year by the US Food and Drug Administration over the past five years.

In fact, though, this is not just about physicians. I get a lot of pressure from patients, actually, who want me to stop harping on them about their daily fast food habit: Just write my damn cholesterol prescription so I can get out of here!

For the record, I think this is lame on all counts.

My Personal Excuse is this:

Over the years, we as a scientific and medical community have failed miserably at making sound dietary recommendations. There was the “margarine is better for you than butter” thing… until the evils of trans fats were discovered. There was the low salt and low fat for everyone thing for a long time. Now we know that is bunk. Coffee was evil for how many decades? Now we know it decreases the risk of Alzheimer’s, cardiovascular disease, and head and neck cancers.

So?

Who the hell really knows.

What works for some does not work for others. The main thing is moderation coupled with reasonable exercise. Anyone who says otherwise is feeding you bunk or trying to sell something.

There is no magic pill or supplement or food!

Does that mean that raw onions don’t work for diabetes? Well, no. They may work great for some people. But they certainly won’t work for everyone. And raw onions (or their theoretical equivalent) cannot ever take the place of calorie restriction and exercise. If I can get someone to adjust their diet and exercise, then raw onions are usually a moot point.

All of that being said, I do work aggressively with my patients to modify their diet and exercise. I have watched gleefully as patients have been able to get off of some if not all of their medications. When I have someone go from seeing me 8-9 times a year to once a year because of lifestyle changes, then I know they are doing something right. I absolutely love that!

So, there you go. My two cents, for what it is worth.

I will leave you with this one last thought, something that has been hard for me to learn personally but which has given me peace: Diet and exercise discussions are not about weight. They are about health.

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63 thoughts on “Doctor Nutrition Deficiency

  1. On the last bit, I’m sorry but could you please explain it to me a little? Sorry! I understand the main point it’s just I’m just a tad confused….doesn’t weight fit into the category of health? (Forgive me, I know nothing really on nutrition.)

    Liked by 1 person

    • Weight is a happy side effect of healthy lifestyle, absolutely! But too many people quit too soon because they are focusing on the numbers instead of their health. Further, we all know skinny, unhealthy people. The weight is not the issue, lifestyle is! πŸ™‚

      Liked by 2 people

  2. This makes sense. I have learned that I need to do my homework when I go to the doctor. I need to be able to effectively describe the problem, time of day, exact spot, etc. I also need to spend some time looking at possible solutions so I can ask the right questions. My doc recently took me off of the baby aspirin because of new studies showing it didn’t help unless you had heart issues (I don’t). My GI took me off flaxseed oil because they caused IBS issues. Personally I am loving a life that’s relatively medication and supplement free. Eating healthy isn’t all that hard for me but my mother started me out that way when I was young.

    Liked by 2 people

      • Life was different then. We didn’t have fast food places and my mother cooked a lot. There just wasn’t as much processed food around. It’s tougher for today’s mothers, many of whom have demanding jobs. But my Mom was awesome!

        Liked by 1 person

  3. I have lots of thoughts, experiences and opinions on this topic. One day I’ll write my own posts. For now I’ll focus in on what you said about the quick fixes and the pharmaceuticalsβ€”oh yes, this. I am/was in complementary care, a LMT specializing in clinical work, similar to doing PT. For many soft tissue problems, stemming from injury to chronic postural issues, etc. this type of work surpasses all other. However, it isn’t a cute little pill. That type of therapy requires the skill of the practitioner, time and compliance in a protocol by the patient. When people took the time, our success rate was high. But we’ve been so programmed (insert tirade about insurance here) for quick fixes that the majority of people chose to go the medication route (which generally only masked the problem) or even preferred invasive surgeries instead. There’s a large similarity there between that and what you are describing with the nutrition/exercise. Changing habits is hard and sometimes even painful.

    Liked by 1 person

  4. The official reason could be that physicians are taught hardly anything about nutrition, and the way food works in the body, in medical school. In North America, at least, they spend far more time on pharmacology than on nutrition. This is part of the reason why clinical nutrition and dietetics is a completely different, professionally regulated discipline.

    The pharmacology industry has a massive influence on what physicians are taught, both in med school and afterward (Big Pharma-sponsored CME events, anyone?), and their huge profit margins mean that they have plenty of money to spend on advertising to convince both physicians and patients that putting their lives in the hands of the right drugs will solve all their problems. And they’ve been remarkably successful. And when their profits don’t increase quickly enough, they change the parameters, like when they lowered the “ideal” Total Cholesterol number to 200, making millions more people candidates for cholesterol-lowering drugs.

    Between Big Food selling us the edible foodlike substances that engender lifestyle-related diseases, and Big Pharma selling us the drugs that manage the symptoms (while keeping the underlying illness going strong), it’s hardly surprising that more poeple don’t understand the way food works in the body. Physicians, especially GP’s, have to know half a million other things; it’s not their fault they don’t know everything about nutrition, too.

    Liked by 2 people

    • You are right on all points. Our nutrition class was… brief. Pharmacology, by necessity, is long and involved. It should be. You don’t want someone who doesn’t know what they are doing writing prescriptions for your body. Pharmaceutical companies have historically had a deathgrip on medicine. This is lessening, thankfully. (See my own thoughts on drug reps)

      Liked by 1 person

  5. I only go to the doctor if something is wrong and my annual checkup. To go to the doctor to find out how to be healthy I would deem a waste of resources. It would be akin to smashing the hell out my car on purpose and then going to the mechanic and asking him how I can prevent/stop my car from being smashed up. Like you said there is no quick fix. Eat properly and excercise. And it is going to suck but it also a solution that is completely in my control.

