What do doc­tors know about food? Not very much.

The Borneo Post - Nature and health - - Front Page - By Rachel Cer­nan­sky

WHEN Amer­i­cans hear about a health craze, they may turn to their physi­cian for ad­vice: Will that su­per­food re­ally boost brain func­tion? Is that sup­ple­ment okay for me to take? Or they may be in­ter­ested in food choices be­cause of obe­sity, mal­nu­tri­tion or the role of diet in chronic dis­ease. But a doctor may not be a re­li­able source. Ex­perts say that while most physi­cians may recog­nise that diet is in­flu­en­tial in health, they don’t learn enough about nu­tri­tion in med­i­cal school or the train­ing pro­grammes that fol­low.

An es­ti­mated 50 to 80 per cent of chronic diseases, in­clud­ing heart dis­ease and cancer, are partly re­lated to or af­fected by nu­tri­tion, ac­cord­ing to Martin Kohlmeier, a re­search pro­fes­sor in nu­tri­tion at the Univer­sity of North Carolina at Chapel Hill. For those ex­pe­ri­enc­ing risk fac­tors early on, a change in diet is im­por­tant.

“Peo­ple are gain­ing a pound or two a year, and no­body says any­thing. But then by age 50 or 55, they’ve of­ten gained 30 or 40 pounds, which has huge im­pacts on their health,” said Wal­ter Wil­lett, an epi­demi­ol­ogy and nu­tri­tion pro­fes­sor at the Har­vard T.H. Chan School of Pub­lic Health. “In the younger years, mid­dle age, peo­ple are ac­quir­ing the risk fac­tors that of­ten don’t show up as ma­jor diseases un­til later in life.”

“You can prac­tise only what you know,” Kohlmeier said. Ac­cord­ing to the Jour­nal of the Acad­emy of Nu­tri­tion and Di­etet­ics, mal­nu­tri­tion is preva­lent but un­der­recog­nised in the United States. That does not sur­prise Kohlmeier, who said, “This is what hap­pens when you don’t teach nu­tri­tion.”

Stan­ford and UNC are among med­i­cal schools work­ing to turn that tide by in­te­grat­ing nu­tri­tion into their cur­ricu­lums. “Just like it was re­ally im­por­tant that doc­tors stopped smok­ing - that made them ad­vo­cates for not smok­ing,” Wil­lett said. “Doc­tors need to set an ex­am­ple, both for their own good and for the good of their pa­tient.”

The As­so­ci­a­tion of Amer­i­can Med­i­cal Col­leges re­ports a more than 50 per­cent in­crease since 2011 in schools of­fer­ing an elec­tive course that covers nu­tri­tion, but that tally counts elec­tives that merely in­clude and don’t nec­es­sar­ily fo­cus on the sub­ject.

AAMC med­i­cal ed­u­ca­tion ex­pert Lisa How­ley is op­ti­mistic. “All of our schools are ad­dress­ing this in some ca­pac­ity. Some are do­ing it quite in­ten­sively, and oth­ers (not as well) - there’s a spec­trum,” she said. “For those who are some­where on the lower end of that spec­trum, it would be lovely to see them learn from their col­leagues and, through shared re­sources, be able to even fur­ther in­te­grate this con­tent into their cur­ricu­lum.”

Teach­ing nu­tri­tion re­quires ex­per­tise and re­sources, but some ef­forts are un­der­way to stream­line the process so ev­ery school doesn’t need to start from scratch. Ry­del and col­leagues are work­ing to cen­tralise nu­tri­tion-re­lated re­search and rec­om­men­da­tions for med­i­cal schools, and the Amer­i­can So­ci­ety for Nu­tri­tion an­nounced in Septem­ber that it would lead a co­or­di­nat­ing cen­tre for nu­tri­tion ed­u­ca­tion.

Wil­lett said that the ini­tia­tives in schools are cru­cial. He re­called a ma­jor study in 2015 that en­cour­aged more-ag­gres­sive treat­ment with drugs that can lower blood pres­sure even though obe­sity and ex­cess weight are ma­jor causes of hy­per­ten­sion.

“There was not a sin­gle state­ment I saw any­where that we should en­cour­age weight loss and sodium re­duc­tion or in­creased potas­sium in­take, which means more fruits and veg­eta­bles,” he said. “That just is such a glar­ing ex­am­ple of the re­sult of our ex­tremely un­bal­anced med­i­cal ed­u­ca­tion.” – Wash­ing­ton Post

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