By Dr. Alan C. Logan, ND, FRSH

In recent years clinical nutrition has evolved into its own medical discipline and many of today’s physicians are hungry for nutritional training so that they can correctly counsel patients. Sadly, very few medical schools provide even basic education in the nutritional sciences. The few hours of nutrition spent in most medical schools is related to biochemical reactions of the energy cycle in the human cells (the Krebs cycle) and the use of life-saving I.V. nutrition. There is little to no clinical nutrition – i.e. the stuff that patients ask about. This sets a tone among medical professionals, because if it is not prioritized in the 4 years of basic medical education, if it is glossed over, then how important could nutrition really be?

A recent study in Nutrition Journal (2005) investigated the basic nutritional knowledge of medical students. The results showed that students need absolute basics of nutrition taught to them. More than one quarter of the respondents did not know that fat contains, gram-for-gram, more calories than an equivalent serving of carbohydrates or protein. Only 26% correctly identified canola oil as a good source of monounsaturated fat, and about half the students were unaware that olive oil is rich in monounsaturated fat. Almost half of the med students thought that folic acid supplementation can make up for a vitamin B12 deficiency and 75% were unaware that vitamin B12 deficiency is commonly observed in the elderly due to poor absorption.

A separate paper published in Nutrition Journal (2003) found that cardiologists, who really should be at the forefront of nutritional knowledge, were lagging in some important areas. You might also assume that internists are on the cutting edge of nutritional knowledge as well – but think again. Half of the physicians did not know that canola oil and 26% did not know olive oils are both good sources of monounsaturated fat. Ninety-three percent (84% of cardiologists vs. 96% of internists) did not know the effects of a low-fat diet on blood triglycerides. Approximately three-quarters (70% of cardiologists vs. 77% of internists) did not know the effects of a low-fat diet on HDL (the “good”) cholesterol.

Back to top

What is wrong here? Why are highly intelligent physicians lacking in nutrition knowledge? I should underscore that I am not citing such research to be critical of the individual doctors and medical students – it is the system that needs to be overhauled. The barriers to nutritional education have been discussed in various medical papers – they include

1. Medical schools have severe limitations on teaching time.
2. Nutrition is perceived as a “soft” topic and unscientific.
3. Nutritional counseling is time-consuming with little reimbursement.
4. There is no accountability in nutritional knowledge via licensing exams. Research shows that only 3% of 6000 medical licensing board exam questions are even remotely related to nutrition.

How much time is spent in nutritional education in medical schools? The largest survey to date, published in Medical Education Online (1998) showed that only 55% of medical schools in the US had an actual nutrition course. Only 7% of the schools had a clinical practice nutrition course which gives future MDs the chance to get into nutrition from a clinical perspective. Regarding the total hours of nutrition education, 75% of the schools required courses that amounted to only 20 hours or less.

A growing number of medical doctors are taking matters into their own hands and pursuing medical nutrition training through courses set up via a select few medical schools. They are to be commended for such action, and their patients will surely benefit from this type of advanced training in nutritional medicine. The annual “Food as Medicine” course (jointly offered by the University of Minnesota and Georgetown University) offers one of the best nutritional medicine courses offered to physicians and allied health professionals. Having taken this week-long intensive course, I can attest to the incredible knowledge base of its esteemed faculty and the brilliance of its content. Courses such as “Food as Medicine” prepare physicians and other healthcare providers with real-world, clinically useful knowledge. This type of training should be part of basic medical school training.

Back to top

Nutrition is the foundation stone of naturopathic medicine – transcripts from my 4 years of naturopathic medical school show 223 required hours of classroom nutritional education, not including hundreds of hours in clinical practicum. In addition, licensure as a naturopathic physician in the select States and Provinces where there are laws governing practice require the passage of biochemical and clinical nutrition board exams.

Clearly, medical nutrition can no longer be considered a “soft”, unscientific topic. The research becomes more and more robust as every week passes – nutrition matters, particularly in the prevention and treatment of chronic diseases. Beyond optimal nutrition, the role of a select number of dietary supplements, such as fish oils and probiotics, has been shown to play an adjuvant role in medical care. Consumers often need guidance in the area of nutrition and dietary supplements from medically trained professionals – licensed naturopathic physicians from 4-year colleges and medial doctors with advanced nutritional education are available to help in the midst of nutritional confusion.

Back to top