Keeping up on the latest trends and research on nutrition can be a challenge for even the most ambitious health professional. As we are bombarded with nutrition messages from health gurus, websites, radio broadcasts, and podcasts, we soon realize the messages often conflict and leave us in a quandary as to what is “scientifically-proven” and what are the best practices regarding nutrition.
The foundational elements of nutrition do not change with time, but the application and best practices for nutrition seem to change almost as frequently as the seasons. For example, we were first told “fat is bad and the cause of cardiovascular disease; bring on the carbohydrates!” and in response, the food industry suddenly changed all its recipes to meet the new low-fat trends. But nearly two decades later we are told that fat is healthy and carbohydrates are the cause of our most epidemic diseases, leading to a rise in the promotion of Paleolithic and ketogenic diets. So how can we claim that both low-fat and high-fat diets are best for curtailing our cardiovascular crisis?
RCTs and Historical Data
As with any other therapeutic modality, research based on high quality randomized controlled trials using a large number of subjects and testing over a long period of time is a good place for gaining reliable information. Historical trends are also useful for recognizing the success (or failure) of dietary patterns. For example, consider the health outcomes and shifts we are experiencing after nearly two decades of advocating and consuming a largely high-carb, low-fat diet. Are chronic diseases waning or growing? As we consider diets of the past and the prevalence of poor health, we can gain insight into possible effects of those diets. It is from this perspective that the Paleolithic and ketogenic diets have been reborn. Historical trends can give us a good starting place for understanding the influence of nutrition on health, but modern technology can convert these anecdotal results into something more “scientifically proven” and reliable based on lab results and analyzations.
By default, most people rely on medical professionals for nutrition information and education; however, for traditionally trained medical professionals, obtaining adequate nutrition education may require a bit more effort and time, but by no fault of their own.
Lack of Adequate Training
Despite our growing knowledge of the importance of nutrition as a fundamental element in health, research shows that medical school still neglects to adequately educate the next generation of practitioners in this crucial field. An online survey of 36 nutrition-related questions was taken by 72 Accreditation Council for Graduate Medical Education (ACGME) program directors in anesthesia, family medicine, internal medicine, pediatrics, obstetrics/gynecology, and general surgery. The results showed that program directors lacked knowledge of nutrition. Nutrition education was provided at 78 percent of the programs, but only 26 percent had a formal nutrition curriculum. According to the study, “Training was variable, ranging from an hour of lecture to a month-long rotation. Seventy-seven percent of program directors stated that the required educational goals in nutrition were not met. The majority felt an advanced course in clinical nutrition should be required of residents now or in the future.”
In another study published in 2018, “A minimum of 25 hours dedicated to nutrition is recommended in preclinical years, but only 40% of U.S. medical schools achieve this goal.” Therefore, most physicians are not competent to provide nutrition advice to patients. Most patients expect that their physician would inform them of necessary nutritional changes recommended for their condition. Instead, only a few conditions such as diabetes are referred out to dieticians/nutritionists for nutritional counseling. Unfortunately, when a secondary practitioner is required, patient’s compliance is usually low and the nutritional counseling often does not happen. Therefore, it is important for physicians to be knowledgeable in nutrition so they can begin counseling patients on the importance of nutritional changes and emphasize the critical need for further education from other practitioners who specialize in nutrition.
Nutrition education and research morphs as our knowledge of human anatomy and physiology, biochemistry, and medicine expands. Therefore, the practitioner must commit to being a lifelong learner and one area which must not be neglected, due to its influence on human health, is that of nutrition as both a means of sustenance and a therapeutic modality.