Dr Margaret Rundle is a Family Physician practicing in Scarborough, Ontario
There is little dispute among care providers that a person’s dietary habits influence preventative and treatment outcomes. Every year, there is more research validating the role of food and therapeutic diets for chronic disease management and prevention. However, basic education around the role of nutrition and lifestyle for a long time has been a blind spot in the Canadian medical school system.
I have spent the past 27 years as a Family Physician, and I make it part of my clinical work to motivate and educate my patients around the role of nutrition in their health and wellbeing. My interest stems from my early school years participation in a variety of athletics so I wanted good nutrition to support my involvement. I completed a four-year undergraduate degree in Nutritional Sciences with the intent to then enter Medicine. In my four years of medical school, I was surprised to find we were exposed to only about 20 hours of nutrition education. I recall it being primarily only about what are vitamins, minerals, carbs, fats; nothing about dietary interventions. When I first started practice, while I still cared a lot about the role of physical activity and nutrition, it was easy to get caught up in handling acute problems, making diagnoses, and writing prescriptions. What had happened to my passion in preventative medicine? It was after I attended a series of conferences that focused on advances in scientific research around food and nutrition, that my passion was renewed. I literally got tingles as I sat in the audience. I was back! Since then, I’ve changed my practice to spend at least 15 minutes of a 45-minute physical talking to, and enquiring about, nutrition, exercise and lifestyle.
From the treatment point of view, many physicians don’t look into what we can do with diet. We share a basic understanding about diet, but food remains underappreciated as an intervention point to empower patients around the treatment and prevention of disease.
Weaving Food and Nutrition into Medical Education
One problem is that in most medical schools, physicians are not being taught the latest concepts in nutrition science. Research shows that doctors currently don’t feel confident enough to counsel their patients about their diets; in fact, more than half of graduating medical students rate their nutrition knowledge as “inadequate”. Nutrition education simply isn’t prioritized enough in the medical curriculum in North America. Another study found that only 27% of 105 medical schools in America met the minimum requirement of 25 hours in nutrition education.
There is demand from Canadian medical students for more nutrition education. In fact, 87.2% of the Canadian students surveyed in one study said that their undergraduate medical program should dedicate more time to nutrition education. While a lot of these students said they were somewhat comfortable in their knowledge about the role that nutrition plays in disease prevention, they felt ill-equipped to counsel patients on dietary requirements across all stages of patients’ lives. They also said they have trouble identifying credible sources of nutrition information.
Medical school faculties need more staff who are qualified to teach nutrition. I believe understanding the role of food as treatment should not be relegated to a few more hours or as a separate course, but woven into the entire medical curriculum. We should talk about nutrition when students study prenatal health, pediatrics, ophthalmology, oncology, etc. In orthopedics, there is an opportunity to teach about nutrition as related to Sports Medicine. Fortunately, at the University of Toronto, this has already begun thanks to the guidance of a several physicians, and through the creation of the Centre for Child Nutrition at the U of T.
A trusted and reliable education resource for physicians and patients in nutrition
What about the physicians who are already practicing? I’m currently working with the University of Toronto on accredited nutrition education for practicing MDs and started the Rundle-Lister Lectureship in Transformative Nutritional Medical Education. This lecture series provides an annual award to a clinician recognized for providing an outstanding contribution to the role of nutrition in patient care. This Food as Medicine event series helps to address the knowledge gap in continuing medical education in nutrition. Our first Food as Medicine conference focused on the microbiome. There is a saying that “we are what we eat” and while there is truth to that, I also believe that as more research is tackled, we may also understand how the foods we eat affect our microbiome and consequently, the impact those changes have on our health.
Patients and physicians alike also look to the internet for educational assistance. For doctors who do not have the time for nutrition counseling, or wish to refer patients to reliable, trusted websites, I envision a day when we can refer to a University-affiliated “go-to” web hub. The University of Toronto is one of the few Faculties of Medicine that has a Department of Nutrition under its umbrella. U of T, by developing such a website, is in an excellent position to become known as the place for physicians to update their knowledge and for patients to get safe, reliable information.
I’m not asking doctors to become dieticians. However, physicians are in a unique and powerful position because they can provide advice to patients during annual check-ups or at times of acute illness when it is most likely to resonate. For long-term change to really happen, the opportunity sits with redesigning medical education for future physicians. They can be taught about the value of nutrition in their clinical practices, and to position dietary approaches as a complement to traditional medicine for the maintenance of health and prevention of chronic diseases.
Editors’ note: A previous version of this blog was published in the Nourish newsletter.
This is why medical doctors need to work together with naturopathic doctors who do have the nutritional knowledge to collaboratively improve patient care. Even if GPs do get more nutritional education, they simply lack the clinical time to discuss the details of diet and nutritoin during patient visits, let alone motivational interviewing.
I agree that doctors should have more nutrition education in medical school to learn the importance of nutrition therapy. However, as a registered dietitian, I don’t want to be out of a job. Doctors need to refer to registered dietitians.
You are so right! We had half a day on nutrition at McGill, and I ate so badly that I got diabetes in my 30s.
Fortunately my wife of 1 1/2 years had survived the war in Scotland, where they thrived on the fruit and vegetables they could grow. She put me on a similar diet, and I gradually learned that sugar is poison, and refined carbohydrates is causing the epidemic of obesity that we see today.
Focusing on real, nutricious food has enabled me to stay healthy to 90, and be still able to enjoy golf and tennis.
Unfortunately people I talk to are now so addicted to sugar products that they are unable to change. I guess it takes a near death experience to change.
But focus on nutrition and the dangers of processed food should be done!