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Nutrition mostly falls off the radar for most physicians in the United States. Here is a rundown of what your doctor probably doesn't know about the roles of diet and nutrition in treating disease.

In the United States, medicine is a graduate field of study. Doctors to be almost always acquire a baccalaureate degree first, and they could have studied almost anything in their undergraduate years, from quantum physics to Romance languages to performance music with a concentration in tuba. 

To compensate for differences in undergraduate education, American medical schools require all medical students to take an intense year of basic sciences at a graduate level, cramming a four-year university level education into an intense nine months at the beginning of medical school. As little as twenty-five hours in the 2000 to 3000 hours future doctors spend studying basic science, however, is devoted to nutrition. 

Many medical school professors believe that much more time needs to be devoted to the study of the role of food in disease and health.

What Goes Wrong in the Teaching of Nutrition to Future Doctors

The sheer intensity of medical education in the United States may be part of the reason the quality of nutrition education is so poor. While relatively few medical school students actually flunk out (typically just one or two in every entering class of 50 to 200), most medical students feel extreme pressure to spend all their waking hours learning as much as they can. As a result, most future doctors fail to eat regular meals. They may live on vending machine snacks, coffee, and Diet Coca-Cola most of the week, and then binge when they have a little more free time on the weekends.

As a result, doctors themselves never acquire the healthy eating habits they need to be able to explain to their patients. When they graduate from medical school and complete their training, doctors usually defer the task of teaching patients about fooc choices and portion control to registered dietitians.

Who Is a Registered Dietitian?

In the United States, a registered dietitian, or an RD, is an person who has successfully completed undergraduate coursework and an internship in dietetics, the science of creating menus of foods compatible with disease treatment. 

The designations "dietitian" and "nutritionist" are not the same. In most states in the USA, anyone can himself or herself a nutritionist. Sometimes a minimal amount of formal training is required to use the title "certified nutritional counselor," or CNC. Many employees of nutritional supplement stores have had at least some college-level training in nutrition and call themselves CNCs.

However, a registered dietitian is someone who has completed a bachelor's degree and who has been certified by the Commission on Dietetic Registration of the Academy of Nutrition and Dietetics (AND), formerly known as the American Dietetic Association.

Every registered dietitian is a nutritionist, but not every nutritionist is a registered dietitian.

To further complicate professional credentials, there is also credential for a certified nutrition specialist (a CNS, not a CNC), who is someone who holds at least a master's degree, and possibly a doctor's degree, and who designs programs for nutritional healing as an independent professional. Registered dietitians usually work under the direct supervision of doctors (or their supervisors who work under the direct supervision of doctors), and certified nutrition specialists are usually seen as independent nutritional specialists.

Why Shouldn't Doctors Just Rely On Registered Dietitians?

Americans are told constantly that they are too fat, that their cholesterol is too high, and that their standard American diet is "SAD". Obesity is said to influence almost every chronic disease from cancer to diabetes to hair loss, so diet and nutrition would seem to be a key medical concern. 

Even so, many of our conversations with our doctors run something like this:

Patient: Should I take a multivitamin?

Doctors: I don't know. Go ask your dietitian.

Patient: Is yogurt good for you?

Doctor: I don't know. Go ask your dietitian.

Patient: Is everything I have been reading about magnesium (or hoodia, or coenzyme Q10, or the supplement of your choice) true?

Doctor: I don't know. Go ask your dietitian.

Most patients don't really want to ask their dietitians for advice. 

Most patients want to get their guidance from their doctors, who should be able to see the bigger picture of a the results of nutritional intervention.

There is at least one major flaw in this approach. Most Americans don't have access to a dietitian except when they are in hospital, and usually not face to face even then. 

So is there any hope that American doctors will ever master the fundamentals of human nutrition? If nutrition educators at the University of North Carolina at Chapel Hill have their way, they will.

Researchers at the University of North Carolina asked officials at over 100 American medical schools how much time was spent covering nutrition in their classes, and learned that only about one-quarter of medical schools offered even 25 hours — half a week — of nutrition study in their four-year curricula. 

To help medical schools bridge the gap between what doctors need to know about nutrition and what they are being taught, the University of North Carolina developed a series of nutrition training modules they now offer online. Medical students and doctors can access the Nutrition in Medicine program for in-depth information on nutritional supplements, the role of nutrition in cancer, pediatric obesity, and nutrition for the elderly.

"Physicians have enough barriers trying to provide their patients with nutritional counseling," registered dietitian and chief educator for the project Kelly M. Adams told the New York Times. "Inadequate nutritional education does not need to be one of them."

Fortunately, the University of North Carolina is no longer alone in providing innovative nutritional training for doctors. Texas Tech University, which has its medical students spent their first two years on its main campus and then sends them out to hospitals, provides its students with training both in their classroom training and in clinic. Texas Tech has its students learn to treat diabetes patients by managing their own diets and practicing giving themselves "insulin" injections with a real syringe. 

And even more medical schools are developing short courses in nutrition for older doctors who did not get nutrition training in medical school and who are already on the job.

Encourage your doctor's continuing education. Don't shy away from asking tough questions about nutrition. And if your doctor starts prescribing supplements — and the medical testing that can tell you whether or not they are actually working — follow your doctor's advice. You have that still-rare doctor who offers you the best of medical and nutritional treatment. When your doctor writes you a prescription for nutritional healing — and some actually do — pay attention.

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  • Chen, Pauline W. Doctor and Patient: Teaching Doctors About Nutrition and Diet. New York Times. 16 September 2010.

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