Thursday, February 19, 2015

Why Your Doctor Might Not Be the Best Nutritional Resource

Why Your Doctor Might Not Be the Best Nutritional Resource
Your doctor is one of the most important people to your wellbeing,
and rightfully so. While you should trust their advice on certain
matters, it's also important to understand the boundaries of their
training, and when you should seek outside help.

I grew up obese despite the fact that both my parents were medical
doctors, and fit ones at that. The few conversations we had about my
weight were essentially lectures on moderation (or simply "eat less, move more").

I always figured the lack of intervention was probably because they
assumed I'd grow out of the chub. Besides, it can't be easy for someone
to dual as parent and diet coach.

Fast forward two decades, and the story is completely different. My
father is now overweight, pops countless (medical) pills for breakfast.
He doesn't know the first thing about losing weight, nor does he care to
learn. Contrastingly, my mother is in great shape, thanks to becoming
an avid consumer of fitness information following my own transformation.

Looking back, I now know that their silence wasn't because they were
hesitant or unwilling to help me lose weight. It was because they had no
clue how to help me lose weight.

My parents are just n=2, but in my coaching experience, many clients
have reported a similar gap in their own GP's knowledge. Sure, their
doctor can tell them when to lose weight, but dispense poor advice to
help them achieve it. This is unsurprising.

What Doctors Know: Disease vs. Health

Why Your Doctor Might Not Be the Best Nutritional Resource
Most doctors spend at least 11 years in school: four years in an
undergraduate program, four years in medical school, and at least three
years in residency (depending on chosen area of expertise). Basically,
doctors learn a whole lot about a whole bunch of stuff, for a long time.
But in all those years, and all those textbooks, very little of that is
about nutrition—the biggest factor in weight loss, and debatably one of the most important factors for overall health.

Of the 40,000 hours that doctors spend on training, typically only 19 of those are devoted to studying nutrition. According to the Chicago Tribune, this number is steadily decreasing:

On average, doctors receive 19 hours of total nutrition education in
medical school; in 2004 the average was 22.3 hours, according to the
study, conducted as part of the Nutrition in Medicine project at UNC. In
2009, 27 percent of the schools met the minimum standard of nutrition
training, compared with 38 percent in 2004.
As such, it shouldn't be surprising that a study from The Journal of the American College of Nutrition
shows that only 14% of internal medicine interns feel they can
adequately talk to their patients about nutrition, while 94% feel it's
their responsibility to do so. Yet, if Dr. Oz's popularity ratings are
any indication, society still considers doctors to be weight loss

To be clear, this is a systematic failing of the medical educational
system, and not the fault of our doctors. Between seeing patients and fixing them—something that they are
incredibly knowledgeable about—there's not a lot of time to make up for
their educational shortcomings. Still, it seems silly to look to medicine to reduce incidence of disease, when dietary intervention may have prevented some of these in the first place.

The Problem with Defaulting to Doctors for Nutritional Advice

Why Your Doctor Might Not Be the Best Nutritional Resource
The nutrition and fitness industry is full of shi—err...incredibly confusing,
which is in no way helped by the apparent paralysis of relevant
regulatory parties. Case in point: despite decades of outcry from the
scientific community, the FDA is only now relaxing its message on the dangers of dietary cholesterol.

With conflicting information abound, people deal with confusion in different ways. Some are autodidacts,
or self-learners, who read voraciously until they can navigate through
the noise. Most people, however, naturally default to someone they trust
to tell them what to do.

Human beings are subject to something called bounded rationality—the
idea that, in the face of complexity, humans sacrifice calculating the
purely rational choice by making mental shortcuts. For most people,
doctors are the gatekeepers of health information. They know doctors are
educated in their profession, and generally trustworthy. Therefore, it
seemingly follows that a doctor's health advice must be reliable.

The problem is that too many people think that "curing disease" is
the same thing as "preventing disease." In reality, these are two
completely different areas of expertise. As my friend Dr. Joseph
Lightfoot once told me: "In medical school, I learned about disease, but
I did not learn about health."

In spite of this, it's hard to imagine a doctor's typical nutritional
recommendations could be harmful, after all how dangerous could an
abundance of cruciferous vegetables be?However, the utility of their
advice is undermined by one of medicine's most basic tenets: "First do
no harm." In other words, they must make sure that any treatment does
not make a patient's situation worse. For nutrition, this often
translates into stock-standard dietary advice.

For example, let's say a doctor is faced with the choice of giving a
recommendation that's in line with the status quo, such as limiting
sodium, or going against the grain by saying that you shouldn't worry
about salt intake. In the doctor's eyes, which is more likely to "do no
harm?" Most doctors would avoid the controversy and just tell their
patient to limit their salt intake, because that's what everyone has
always said. Their assumption is that this advice "does no harm."

The problem is that it does do harm. It increases their
patient's chances of failure, thereby precluding them from the benefits
of maintaining a healthy weight and an enjoyable lifestyle. Quite
simply, research shows that the best diet is one you can stick to. By creating false restrictions
and limiting choice, you state that there is only one path for success
(the doctor's)—a low sodium, low saturated fat, low cholesterol,
alcohol-free one—when in reality there are many.

According to obesity specialist and frequent Lifehacker contributor Dr. Spencer Nadolsky:

Unless trained through ABOM (American Board of Obesity Medicine),
ABPNS (American Board of Physician Nutrition Specialists ), or similar
training/experience, the typical doctor isn't as well equipped to help
with dietary guidance. This doesn't mean the doctor is bad, it just
means it wasn't in their training.

How to Find a Doctor That Can Help You

Why Your Doctor Might Not Be the Best Nutritional Resource
Of course there are plenty of doctors with abundant nutritional knowledge, like Dr. Nadolsky or Dr. Yoni Freedhoff,
another frequent Vitals contributor. In fact, because of their
multi-domain expertise, these doctors have unique insights around
preventative health and disease that few others possess. The danger, however, is that assuming that all medical doctors have this same expertise.

Here's how to find out if your doctor can help you with your own nutrition and fitness endeavors:

  • Research the latest evidence on topics such as saturated fat, protein intake, and dietary cholesterol.'s FAQ
    is a good place to start. Ask your doctor questions about these topics,
    such as "Is a high protein diet right for me?" or "Are eggs bad for my
    health?" If they default to outdated wisdom without batting an eyelash,
    then you may want to seek nutritional guidance elsewhere.
  • Pay close attention to whether or not their advice is specific and actionable.
    Are their recommendations vague, such as "eat healthy" and "do things
    in moderation?" or do they go into specific recommendations, such as
    "keep a food journal and track calories."
  • Look at other credentials other than the "Dr." in front of their name. You can use this handy PDF
    to search for a physician's certifications by any state. Are they
    trained by the American Board of Obesity Medicine, the American Board of
    Physician Nutrition Specialists, or something similar?
  • Be realistic about how well you get along with your doctor. Knowledge isn't everything. Your doctor can be the most knowledgeable in the world, but their advice can backfire if you feel that they are overly judgmental or lack empathy.
At the end of the day, the onus is on you to make sure that you have
the resources you need in order to get (or stay) healthy and fit. Stay
as informed as you can on the latest nutritional research. Don't expect
your doctor's knowledge about medicine to apply to other domains. After
all—like you—they are only human.

Images by LalithHerath (Shutterstock), murphy81 (Shutterstock), katherinarspb (Shutterstock), caliorg, Jeremy Wong, and Ilmicrofono Oggiono.

Why Your Doctor Might Not Be the Best Nutritional Resource

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