Doctors cop a lot of heat about how much (or how little) they know about nutrition. Then again, so do university-trained dietitians.
But to put the debate to rest, consider this: Imagine you’re driving down the road listening to your favourite song, humming along, tapping the steering wheel, just enjoying the beautiful weather.
As you enter an intersection, a speeding car runs a red light and slams straight into you, ramming you off the road and into a telephone pole.
Everything goes black. You wake up in the hospital laid out on an operating table, drifting in and out of consciousness as a team of trauma surgeons work diligently to surgically remove a muffler from your ass.
Who would you prefer to operate on you at that critical moment?
A highly skilled trauma surgeon or a dietitian?
Obviously you’d want the trauma surgeon, but why not the dietitian?
Don’t dietitians learn anything in their dietetics program about how to clip a hemorrhaging artery?
Then again, would you even expect them to know?
What if a dietitian wrote a book called “The 5-Minute Trauma Solution?”
Would you buy it? Why not?
On the other hand, when it comes to nutrition advice, would you buy a diet book written by a medical doctor?
And what DO doctors know about nutrition anyway?
Dietitian education
First off, exactly what coursework does a dietitian complete as part of their university training?
Speaking from first-hand experience, my bachelors in nutrition and masters in exercise physiology included coursework in:
- biology
- microbiology
- physiology
- chemistry
- organic chemistry
- biochemistry
- advanced biochemistry
- nutrition
- advanced nutrition (nutritional biochemistry)
- food chemistry
- diet therapy
- exercise physiology
- exercise biochemistry
Gluttons for punishment, even after all this coursework, dietitians are still required to undergo at least a year-long slave labour dietetic internship to gain practical hands-on clinical experience.
Doctors’ nutrition education
Doctors are often crucified for “knowing nothing about diet because they get less than 25 hours of nutrition education in medical school” and are “only taught how to push drugs to keep big pharma in business.”
And it is true that doctors are, in general, not the sharpest scalpels in the hospital when it comes to recommending what to put in your mouth.
A Harvard-trained cardiologist friend of mine once confided in me that, while he can navigate a catheter into a coronary artery and deploy a stent, he doesn’t know much about nutrition and exercise.
A 2019 systematic review on nutrition education in medical schools published in The Lancet concluded that, “despite wanting to receive nutrition education to develop knowledge, skills, and confidence to counsel patients, graduating medical students are not adequately supported to provide high-quality, effective nutrition care to patients.”
Another report in the American Journal of Clinical Nutrition came to a similar conclusion (Status of Nutrition Education in Medical Schools (2006) Am J Clin Nutr April. 83: 941S-944S).
The authors found that medical students received, on average, around 24 hours of nutrition instruction (ranging from 2 to 70 hours).
Of the 99 medical schools that responded to the researchers’ survey, only 40 schools required at least 25 hours of nutrition education.
Don’t totally discount the value of doctors
However, in defense of doctors, you should know that nutrition concepts are also covered in context when learning about organ systems and other physiological and biological processes related to disease.
For example, most doctors know that overeating contributes to obesity, obesity contributes to the development of type 2 diabetes, and type 2 diabetes can wreak havoc on the pancreas.
If a diabetic patient is living on a daily diet of cheeseburgers and washing it down with a 2-litre bottle of Coke, then it would not be unreasonable for a doctor to suggest nixing the burgers and Coke in favor of eating more fruits, vegetables, and whole grains.
Should doctors like Dr Oz write diet books or give nutrition recommendations?
Ok great. Debate settled.
But while there is so much negative sentiment towards doctors and their lack of nutrition knowledge, why is it that when medical doctors write books on nutrition, the general public runs out, scoops them off the shelves, and then gobbles up the advice as if it were the God-given diet gospel?
Need an example?
Cardiothoracic surgeon Mehmet Oz wrote You on a Diet and the book flew off shelves and onto the best seller list.