    Liked by 1 person

  6. “Failed…” is an apt and accurate word choice. I appreciate your acknowledging the blatant flaws of how Western Medicine is, to a measurable extent, presently practiced and sadly prescribed. Here’s to more holistic, balanced, and integrative views and approaches, including nutrition advocacy. Big Pharma and its interrelationships have all but become “to big to fail.” I feel (and know I am) blessed to have self-discovered the merits and value of nutrition a decade ago. Thanks for a good post and topic.

    Liked by 1 person

  7. Dear Victo, thank you very much for this important and very honest post! I want to make very important point: “Each of us is responsible for our own health. It is our duty to know what we must do to be healthy and to implement our knowledge every day. Doctors can help us but they should not be the first line of defense against diseases and aging”.

    Liked by 1 person

  8. I think one if the biggest myths about nutrition is that certain specifics diets are good for you when there is actually not a lot of concrete evidence to support these diets. I agree that moderation and healthy calories are probably the best way to go! It is a very hard topic for doctors to discuss, it opens up a can is worms. I often have to start this conversation when patients come to me asking for liposuction, and tummy tucks as a way to lose weight!!!

    Liked by 1 person

  9. Moderation really is the key — in all things. I do worry about folks who take a lot of supplements, because unlike pharmaceuticals, nobody watches the supplements. Nobody inspects the manufacturers, sees if they really do contain 500 mg of whatever. Different brands contain different amounts and work somewhat differently (unlike generic drugs) . And you don’t really have any guidance in using them like you do with prescription drugs.

    Of course, I’ve really been lucky in the drugs I’ve taken all my life. I’d be dead or disabled with my Crohn’s if not for modern pharmaceuticals. So I am biased!

    Liked by 1 person

  10. While I agree that pharm has been pushed on us as a “fast” solution, at least as much of that pressure comes from patients themselves who would much prefer I write them a script for something than talk with them about small changes that will make incremental improvements in their overall health. Weight loss, an active lifestyle and healthy eating take a LOT of effort and everyone is not willing to do that.

    That being said, I do think that the education around nutrition for medical students is abysmal. Almost everything that I carry in my “tool belt” comes from coaching and from growing up with a mom who is an RD. When I do talk to patients about changing their diets or activities, it’s her wording that comes out of my mouth and nothing I’ve been taught in medical school.

    Finally, it’s really the combination of pharm and lifestyle changes that is most powerful. Statins are life changing for SO many people, some of whom could walk/run/exercise and eat perfectly and still never get a substantive change in cholesterol profile.

    Steps awayyyyy from the internet now…

    Liked by 1 person

  11. I went hard ass on a candida diet. I will never do that again. Whomever came up with that diet is nuts. I’m having a very hard time coming off of it now as my body reacts to coming off. Basically it starves you. All you’re allowed to have are basically veggies organic chicken and quinoa

    Liked by 1 person

  12. It’s so true. Dietary recommendations keep changing. I ate margarine for years thinking I was doing the right thing and artificial sweetners. Now I try to use common sense. I am not a diet angel by any means. I love this scene in a Woody Allen movie where he wakes up after being asleep for a few hundred years and finds out milkshakes are good for you. πŸ™‚

    Liked by 1 person

  13. I’ve learned the hard way that what’s healthy for one person may not be healthy for someone else. I’ve also learned that sometimes drugs are necessary to manage a chronic condition like ulcerative colitis, in conjunction with a change in diet. But I still avoid any drugs that aren’t absolutely essential, and I tend to research a drug my doctor prescribes before I actually agree to take it. Sometime my family doctor gets a little annoyed with me.

    Liked by 1 person

  14. Drat. Moderation and exercise—just like mother always said. Well, I’ve done that. Fortunately, I never bought the modern fast food and soda life style. Now there’s just one remaining problem, so point me at the fountain of youth and I can take care of that one, too.

    Liked by 1 person

  15. Up until a year ago this past October I wasn’t paying any attention to my diet – nutrition or health-wise. Then I was told by my doctor (I’d like to point out that I am a U.S. Navy veteran and use the local Vets health clinic) that I was pre-diabetic, which included the diagnosis of elevated blood pressure. I was told their were medications that could help me get back to “normal.” I made it clear that I did not want to rely on medications unless it was absolutely necessary, and was told that it was very difficult for pre-diabetics to accomplish anything without the use of some medications. I proved them wrong; 6 months later with nothing more than self-determination, a 30-minute daily brisk walk, and limiting my caloric daily intake to 1500, I turned my pre-diabetic diagnosis into one of a perfectly healthy and “normal” male! (I use quotation marks around “normal” to signify what is normal for me.) I lost 20 pounds, my BP is good, and I was told by my doctor that I could be a poster child for those wanting to make healthy lifestyle changes!

    Liked by 1 person

  16. I believe good nutrition is the responsiblity of the individual and not just a doctor. Each one of us is different and if we do not listen to our bodies, we don’t know what is best for us. How can a doctor know then what is best for someone? Impossible. Yes, a doctor can give a general diet plan, yet it still is the individual’s responsibility to educate self. People are just downright lazy and want either a pill or someone else to do the work. IMO.

    Liked by 1 person

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