Nutrition is (still) poorly represented in modern medicine.
We have known for decades that the vast majority of disease in the Western World is caused by environmental factors (primarily diet and lifestyle). In 2018 the top medical journal JAMA published that poor diet was the leading cause of death in the US and worldwide.
Despite this, nutrition education in our medical schools and continuing medical education (CME) continues to be woefully under-emphasized. By recent analysis, only 29% of medical schools meet the minimum recommendations for nutrition education in their curriculum. Over a third of medical schools have very little to no nutrition education in their curriculum.1
Those that do include nutrition often give it short shrift, focusing only on the very basics of vitamins and minerals, using outdated material and never delving into the profound effects of diet on metabolism, the microbiome, inflammation, brain function or epigenetic programming. The bottom line: most doctors know very little about nutrition and the effect of food on the human body.
After entering our profession we spend hours every year updating our knowledge with continuing education, however most conferences focus solely on pharmacology or new technology. Nutritional therapy and cutting-edge nutritional research are seldom mentioned even though these provide the only viable way out of the health mess we are in as a nation.
How can we be expected to help turn the tide without the tools needed to do so?
Something has to change.
When we explore the state of our Nation we discover that chronic diseases are skyrocketing. We are fast approaching 40 million Americans with type 2 diabetes.2 Currently 88 million adults and 20% of teens in the US are prediabetic and entering the diabetes on-ramp.3,4 The cost of this surge both in dollars and lives is staggering. Think this is all caused by obesity? Think again. Close to 1/3 of normal weight (non-obese) adults are prediabetic, with most being blissfully unaware of the time bomb lurking inside them. Fatty liver disease (NAFLD) is also reaching epidemic proportions with 100 million people in the US falling victim to this metabolic derangement. Yes, you read that correctly. 100 million Americans have NAFLD according to the American Liver Foundation and are at increased risk for cirrhosis and liver cancer. How did we get here?
Poor nutrition affects more than our metabolic health.
Beyond these more recognized chronic deseases, nutritional therapies for neurodevelopmental and mental health disorders in our children as well as neurodegenerative disease in our adults may be heavily influenced by nutrition.5–9 Pregnant mothers are not getting adequate nutrition counseling to properly support optimum development of their child’s brain, and stress and nutrient poor diets may be epigenetically programming them for a life of chronic disease. The rates of many autoimmune diseases also continue to rise out of proportion to our population growth, with growing links to our food system.10 Mounting evidence suggests that the rise in most of these diseases likely represents the intersection of genetic predisposition combined poor nutrition (and subsequently an altered microbiome), and environmental exposures (including Envoronmental toxins and Endocrine Disrupting Chemicals (EDCs) through our diet.
It is imperative that we all step up our nutritional game if we want to provide good medical care.
Patients need and want more from their healthcare provider. Patients are hungry for nutrition information from reliable sources (pun intended). We all know that food choices cause chronic disease, but we need to be offering actionable solutions and pathways to use foods that heal. Where do we start?
The lofty (but attainable) goal of including dedicated nutrition coursework as core curriculum in all US medical schools continues to be shelved by the Association of American Medical Colleges (AAMC).
We as individual providers need to seek out our own nutrition education and demand more from our professional organizations. The paradigm shift begins with each of us.
As a nutrition first medical provider I have read thousands of peer reviewed studies published each year on the importance of the microbiome in human health, and the impact of diet on metabolism, inflammation, brain and immune function. Many do not have the time to dedicate to this, fortunately high quality nutrition-heavy continuing medical education is available to providers who seek it out. The best conferences I have attended in the past decade are the Metabolic Health Symposiums, hosted by Swedish Medical Center in Seattle, WA. These multi-day conferences provide an evidence-based look at the effects of nutrition on a host of metabolic disorders and human disease and are eye-opening and inspirational even to those fairly well versed in nutrition. If the conferences you attend do not discuss an in depth look at medical nutrition therapy, ask for it. Send emails, fill out your conference questionnaires.
It is ultimately up to us to change the state of our profession and use nutrition to make a positive impact on the health of their patients.
References
- Adams KM, Butsch WS, Kohlmeier M. The State of Nutrition Education at US Medical Schools. J Biomed Educ. 2015;2015. doi:10.1155/2015/357627
- Lin J, Thompson TJ, Cheng YJ, et al. Projection of the future diabetes burden in the United States through 2060. Popul Health Metr. 2018. doi:10.1186/s12963-018-0166-4
- Andes LJ, Cheng YJ, Rolka DB, Gregg EW, Imperatore G. Prevalence of Prediabetes among Adolescents and Young Adults in the United States, 2005-2016. JAMA Pediatr. 2020;174(2). doi:10.1001/jamapediatrics.2019.4498
- CDC. New CDC report: More than 100 million Americans have diabetes or prediabetes | CDC Online Newsroom | CDC. In: Cdc. ; 2017.
- Tengeler AC, Kozicz T, Kiliaan AJ. Relationship between diet, the gut microbiota, and brain function. Nutr Rev. 2018;76(8). doi:10.1093/nutrit/nuy016
- Georgieff MK. Iron deficiency in pregnancy. Am J Obstet Gynecol. 2020. doi:10.1016/j.ajog.2020.03.006
- Berkowitz C, Mosconi L, Scheyer O, Rahman A, Hristov H, Isaacson R. Precision Medicine for Alzheimer’s Disease Prevention. Healthcare. 2018. doi:10.3390/healthcare6030082
- Cusick SE, Georgieff MK. The Role of Nutrition in Brain Development: The Golden Opportunity of the “First 1000 Days.” J Pediatr. 2016. doi:10.1016/j.jpeds.2016.05.013
- Schwarzenberg SJ, Georgieff MK. Advocacy for improving nutrition in the first 1000 days to support childhood development and adult health. Pediatrics. 2018. doi:10.1542/peds.2017-3716
- Lerner A, Matthias T. Changes in intestinal tight junction permeability associated with industrial food additives explain the rising incidence of autoimmune disease. Autoimmun Rev. 2015;14(6). doi:10.1016/j.autrev.2015.01.009