Now I’ll admit Dr Oz seems like an affable guy and it would probably be fun to slam tequila shots with him in Puerto Vallarta, but exactly how much nutrition education did he actually receive in medical school?
Doesn’t much seem to matter now that he’s a TV personality. His credibility is in his celebrity status.
What is disconcerting, however, is that Dr. Oz gives airtime to dietary wonder panaceas such as raspberry ketone supplements and nobody questions it.
He is a “doctor” after all.
It’s also noteworthy that Dr. Oz, at this late date in time, is finally coming under much needed scrutiny over the grandiose nutrition claims he makes on his show.
There have been calls by his colleagues for his resignation and he was called to testify before a congressional subcommittee for deceptive advertising and making over-the-top claims on his show.
I have colleagues and personal friends who are highly-trained cardiologists and heart surgeons but, by their own admission, know comparatively little about nutrition or exercise physiology.
They defer to the better judgment of a trained dietitian or clinical exercise physiologist.
Simple. They refer to us and we refer clients with chest pain to them – fair deal.
But why are people still so enamored by doctors who give nutrition advice even if they cognitively know that they receive very little nutrition training in medical school?
I believe that, in western culture, medical doctors have been put up on a pedestal and deified to the point where the public expects them to have an expert opinion on just about any health topic that comes to mind, including nutrition (See NY Times article on this).
I mean, heck, if you spent four years getting a bachelor’s degree (usually in a health science), another four years in medical school, and then another six or more years of specialty training on top of this, you’d better know something.
Unfortunately, far too many people are swayed by a long string of initials after a name, a slick Italian suit, a gold watch, and a Ferrari.
Doctor vs dietitian debate settled: hire the right person for the job
Taking a step back and looking at the big picture, I’d say it all boils down to this:
- If you’re sick or need surgery, go to a qualified medical practitioner. If it was life or death trauma surgery, I can tell you with reasonable confidence I don’t want the surgeon who spent all his time studying the food guide pyramid. I want the nerd who was in his dorm room every Friday and Saturday night sharpening his scalpel and memorising his anatomy and physiology text books!
- If you need nutrition advice, hire a university-trained registered dietitian (USA) or accredited practising dietitian (Australia). It’s true that you are what you eat, but careful who says so!
- If you need specific exercise guidelines for a health condition, hire a qualified masters-level clinical exercise physiologist.
Thanks for the info Bill. Imagine that a thoughtful logical answer to an interesting question. I thought that sort of thing was banned on the internet?
Agree about Dr v dietitian, but for nutritional advice would choose nutritianist over dietitian.
Hi Andrew,
I think you still have to take it on a case by case basis in that the term “nutritionist” is unregulated and anyone can declare themselves one. The same way you wouldn’t want to get brain surgery from Bob’s Fish and Chips and Neurosurgery restaurant, I would not want to get nutrition advice from someone who does not have a firm understanding of the hard sciences. I trained as a dietitian first before deciding to branch off into exercise physiology, so I am well aware of the level of education dietitians receive. I think the general public distrusts (or may not like) dietitians because often the information they provide is evidence-based and not very sexy. Many self-promoting nutritionist (self-proclaimed gurus) who are great at marketing tend to spout off a lot of unfounded theories and, in my experience, when questioned, generally tend to be confused by basic physiological concepts (which makes me question their theories). Anyone can tell you to eat 3 times your body weight in grams of protein, but if a little is good, then a lot is not necessarily always better.
Hi my name is Daniel and wanted to ask a few questions. I recently was losing hair at my hairline and trying to figure out why. I have been checking about nutritional defiences and do not have any other problems. I am quite healthy and I did not even get sick this year. I was thinking male pattern baldness but I am only 20 years old. What would you think it is? Also I have to admit I have not been eating much vegetables and passing gas lately alot. Also I am starting to have indents in my head like Terry Crews, why is that? Should I consult with a dietician, nutrition, or doctor about these problems?
