What should any doctor (PCP or a specialist) know about nutrition?

That’s why I always refer to a registered dietitian.

I’ve known some doctor’s that have been good about discussing nutrition and others that seemed clueless. I think doctor’s should be more up to date about nutrition. I think the problem is that it has been changing a lot in the past decade or so and medicine has also been changing a lot. In choosing which things to keep up to date with, I think doctors tend to focus mostly on the medicine side of things and focus less on nutrition. Also, with the number of new medications that come out, that is another area that they have to focus on. All in all, I think doctors have a lot on their plates. When they really aren’t sure, they should be referring their patients to dietitians (which should be covered by insurance in my opinion).

@Rarebear And that’s certainly a luxury in certain medical settings – for example, there are two private practices that I work with and they don’t feel the need to hire a social worker or a nutritionist because all they care about is the money so my patients have no idea what to do and so many want to learn to eat properly and their 30 second interaction with their oncologist once every month doesn’t cut it. Besides, when a patient gets told ‘go see a nutritionist’, it’s never going to happen unless they’re educated and well to do, relatively speaking.

It’s important to understand that anybody can call themselves a “nutritionist.” Only registered dietitians have gone to school to become registered dietitians.

@Rarebear Right, fine, agreed…my comment still stands.

And the answer to your question is “not much” unless they’ve gotten extra training.

@Rarebear How do you feel about your knowledge of nutrition? And what does this extra training entail?

To answer your question most directly, I think it’s not feasible for them to be the expert, but that they damn sure ought to be referring to them as often as possible.

I think part of the problem is that nutrition mostly falls in the “wellness” category which is something western medicine and insurance is reluctant to adopt. I would also guess that it’s sort of a losing battle to monitor nutrition when it comes to patients. It was big news, for example, when one doctor fired his patient when she refused to quit smoking. Doctors would have no patients if they took such a stand on nutrition.

Thirdly, the food industry and the USDA have made nutrition terribly confusing and contradictory since the ascension of food processing (in an effort to sell more calories and to charge more for “value added” calories. I mean, if we’re to the point where people are contemplating selling statins with cheeseburgers, then what hope is there of emphasizing nutrition in a clinical setting?

For the poor and indigenous, food is also heavily intertwined with culture, so one ought to ask whether this is proper battleground for a PCP.

The hospital I used to work at had its origins as a sanitorium for tuberculosis patients in the early 1900s and actually had a farm as part of its operation with the logic that patients required good, clean food for healing. When I learned that, I thought it was obvious question why that was abandoned.

@Simone_De_Beauvoir Well, I’m the wrong person to ask. I’m married to a dietitian and I’m the medical director of the nutrition support committee at my hospital. So I know quite a bit. I learned mine through conferences and clinical experience.

@Rarebear Somehow that’s a rare physician experience, in my opinion (though amazing) – how did you find yourself caring?

@Simone_De_Beauvoir How did I find myself caring about nutrition?

@Rarebear Yep.

@Simone_De_Beauvoir, back in my healthcare days, I would have tried solving that problem by marketing dietitian services to PCPs as well as educating physician groups to create best practices/policies around making referrals for applicable diseases/conditions.

@Simone_De_Beauvoir Well, I run an ICU. There is tons of writting on nutrition in ICU patients, so it’s an aspect of the literature I need to keep up with. So it’s really not an issue with “caring” or not. It’s part of my job.

@Rarebear But I know there is tons of writing on nutrition and every chronic disease imaginable so why aren’t other physicians reading it?

Newer graduates of the better medical schools have been better trained than their predecessors on basic nutritional requirements and the relationship between nutritional deficiencies and disease. Some of these keep up with developments that affect their practice better than others.

@Simone_De_Beauvoir Too much other stuff to read.

My GI has been extremely disappointing to me on this front. You would think a GI, of all doctors, would know this stuff. I have ulcerative colitis, and I’ll read about people who can manage their disease by diet alone, but when I ask my doctor about this possibility, his response is, “Diet plays a minimal role.” And his solution is medicate, medicate, medicate. It bothers me too that usually when I’m hospitalized I come out worse than I went in because hospital food is so harsh on my digestive tract.

@Mariah Exactly.

@Mariah Sadly, diet doesn’t have a lot to do with UC, but there is a good book I can recommend called Eating Right for a Bad Gut It doesn’t change clinical course, but it may make you feel better.

@Rarebear Well I would say that depends a lot on who you talk to. Some people claim to have been “cured” (that is, their symptoms went away and never came back) by the Specific Carbohydrate Diet. (I already have the book you recommended, haha. Thanks, though!)

As the “primary” health care people, doctors should have a vast knowledge of nutrition as well, and i find it sad and pathetic that they are not able to advise patients how to regain and maintain their health through proper nutrition. This is a major reason why i stay away from doctors as far as i can.

I agree with @NaturallyMe – this is information that should be part of the standard education. It is, in fact, the information that would theoretically prevent us from getting ill in the first place.