What are so many doctors lacking nutrition knowledge?

Seems insane, but that is my experience. (UK). Do others find this is the case? Why do you think that is? What things do you think would improve it?(government intervention for the pharma directed education? etc)

Sarkari job

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Because doctor’s have specialties like anyone else. I’m not going to ask a mechanical engineer to do the work an electrical or chemical engineer does.

In the States, most outside of disciplines that focus in nutrition probably only had a semester of nutrition as an undergrad.

At the end of the day they’re human, and only have so much time / brain capacity. Also, if you don’t practice it everyday, you lose that knowledge.

If you have a specific nutrition need, you need to seek out a licensed nutritionist.

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Out of interest, what experience led you to make that observation?

And here in the USA, finding one that is current and truly understands the subject can be a long complicated fight. (I have lost count with the number of licensed folks that desperately need some of Coach Chad’s deep dives.)

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Are we talking sports nutrition or other types. Most specialize in diabetics and people with other conditions.

If you come in guns blazing with internet knowledge, then why bother if you think you know better?

Several of my doctor friends can talk all day about patients who got their doctorate from WebMD, Facebook, or their cousin’s boyfriend’s wedding’s best man, etc.

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An alternative question could be ”how would this knowledge benefit doctors in their practice?” Doctors have to know a lot and it’s perhaps not reasonable to expect them to know the things that we have RDs for.

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A very odd post without details and the mention of ‘pharma’ is veering towards conspiracy theory.

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Leaving any conspiracy stuff aside about pharma, I think a lot of doctors get very basic training on a variety of topics and more extensive in others. Heck, for folks in the US, there’s Dr. Oz, who is from all accounts a very accomplished doctor in his field, yet he’s veers into quackery with his TV show. I think it would benefit general practitioners to be more wellness oriented (vs treatment oriented) but it’s natural that a lot of care is oriented toward treatment/management of conditions vs prevention

This reminds me of a post on Instagram I recently saw from a doctor that specializes in obesity and works with Renaissance Periodization. He’s been a recent good follow for me and has some pretty funny and interesting content.

Post Link

Content:

The other day I posted about lipedema and how I hadn’t been taught about it at the time I saw it as a lowly intern just seeing patients. There were a couple people were appalled that a doctor hadn’t heard of it.

Let me explain how medical training goes. You go to medical school for 4 years. In general the first two years are all in the classroom where you basically drink from a fire hose trying to learn biochem, anatomy, physiology, pathology, pharmacology, microbiology, etc. The second two years are where you start shadowing and working with physicians in the clinics and hospitals where you see patients and figure out how to treat them.

In your fourth year of medical school you decide on what speciality you want to do and then try to get into what’s called a residency. The residency is usually 3-5 years depending on the speciality. This is where you start treating patients by yourself but under the supervision of what’s called an attending physician. Here is where you learn to take your theory into practice and continue to learn more theory as well. After this you can specialize further with board examinations and fellowships.

One of the things they teach us in residency is that you have to be comfortable with knowing you won’t know everything. It’s because not one doctor knows everything about everything. Yes we have super specialists who carve out a small part of medicine and know pretty much everything about that topic but even still. For example I am now specialized in obesity medicine and lipidology after I did a residency in family medicine.

Anyway my point is that it takes time to learn and no doctor (or anyone else for that matter) will know everything. It’s impossible. Learning takes time. The more you practice and more you learn. That’s the process.

Life is a learning process too. It’s not just medicine! :heart::heart:

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Uhm… maybe because they’re not nutritionists?

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The answer to your question is quite simple, medical doctors receive little to no explicit education on the subject of nutritional biochemistry. See below for a standard medical school curriculum in the USA. In my opinion, this is something that needs to change—especially as medicine moves towards disease prevention. It is quite clear that many devastating metabolic diseases can be entirely circumvented by good nutrition and exercise.

As a biochemist, I have been appalled by the lack of curiosity and/or knowledge that the medical community has when it comes to nutritional biochemistry. Were I not familiar with these principles myself, I would have no idea how to navigate the toxic food space that is a contemporary grocery store. I feel sorry for those that have been misled or lack the knowledge needed to make good decisions when it comes to nutrition.

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I’ve had physicists say similar things to me, an engineer, about the courses they teach or have taken. There’s the very basic classes taken and as their education progresses people become more specialized in an area or department. The entire medical field is broken up into many specializations, I don’t see an issue with one more such “department” that deals with nutrition. Overseeing those dietitians or nutritionists could be another story, unfortunately, although levels of quality exist for any type of worker.

I don’t think the responsibility of knowing what a quality diet is falls squarely on the medical field. The CDC has information online for anyone to view, if they have access. K-12 education systems, and the worldwide equivalents, could also take on some of the responsibility.

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The major issue is that primary care is inundated with chronic issues caused by poor diet and lack of exercise (modern western life).

A primary care doctor doesn’t need advanced training in nutrition to tell patients to:

stop drinking soda and sugar all day
stop eating fast food and junk food
actually cook meals at home from whole foods - eat a balance of quality proteins and whole food carbohydrates (vegetables - not bread and pasta for every meal)
don’t smoke
move and exercise at minimum a few times per week but preferably a little every day

The 1% of cases that need very specific dietary help can go see a specialist.

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I assume you’re talking about a GP. I think the clue is in the name.

However, from talking to friends who are GP’s, most of the nutrition/ poor diet stuff they’re dealing with is not very nuanced due to the target patient.