Hi Daniel,
I would suggest seeing your doctor for a proper consult and work up which might include blood tests to rule out anything more sinister. Clearly healthy eating is a step in the right direction whether you’re losing your hair or not. But in the meantime I’d strongly suggest seeing your doc as a first point of contact. Cheers, Bill
Some states license nutritionist, but not every state does. To find out which states license nutritionists go to the website for the “Center for Nutrition Advocacy”. I am a Nutritionist licensed by the state of Washington Department of Health. In my state, persons with a masters degree or higher in nutrition may apply to become a Certified Nutritionist (CN). My experiences with Registered Dietitians 20 years ago, made me realize that I did not want to be a part of the organization that governs them.
The reason I am on this site, and participating in the conversation, is that I am interested in working more closely with doctors as a team, and I am trying to figure out how our culture can get the Doctors to see Certified Nutritionists as part of the team. I would like to work more closely with doctors, so that we can be offering some similar help to the patients. The doctor would “plant the seed” and the Nutritionists can work out the details with the patient. I think this relationship can be built up and turned around, for the sake of all of the people for whom nutrition could help their medical conditions. Cheers….Annette
@Andrew, Um… Did you really just say that? Tell me, what is an RDN? What does it stand for? Anyone can call themselves a nutritionist. ONLY DIETITIANS can counsel people on nutrition.
Your comments are very US-centric.
Doctors in Commonwealth countries, in Europe, receive a lot more training in nutrition, diet and physiology than the 25 hours you quote.
You are also ignoring post-doctoral qualifications. You would expect a physician that is involved in community health to gain further training in subjects that would add to their repertoire – such as exercise science and nutrition.
Your comments are very narrow minded, in my view.
Hi Mike,
Thank you for leaving a comment. Whilst there are references to the US training of doctors, I am currently located in Australia and have lived in New Zealand as well. Doctors here are not necessarily specialists in nutrition either, even if they have taken a few extra classes in nutrition.
I think the spirit of my article was that, in general, doctors are trained as doctors and dietitians are trained as dietitians. There is a level of specialisation that makes them good in their respective areas. Just because a dietitian might have taken a few classes in general medicine does not necessarily make her qualified to practice medicine.
You mention that I “would expect a physician that is involved in community health to gain further training in subjects that would add to their repertoire – such as exercise science and nutrition.”
I agree with you. I “would” expect that, but I also know the reality is that the majority do not take those extra steps. I myself spent 13 years in total attending university through to my PhD, not far off of what a medical doctor would spend with their training and specialisations. And I can tell you that spending yet more time gaining further degrees and specialisations would be downright exhausting and perhaps superfluous if I could just refer to someone else who has that specialty. I do, however, undergo yearly continuing professional development to maintain my additional registration credentials, as do doctors.
Please re-read my article, as I think you may have simply missed the main point of what I was trying to convey.
Are you joking? “Doctors” in commonwealth countries in Europe usually only have a bachelor’s degree in medicine. They have far less education and training, including in nutrition, than US doctors.
Hi Bill,
What’s your opinion of ACNEM doctors?
Jon
They certainly have lots of letters after their names
Apologies for my persistence. I do appreciate your response. Does this mean that acnem are trustworthy? Have you been to one of their conferences? Nutrigenomics seems big in their group – do you think it has a place within contemporary dietetics? I got the impression from the post (correct me if I’m wrong) that doctors advice should come second to a RD. But what of that doctor has a Fellowship in Nutrition and Environmental Medicine?
Thanks in anticipation.
Hi Jon,
At a glance, the doctors listed certainly appear well-qualified, but I don’t know a lot about the organisation itself. As per my article, I do believe that, in general, dietitians are better qualified than doctors to offer nutrition advice mainly because they have focused their studies and professional duties on nutrition. I studied nutrition myself and I remember all the hardcore science training. It was not some fluffy nutrition certificate where you sleep through it, pass an easy exam, and voila, you’re a “nutrition coach” or whatever the name du jour is these days. Doctors are clearly intelligent in their own right, but for the most part, they have not studied nutrition in exhaustingly nauseating depth.
