THE UN­EX­PECTED RISE OF THE DOC-TRITIONIST S

Frus­trated by the gap­ing nutri­tion-shaped hole in their med­i­cal train­ing, some doc­tors are pushing the heal­ing and pre­ven­ta­tive power of food to the fore. WH catches up with medicine’s new wave

Women's Health (UK) - - EAT SMART - words CLAU­DIA CANA­VAN

You couldn’t swing a kettlebell for all the self­styled foodie in­flu­encers in 2017, but the past 10 months have most def­i­nitely be­longed to the ‘slashies’. With their job ti­tles spilling over three lines on Linkedin, punc­tu­ated by slashes or hy­phens, their many roles used to be of the best-life mil­len­nial va­ri­ety – healthy chef/sup­per club host/dj/brand con­sul­tant. But there’s been a shift of late. Turn to the health and life­style shelves at your lo­cal Water­stones and you’ll find a new breed. One that in­cludes a very au­thor­i­ta­tive ti­tle: Dr.

Med­i­cal pro­fes­sion­als, flush with five-plus years of train­ing and sub­se­quent front-line ex­pe­ri­ence of treat­ing pa­tients, are adding nu­tri­tional nous and culi­nary skills to their arse­nal. Take Dr Ran­gan Chat­ter­jee,

GP, TV pre­sen­ter and author of The Sun­day Times best­seller The 4 Pil­lar Plan and the up­com­ing The Stress So­lu­tion (both £16.99, Pen­guin Life). He views the holis­tic quar­tet of nutri­tion, phys­i­cal ac­tiv­ity, re­lax­ation and sleep as the so­lu­tion for many of to­day’s com­mon ail­ments, dish­ing up recipes for golden buck­wheat bread and ap­ple cin­na­mon break­fast bowls along­side prac­ti­cal advice on manag­ing stress and catch­ing qual­ity zeds. Dr Rupy Au­jla, GP and author of The Doc­tor’s Kitchen (£14.99, Harper Collins) is part of the same squad. His web­site fea­tures im­ages not of pill pack­ets or stetho­scopes, but of nu­tri­tion­ally dense dishes more colour­ful than Danny Dyer’s vo­cab and more mouth­wa­ter­ing than an M&S ad­vert.

FRIDGE THE GAP

Why is it that th­ese pro­fes­sion­als with tightly squeezed sched­ules are choos­ing to add yet an­other string to their bow? Be­cause, in a nut­shell, main­stream medicine doesn’t tally up with mod­ern health­care needs. ‘I’ve been see­ing pa­tients for nearly 20 years, and the vast ma­jor­ity of ail­ments pre­sented to me are in some way re­lated to our col­lec­tive mod­ern life­style,’ says Dr Chat­ter­jee. ‘If 80% of the prob­lems pa­tients present are re­lated to life­style, but doc­tors aren’t taught life­style fixes, how can they pro­vide the best ser­vice pos­si­ble?’ This dis­par­ity be­tween what train­ing doc­tors are given and the treat­ment cur­rent health con­di­tions de­mand is grow­ing. ‘Med­i­cal train­ing hasn’t re­ally kept up to date with the chang­ing health land­scape,’ he adds. ‘I don’t re­mem­ber re­ceiv­ing any sig­nif­i­cant nutri­tion train­ing at med­i­cal school.’

And so the med­i­cal/life­style guru is born. Dr Chat­ter­jee, Dr Au­jla and co are tak­ing it upon them­selves to bridge the gap, by educating them­selves – and then the pub­lic – on the ben­e­fits of good nutri­tion and a healthy life­style. ‘Forty years ago, I think the cur­rent model worked well,’ says Dr Chat­ter­jee. ‘Now, it doesn’t.’ Es­sen­tially, a life­style more geared around seden­tary jobs and highly pro­cessed food – as well as per­sis­tent low-level stress and con­stant stim­u­la­tion by tech­nol­ogy – has left you sus­cep­ti­ble to chronic dis­eases, such as type-2 di­a­betes, obe­sity, mi­graines and gut prob­lems.

WELLTH OF KNOWL­EDGE

There’s ev­ery chance you know more about what to eat to im­prove your health than your GP does. Cur­rent UK med­i­cal stu­dents only re­ceive be­tween five and 20 hours of nutri­tion ed­u­ca­tion dur­ing their train­ing,

de­pend­ing on where they study. That’s ac­cord­ing to Ally Jaf­fee and Iain Broadley, med­i­cal stu­dents at the Univer­sity of Bris­tol and co-founders of Nutri­tank, a net­work of doc­tors and med­i­cal stu­dents aim­ing to pro­mote the need for greater nutri­tion and life­style medicine ed­u­ca­tion within for­mal train­ing. Those few hours are mostly taken up with the bio­chem­istry of in­di­vid­ual macronu­tri­ents – pro­teins, carbs and fats – and advice on vi­ta­min and min­eral de­fi­cien­cies. ‘We’re hardly taught about the role of nutri­tion in pre­vent­ing, treat­ing or manag­ing chronic dis­ease,’ says Jaf­fee. ‘Or even the science be­hind pos­i­tive di­etary pat­terns for health, like the ben­e­fits of a Mediter­ranean-style diet.’ Dr Har­ri­son Carter, junior doc­tor and Bri­tish Med­i­cal As­so­ci­a­tion spokesper­son, agrees. ‘We’re at the stage where re­ceiv­ing any nutri­tion ed­u­ca­tion at med­i­cal school is good,’ he says, never mind a ro­bustly taught cur­ricu­lum aligned with pa­tients’ needs. While cer­tain in­sti­tu­tions are lead­ing the way (Dr Carter ref­er­ences the Univer­sity of Cam­bridge’s med­i­cal school, which works with the Need

For Nutri­tion Ed­u­ca­tion/ In­no­va­tion Pro­gramme, a lo­cal train­ing academy pro­vid­ing nutri­tion train­ing to their med­i­cal stu­dents), the gen­eral pic­ture looks, well, weak.