You could widen the question to why does the world lack nutrition knowledge. The macro problem is that its impossible to study.

Nutritional epidemiology is a giant dumpster fire. Food survey data is less than worthless. People cant estimate or even measure food. They lie about exercise and food. The healthy user bias clouds virtually every study.

RCT is crap in this space as well. Controlled metabolic ward studies are always going to be under powered because its miserable and expensive so they have to be small and they take out environmental factors and this stuff works over years and decades not days and weeks.

So we have a formula with 1000 variables, environmental factors, perhaps inter-generational epigenitic factors, and outcomes that take decades to see measures on. The fact that we even have better theories is amazing. Its going to be a long time before we ‘know’ a damn thing.

Even at the cellular level we only have better ideas, we dont KNOW shit.
What is insulin resistance? It makes insulin work less well? Oh, it does? Then why does it still work so well in fat and liver cell? You mean its cell specific? It works on fat stores in a cell to prevent glucose uptake? Oh thats super clear. But wait, in well trained athletes they have even more fat stores in cells that dont have this resistance effect. Lots of ideas, we have learned lots, we dont know shit.

Is sugar bad? What do you mean by sugar? Fructose? glycogen? Those are pretty different things people lump together. Can fructose make you perform better? Maybe. Any other use? Putting on fat to survive a hard winter? We dont really know. We understand more, but the width of what we dont understand grows twice as fast as what we learn.

LDL, same thing. We know so much but still have giant holes in our basic understanding that would let us clearly answer the question ‘what should i eat’. (this one is a super interesting rabbit hole if you want to lose a couple days-weeks learning at a high level about lipids).

Clearly some stuff is black and white. Dont eat soda and fast food. Eat real food. Eat quite a lot of fiber. Do some exercise. Anyone who claims they KNOW anything beyond that, add some grains of salt.

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And even if they did, that would be virtually useless in application.

Clinical dietetics and sport-specific dietetics would be necessary beyond that, and is far outside the scope of all that must be fit into a medical curriculum.

@andrew61 Most doctors are well aware that they are not nutrition experts. I have at least 10 MD’s as clients for whom I write nutrition plans.

Even in exercise science programs from BS up through PhD, >90% of the focus is general population and clinical-prep. Probably closer to >99% in many schools. Understandable. But, if you’re looking for an MD who has sport nutrition knowledge, you’ll be very very hard-pressed to find one (who isn’t also trying to sell you some product or “method”)

Bingo!!

Except that it probably merits referring out to specialists much sooner in >50% of cases because while all the advice listed there is appropriate, the result is often pretty pronounced hunger, if the person successfully carries out even half of what is listed. Thus resulting in reverting back to what was normal for them.

Not to mention it’s not exciting research. You don’t produce freaks of nature athletes or top-performance cars, or the most efficient x, y, z, while researching nutrition. You’re effectively researching “how do I make people stay normal” where “normal” is “healthy.” Riveting. Hence, a lot of the best and brightest minds go and find more exciting things to do elsewhere, IMHO. (like become surgeons, biotech researchers at for-profit companies, CEOs, and F1 engineers, you name it… but not academics studying how many carbs per day is best and “what color should your food be?”)

For optimal maintenance of general health (ie. preventing all-cause mortality and morbidity), you’re right. We know very little specifically, outside what you’ve listed, precisely because of the broadness of the question and infinite number of variables.

For very specific outcomes in more niche scenarios (specific pathologies, or sport performance goals), there are absolutely subject matter experts who can tell you a litany of very specific things we do now, in terms of the outcomes that result from a litany of specific interventions or strategies. I digress.

I agree with you, that a principal reason MDs do not know much about nutrition for gen pop is that there is not much known outside the basics.

Result: MDs sound like simpletons when they tell you to eat your veggies and cut the crap. Turns out, the registered dietitian (my wife) will tell you the same thing. She’ll just be better at motivational interviewing and convincing you to actually do it.

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I’m a doctor, specialising in Family Medicine. I can confirm what someone said above: the majority of the population only need to hear very simple things about nutrition, and that will achieve 90% of the results.

I will always say to my patients:

  • Try to move as much as you can. Go for a walk, ride a bike, run. Whatever you can. Even if it’s a short one, it’s better than nothing.
  • Don’t drink alcohol and sugary drinks
  • Don’t smoke
  • Avoid eating too much red meat, processed foods, animal fats, smoked meats.
  • Avoid salt in your food

That works for the majority of the population, and it’s a simple and effective message to transmit in the short time we have in each consultation. Most doctors will have no trouble to tell you this information.

Of course if you are looking for sports nutrition, weight loss diets, etc. thats completely different, and there are healthcare professionals who specialize in those fields.

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Well I’m never not going to eat chourico and presunto, I wouldn’t be a true transmontano lol

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Ahah of course :joy:

I’m going to tell you a trick I learned when I started doing this kind of counselling: If you say to people to don’t put salt in their food, they will put a little bit. If you say to put only a little, they will put a lot more of it. So just say to don’t do it, because you know they will put it anyway :sweat_smile:

Same thing with chouriço, bread and all the other stuff :man_shrugging:

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Yeah it’s pretty frustrating to see people on TV picking up and reporting about every new FAD and have segments about whichever latest over-sensationalised (and often misrepresented) study, that always end in them throwing there hands in the air “who even knows what we should eat…”
In reality it’s really pretty simple and hasn’t really ever changed.

My favourite summary :laughing::

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