For doctors that take additional training in nutrition, I tip my hat to them. I would like to see more of this, but the reality is that it’s not feasible if they are running a busy practice, raising a family, and trying to have some semblance of a social life on the side. As you are well aware, studying a course at uni can be immensely time consuming and many people, independent of their current profession, find it hard to go back and do additional training.
In the U.S., there are many states where having a Masters degree or PHD in nutrition, does not mean you can practice Medical Nutrition Therapy (MNT) in that state. RD’s have what is called “exclusive scope of practice” in many states, however that is changing. What is also changing, is that RD’s will be (as of 2024 according to the ADA), required to hold a Masters degree or higher to practice Medical Nutrition Therapy. The requirement now is for RD’s to have only a bachelors degree. In my opinion, part of the problem in the past with RD’s having exclusivity over the field of nutrition, is that they are not required to have an advanced degree. Reading and interpreting research is essential to staying informed in the field of nutrition. We new 20 years ago that the Framingham studies, on which many recommendations were based, were very flawed studies. I learned this in graduate school in the early 90’s when I was taught to read research and also did a Masters Thesis. This is my opinion, that Registered Dietitians do not have adequate training, if it did not involve getting a Masters Degree. Thanks for the venue for discussion. I would also say that in my many years working in public health, I have respect for and worked with some good RD’s. It bugs me now, how dietitians are wanting to call themselves nutritionists because they want distance from their own profession. Cheers! Annette Marsden M.S., C.N.
p.s. The Center for Nutrition Advocacy has a website that has information on licensing of nutritionists and dietitians, and the laws are different in each state.
cheers,
Annette Certified Nutritionist (CN) licensed by the Washington State Department of Health
Any thoughts on the current disciplinary action happening in South Africa around Dr Tim Noakes?
https://www.news24.com/SouthAfrica/News/LIVE-Tim-Noakes-HPCSA-hearing-20150604
I’ve just heard about this. Will have a deeper look into it. Cheers
Hi. I am Rebecca. I would like to know the clear cut difference between a dietician and a nutritionist
Anyone can call themselves a “nutritionist” but not anyone can call themselves a dietitian. A dietitian has a university degree in nutrition and is required to do an extensive internship to then be eligible to apply for registration. A “nutritionist” on the other hand may or may not have a university degree in nutrition. Nowadays there are lots of people with an interest in food arbitrarily declaring themselves “nutritionist.” In short, it’s the wild west out there.
Hi Bill,
I would love it if you could also include Associate or Registered Nutritionists in Australia along with Accredited Practising Dietitians in your article. Yes, the term Nutritionist is as yet, an unprotected title, but the Nutrition Society of Australia offers registration for Nutritionists with tertiary qualifications (Bachelor degree + three years clinical experience to become a Registered Nutritionist or Bachelor + Masters + 1.5 years clinical experience). If someone is calling themselves a Nutritionist without proper qualifications you can also personally call them out on it, and more often than not, they will cease using the title. Those who have completed online ‘nutrition’ courses such as IIN (Pete Evans, Sarah Wilson) recognise this and will publicly say they are not Nutritionists, but health coaches (great progress!).
The reason I believe this is important is there are some nutrition professionals who do not wish to belong to the DAA and want to practice unbiased nutrition, as the DAA is sponsored by/collaborates with Meat and Livestock Australia, Dairy Australia, Nestle, Kelloggs, and even Coca Cola sponsored one of their conferences. It is also worth reading about former Dietitian Jennifer Elliot being excluded from the DAA for advocating a low carbohydrate diet for diabetes mellitus. I also have local Dietitians selling MLM products, and even after contacting the DAA with a positive response that they will be stopped, they still continue to practise with a lack of duty of care. Before I began my nutrition tertiary education I soul-searched for a long time and just could not see myself being comfortable practicing under the DAA.