The fact that the med­i­cal train­ing model is so tra­di­tional and un­re­spon­sive means that, de­spite all the re­cent re­search into di­ges­tive health, nutri­tion

and its di­rect im­pact on gen­eral well­be­ing, it can take ages for the cut­ting-edge science to in­form the treat­ment and advice doc­tors give. ‘It takes around 17 years for re­search to get trans­lated into clin­i­cal prac­tice,’ says Dr Me­gan Rossi, re­searcher at King ’s Col­lege Lon­don and reg­is­tered di­eti­tian (@theguthealth­doc­tor). ‘That’s to make sure treat­ments are safe and cost-ef­fi­cient. So there are rea­sons for the bar­ri­ers, but it’s far too long to wait.’

DOC­TORS WITHOUT BOR­DERS

Some naysay­ers might sug­gest that it’s not a gen­eral doc­tor’s place to wade in on nutri­tion. Af­ter all, di­eti­tians go through ex­ten­sive train­ing (ei­ther a stand-alone bach­e­lor’s de­gree or a life sciences de­gree plus

post-grad qual­i­fi­ca­tion) to gain in­sight into why cer­tain foods are a balm to some health con­cerns and oth­ers fan the flames. (Side note: the term ‘nutri­tion­ist’ isn’t as tight. The ti­tle isn’t legally pro­tected, so peo­ple with vary­ing qual­i­fi­ca­tions can adopt the moniker.) Should med school grads stick to pills and surgery and leave the cru­cif­er­ous veg chat to their col­leagues?

With the NHS as stretched as it is, doc­tors are in no po­si­tion to be turn­ing peo­ple away. So says Dr Hazel Wal­lace, who has au­thored two recipe and life­style books. ‘We need to know the ba­sics,’ she says. ‘There’s a pan­demic of chronic con­di­tions and dis­eases, and di­eti­tians don’t see pa­tients first. Within the NHS, it’s not al­ways pos­si­ble to re­fer pa­tients to one.’

Dr Rossi isn’t wor­ried about gen­er­al­ists step­ping on her turf. ‘While med­i­cal pro­fes­sion­als need to be aware of their lim­its [when it comes to deep nu­tri­tional ex­per­tise], I be­lieve they should have fun­da­men­tal knowl­edge.’ Dr Au­jla is sim­i­larly dis­mis­sive of the idea that he should stay in his lane. ‘It’s like say­ing that doc­tors should stick to what we did 100 years ago –

‘We should have been do­ing this 30 years ago’

us­ing leeches or blood-let­ting,’ he says. ‘This is mod­ern science and some­thing we should have adopted 20 or 30 years ago when the ev­i­dence about the ben­e­fits of eat­ing a Mediter­ranean diet first came out.’

COURSE OF TREAT­MENT

Nod­ding vig­or­ously? Be as­sured that this is more than wellinten­tioned chat. Th­ese doc­tors want change and they’re not wait­ing around for an in­vi­ta­tion. In­spired by the culi­nary medicine course at Tu­lane Med­i­cal School in New Or­leans – on which med­i­cal stu­dents are taught kitchen skills along­side the science of how cer­tain foods can be used to al­le­vi­ate and pre­vent chronic dis­ease – Dr Au­jla has cre­ated his own course for a UK au­di­ence. July 2018 saw the first batch of stu­dents en­rol in the pi­lot scheme at Bris­tol Med­i­cal School. At this stage, it was an elec­tive that fu­ture doc­tors could choose to do, al­low­ing them to delve into some­thing that isn’t on the manda­tory cur­ricu­lum. Yet.

Nu­tri­tion­ally savvy fu­ture doc­tors Jaf­fee and Broadley worked to get Dr Au­jla’s course to their Bris­tol cam­pus – and both en­rolled. The lengthy wait­ing list for places is tes­ta­ment to the ap­petite for th­ese skills among med­i­cal stu­dents. Given that the course has been li­censed for more than 35 med­i­cal schools in the US, Dr Au­jla hopes this sets a prece­dent for it to be in­tro­duced in the UK. Ul­ti­mately, he wants this stuff to be manda­tory. ‘The longer we take to adopt it, the more the pub­lic will suf­fer as a re­sult,’ says Dr Au­jla, be­fore hang­ing up and nip­ping back to his Lon­don GP clinic for the af­ter­noon’s ap­point­ments. With such a col­lab­o­ra­tive mind­set and sense of pur­pose, the fu­ture of your health is in safe, if per­haps beet­root-stained, hands.

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