Doctors’ Nutrition Knowledge: Settling the Doctor vs. Dietitian Debate

doctor vs dietitian
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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.

According to a 2010 article on the American Academy of Family Physicians’ website (Nutrition in US Medical Schools “Precarious” Say Researchers), the 25-hour threshold of nutrition training is reasonably accurate and confirms that physician nutrition education is, indeed, inadequate.

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 he’d probably be fun to slam tequila shots with, 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:

1) 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!

2) 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!  

3) If you need specific exercise guidelines for a health condition, hire a qualified masters-level clinical exercise physiologist.

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