Regardless of these points, I have all the respect in the world for Dietitians, the education they have, and there are some fantastic ones out there. But I believe qualified Nutritionists also deserve recognition for their hard work and expertise.
Hi Courtney,
I am interested to know that in Australia, that there are some similar issues in regard to nutritionists who do not want to be part of the DAA (which I assume is the equivalent to our ADA). Fortunately, in the state I live in, (Washington State), the CN (certified nutritionist) title is granted by the Washington State Department of Health, and is protected. CN’s must have a masters degree or higher in nutrition, and allowed health insurance reimbursement. We have many states where the title “nutritionist” is not protected and anyone can get some online certificate and hang up a shingle. That gives us Nutritionist who have worked hard for our title and education, well it is discouraging. Conversations like this help….so thanks for the discussion and good luck out there. Annette Marsden M.S., C.N.
Hi Bill!
What would you say about medical doctors who , after med school, go onto doing a masters degree in Nutrition (and dietetics) or clinical nutrition?
Hi Rucha,
I would like to see more medical doctors complete proper scientific training in nutrition and/or clinical nutrition. I have a lot of doctor friends who are very intelligent but did not study nutrition in any depth and therefore are not really qualified to provide nutrition advice. Unfortunately, this has not stopped many other doctors out there with zero nutrition training from going out and writing rubbish nutrition books that, with a lot of misleading advertising, go on to sell like hotcakes.
I would like to see nutritionists START to “complete proper scientific training in nutrition and/or clinical nutrition.” Sadly, that profession has yet to adopt science into their curriculum.
I’ve got a good question for you I have been trying to find a doctor specializing in nutrition my area…. having a real hard time can you point me in the right direction
Hi Mitcheal,
Based on your IP address, you appear to be located in Texas. I would suggest contacting the Texas Academy of Nutrition and Dietetics who can help you find someone best suited to your needs. Check them out here: https://www.eatrighttexas.org Kind regards
This article is nonsense. The “science” listed in the nutrition degree is lightweight science, not didactic science. Medical doctors, at least in countries that go by the Flexner reforms in medical education, are the top educated authorities in medical science, which includes nutrition. So expecting a doctor to know nutrition does make sense. And as far as the education in nutrition a doctor gets: Yes, we get little to no training in the unscientific dogma of nutrition that nutritionists get, based on the century old puritanical beliefs of JK Kellogg, SW Graham, and others. However, DIDACTIC biological sciences and biochemistry ARE nutrition. I wish more doctors realized that. So while our education isn’t filled with courses that have “nutrition” in the title, or the “tastes good = bad for you, tastes bad = good for you” mantra as the content, Doctors in countries that honor the Flexner reforms are better educated in nutrition than everyone else, assuming they ignore the culturally ingrained dogma mentioned above.
Justin Hamlin, DO
Board Certified Family Medicine
Board Certified Obesity Medicine
Board eligible Clinical Lipidology
@Justin Hamlin, DO, Are you joking? Do you have any clue what an RD’s “lightweight” DPD science requirements even are? Listen, no one would doubt your educational/ science-related requirements that involve nutrition and it’s biochemical role in the body. My father is an MD (not a DO) so I get it. But he also has an MS in nutrition and tells his patients to see dietitians over doctors for nutrition advice. Why do you get to claim that every single health-related topic is within your scope of practice as a DO? Just to elucidate you a bit on what the “lightweight” RD requirements are see DPD coursework completed in undergrad below. Mind you, this and a masters degree are now both required before applying to a dietetic internship (or other recognized programs), which is >1,000 hours of supervised practice in clinical (inpatient and outpatient), food service and community-based settings, and pass an RD exam with a 68% pass rate.
