Eating well can help prevent chronic conditions including heart disease, diabetes and obesity. So why aren’t more doctors prescribing broccoli and flaxseed?
Despite the wealth of research linking nutritious diets to disease prevention, the importance of food receives little attention in most physicians’ practices. But a shift is slowly happening, doctors say. More are recognizing the link between food and health and are advancing their nutrition knowledge to provide better patient care.
The National Academies of Science recommend a minimum of 25 hours of nutrition education for medical students, but a 2015 study showed that 71 percent of medical schools failed to meet that goal. Despite this lack of formal nutrition education, doctors remain a trusted source of nutrition information for patients. But just 14 percent of physicians say they feel adequately trained in nutrition counseling.
“Food touches our patients in so many conditions — diabetes, celiac disease, food allergies, high blood pressure — we need more education about food and nutrition so we can be better physicians,” says Timothy Harlan, a practicing internist and associate dean for clinical services at Tulane University School of Medicine.
Harlan is part of the groundswell toward educating physicians about nutrition. He’s also executive director of Tulane’s Goldring Center for Culinary Medicine, the first dedicated teaching kitchen implemented at a medical school. Yes, you read that right: It’s an actual kitchen where medical students learn to cook and provide nutrition advice to patients.
“We translate courses like anatomy, physiology and biochemistry into practical conversations about food that doctors will have with patients in exam rooms. We teach doctors about food so they can teach the community,” Harlan says.
The inclusion of nutrition education in medical schools is a growing trend. The Goldring Center has already licensed its culinary nutrition program to 25 other medical schools and six residency programs, and Harlan says he talks to a few medical schools or residency programs every week about what Tulane is doing.
There’s even a bill before Congress to try to enforce nutrition education for physicians. The Enrich Act hopes to use grants to encourage the development and expansion of nutrition and physical activity curriculums.
For doctors who missed the culinary curriculum in medical school, there are now opportunities for nutrition-based residencies, fellowships, conferences and online continuing medical education (CME) courses.
“The few hours of nutrition that are taught in medical school are often nutritional biochemistry, which has nothing to do with food. Those scientific teachings can’t help doctors answer practical patient questions, like ‘Which fat is best — butter, margarine or oil?’ ” says Victoria Maizes, executive director of the University of Arizona Center for Integrative Medicine, which offers nutrition courses both in medical school and as post-graduate education.
The center’s most popular CME course focuses on the “anti-inflammatory diet,” Maizes says. Culinary-minded physicians can also attend the center’s Nutrition & Health Conference, a combination of lectures and tastings that focus on everything from gluten-free diets to sustainable food systems.
“When a doctor learns about a healthy lifestyle, they are more successful at motivating their patients to be healthier, too,” Maizes says.
Seventy percent of Americans say registered dietitians are their most trusted source for nutrition information. So why do doctors need to know more about nutrition?
“We’re not trying to turn physicians into dietitians,” Harlan says. “But many people don’t get to see a dietitian as easily as a doctor. So the physician should have some basic nutrition knowledge.”
He and others in the field have said that when doctors learn more about nutrition, they are better at integrating dietitians into the health-care team and are more likely to refer patients to a dietitian as readily as they would to a cardiologist or endocrinologist. It creates a more effective medical plan, they say, where patients are taught about using food as prevention or treatment before turning to medications or surgical intervention.
Robert Graham,co-founder of Fare Wellness in New York, is one of a small but growing number of doctors who have embraced the concept of a “farmacy.” He provides patients with nutritional prescriptions — such as “fruits and vegetables 5-9x/day” — that they can take to the farmers market or grocery store.
“People are looking for a prescription from their doctor, so why not make it have some impact?” Graham says. “My prescription depends on their condition, but the aim is to get people towards a whole-food, plant-based diet, because the more plants you eat, the longer you live.”
Graham says patients are more likely to fill a prescription than to follow spoken advice. And his success rate? “One-third of my patients contemplate the advice; one-third take action and make steady dietary changes; the final third want deeper details and are referred to a dietitian for nutrition counseling.”
With better eating habits, Graham says, his patients see measurable changes in their health, such as lower blood pressure and reduced cholesterol. He wrote in an email: “Doctors need to take off the lab coats and put on chef jackets; put down prescription pads and pick up recipe books; slow down and learn how to cook so that we can prescribe cooking and eating real food to our patients.”
Registered dietitian Cara Rosenbloom is president of Words to Eat By, a nutrition communications company specializing in writing, nutrition education and recipe development. She is the co-author of “Nourish: Whole Food Recipes featuring Seeds, Nuts and Beans.”