“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.
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.