Sciences:
1. Chemistry
2. Organic chemistry
3. Microbiology
4. Physiology or Anatomy
5. Biochemistry
6. Advanced biochemistry
7. Psychology
Clinical:
1. Diet assessment and planning
2. Clinical nutrition assessment and intervention
Community nutrition:
1. Nutrition and Health (intro to nutrition)
2. Nutrition through the lifecycle
3. Community nutrition
4. Nutrition education
5. Nutrition education and counseling
Food Service:
1. Intro to food and food science
2. Food management theory
3. Food production and management
4. Food science and technology
Other:
1. Current Research in Nutrition
We respect your profession, so why do we not deserve the same from you? As I said, I have utmost respect for MDs/DOs, but you do not own the entire health care profession. I hope this is at least helpful in understanding our requirements and no, we do not follow the thoughts of JK Kellogg and SW Graham (we don’t make cereal or run sanatariums), we follow evidence-based nutrition, which, as Bill said may not sound sexy, but it is based in research not in “taste good=bad for you, taste bad=good for you.”
I am not speaking for every type of nutrition professional, just registered dietitians in the U.S., so please don’t mistake my comments as applying to every or state. Nutritionist is one state may or may not be the same as an RD in another, or a certified nutritionist, or a licensed dietitian nutritionist, etc. RDs are specifically licensed to practice medical nutrition therapy, but other nutrition professionals are similarly qualified. I am not trying to be snarky, just defending the career choice that thousands of people have decided to dedicate their life towards. It’s common decency. If you can solve the following without looking anything up, then ignore my entire message, I genuinely applaud you.
Currently a patient is receiving 500 cc of 8.5% amino acids and 500 cc D50 at 100 cc/hr, and is increasing his nutritional status. The patient is started on Osmolite 1.2 at 20 cc/hr. What rate would you decrease the TPN to, to maintain good nutritional support? What things would you look at in transitional feeding?
I
I have a couple questions. My father in-law has had a heart attack has type 2 diabetes mellitus and is in stage 3 of kidney failure. His endocrinologist told him to eat no more than 30 carbs per meal and his nephrologist said no more than 12 ounces of diet Pepsi per week. He just saw a dietician who is telling him he can eat 45 grams of carbs in each meal and thinks he should be able to have 1 can of diet Pepsi every day. Personally I side with the doctors in this instance. What do you think?
Hi Lisa, without being involved in your father in-law’s direct care, I don’t know the entire picture. When it comes to kidney failure, I would make sure that you’re dealing with a licensed clinical dietitian. Also, is this dietitian working in partnership with the endocrinologist and nephrologist? If not, they should all be on the same page. In this instance (without knowing the entire clinical history), I’d be inclined to err on the side of caution re: sugar intake so would tend to go with the endocrinologist and nephrologist.
@Dr Bill Sukala, I am sorry to inform you that as far as MNT for the management of Diabetes or CKD in any stage is concerned, the emphasis is not overly on the grams of carbs in the diet. There are more important things to worry about the diet of a patient in such situation than to be restricting his or carbs as did both doctors. I also don’t know the bigger picture but I side with the Dietician.
I agree. A clinical dietitian has the skill set to manage such patients.
@Seth Amenyah,
Hello, I actually hope my question isn’t that bad, I intend studying nutrition and dietetics but need counselling as a lot of people are saying that, there isn’t no carry in nutrition and dietetics….
Thats interesting. The majority of classes credited to the dieticians as taking we also take in medical school. The overwhelming g majority. And usually multiple biochem classes. I agree that nutritionists are vital and more prepared for advanced nutritional guidance….however there is a massive implications in this article that doctors are not thoroughly trained in the science behind nutrition or the effects. That’s false.
Absolutely. There are some doctors that are nutrition savvy and have done the extra work. A dietitian’s training is mean to prepare them for a career in providing nutrition guidance and, with experience, they become more refined in their craft. If a doctor took several nutrition classes in medical school but is not actually practicing nutrition every day, then would they be as prepared and up to speed with the latest research compared to a dietitian?