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

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

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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.

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:

  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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Friday 8th of February 2019

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?

Samuel felix

Wednesday 5th of April 2023

@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....

Seth Amenyah

Saturday 3rd of July 2021

@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.

Dr Bill Sukala

Friday 8th of February 2019

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.

Justin Hamlin, DO

Wednesday 9th of May 2018

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


Friday 28th of April 2023

@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?


Mitcheal Laborde

Wednesday 28th of June 2017

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

Dr Bill Sukala

Thursday 29th of June 2017

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: Kind regards

Rucha Dadhe

Friday 7th of October 2016

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?

Dr Bill Sukala

Tuesday 11th of October 2016

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.


Saturday 7th of May 2016

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 thanks for the discussion and good luck out there. Annette Marsden M.S., C.N.