This is important to know when it’s your health that’s in view. At this writing on March 29, 2020, most practicing physicians have not had any substantial training in the relationship between nutrition and disease, also known as diet therapy, nor is continuing education in such required. This gap is flat-out crazy nutsy cuckoo, because those very doctors are whom we turn to for guidance about what and how to eat. Just seven years ago when my dad came out of heart surgery at Rochester’s Mayo Clinic and was able to eat solid food, hospital staff fed him a hamburger. He was advised that he could resume his previous diet, the very same food that over time created his heart issue. In Illinois, my friend’s father’s cardiologist said nothing to him about diet over the course of several years, cardiac events and stents. But come springtime 2019 and yet another heart attack, the father’s new cardiologist recommended he seek a plant-based cardiac rehab program. Which he did, with amazing results. There is progress!
Let’s take a closer look. Most doctors practicing presently were required to have a tiny amount of nutritional education, 3-4 credits, if any, and that coursework related to the likes of biochemistry, vitamin C/scurvy issues, but not to practical diet therapy. This educational gap is beginning to resolve, but just so. Odds are you won’t experience this shift in the doctor’s office you’re visiting today.
Shedding more light on the subject, Scott Stoll, MD, co-founder of the The Plantrician Project, describes that after medical school, practicing physicians “rarely have time to go back into the literature and read what’s being written by their colleagues who are doing the research.” With that, Stoll notes, most doctors are getting their nutrition information – if they have time – from the same sources as do their patients, from popular books, and magazine and newspaper articles.
So essentially from a diet-and-health view, most of today’s practicing physicians are stuck at whatever diet therapy formative point they were in at medical school, unless they’ve made time to pursue current research and education on their own.
This info-gap is terribly unfortunate, because most doctors and health professionals really do want to help people get better. Doctor’s medical school training in pill-procedure-treatment methods typically help a patient manage a disease but do not cure it, nor resolve the cause. I heard T. Colin Campbell, PhD, describe that, when speaking with physicians about the power of practical nutrition, those doctors are often agog and even angry that they haven’t been given the information with which to most easily help their patients. Father of medicine Hippocrates, c. 400 BC, said “Let food be thy medicine,” but somewhere along the line the notion fell off.
Still, not all docs are immediately open to learning. When presented with ideas regarding nutrition and health, some will dismiss that food has anything to do with health outcomes, they’ll call it ‘a spontaneous recovery’, while others are moved to say “huh, I’d like to know more.” But for all the seed is planted. Doctors are human, and as a species, we’re not always open to learning and new information, especially when our expensive, highly regarded training did not include it. There are other factors that come into play (direct patient care time, medical systems, culture, reimbursement and incenting) but I’ll leave those for now.
This information and practice gap is changing, but not fast enough for individuals like you and me whose health is on the line right here, right now. Thankfully, eating more vegetables, fruits, grains and legumes does not require a prescription. You can do it now without anyone’s permission! And nearly everyone would agree that eating more of those foods is a good idea. (There are some rare exceptions.)
Let’s look at the shift. There’s much to appreciate. In the growing wave of doctors frustrated and wanting better outcomes, doctors wise to the power of diet and its ability to create health are physicians who have:
1) Have stood back to observe a relationship between disease and diet, then studied it (T. Colin Campbell, PhD, Dean Ornish, MD, John McDougall, MD, Caldwell Esselstyn, MD, Neal Barnard, MD/Physicians Committee for Responsible Medicine, and Michael Greger, MD/Nutritionfacts.org for example),
2) Have suffered their own health crises, not been satisfied with the medical prognosis and treatments, and have pressed on to study and discover the power of plant-based diet (Kim Williams, MD – cardiology, Saray Stancic, MD – multiple sclerosis, see Doctors Are Patients Caught in Info Gap, Too, and Brooke Goldner, MD – lupus, are just three of many), and/or
3) Have caught onto the diet-and-health impact and are now studying it as well, and are seeking CEUs at diet-and-lifestyle health conferences. (Those conferences are selling out, by the way.) Physicians Committee for Responsible Medicine (Neal Barnard, MD, founder) and The Plantrician Project (Scott Stoll, MD, cofounder) are among two sponsors. Further, the American College of Lifestyle Medicine (Susan Benigas, founder) is board-certifying physicians and allied health professionals, and is also hosting conferences and seminars.
Among physicians bringing diet therapy to their practices are NYU med school professor and internist Michelle McMacken, MD, at New York City’s Bellevue Hospital. And get this: Dr. McMacken is helping her patients, most of them on shoestring budgets, resolve disease through diet successfully. Most of her patients don’t speak English and she talks with them through interpreters. How’s that for busting some “it-can’t-be-done” notions!
In March 2019, the afore-mentioned Plantrician Project launched The International Journal of Disease Prevention and Reversal, an open access, peer-reviewed journal, which has published two issues to date.
In further good news, there are several physicians who are actively a) advocating that diet therapy be required in medical school curricula, and b) lobbying to require that nutritional education be required continuing education for practicing physicians. Michael Klaper, MD and John McDougall, MD respectively are two among many working on these fronts. John McDougall, MD, for example, suggests that it’s insulting to physicians that they not be trained in the most powerful aspect of restoring patients to health.
In my now-home state, Iowa, the Quad Cities’ Cheryl True, MD, is introducing family medicine residents to nutrition and lifestyle medicine. As Iowa Osteopathic Medical Association president, Jacqueline Stoken, DO, brought Caldwell Esselstyn, MD’s work to her colleagues and community in Des Moines. At Des Moines University, medical students have a kitchen-based diet therapy course available. This is not all, to be sure, but there needs to be more happening, in Iowa and across the country.
So. The shift is happening. If you do not yet have a doctor or health team that is aware, they aren’t talking to you about it, mostly likely it’s because they are not … yet.
Let’s help turn that tide.
Five important follow-up notes:
One. This plant-based nutrition knowledge has been around for a long time. The docs I mentioned who’ve been scratching at this subject have found guidance in studies done decades prior, among those works the Walter Kempner, MD Diabetes Rice Diet/Diabetes Study which started at Duke University in 1939.
Two. Some insurance providers, including Medicare, now reimburse patient participation in Dr. Ornish’s Program for Reversing Heart Disease® which is plant-based. This is progress if you can get to it. Currently, there are 17 Ornish cardiac rehab programs in the US; the nearest location to me, writing from Iowa, is in Springfield, Illinois.
Three. Dietitians/Nutritionists. To use a professional phrase, YAHOO! In 2016 the Academy of Dietetics and Nutrition released a position paper describing their position on plant-based diets. It’s pretty bold. Here, from the abstract: “appropriately planned vegetarian, including vegan, diets are healthful, nutritionally adequate, and may provide health benefits for the prevention and treatment of certain diseases. These diets are appropriate for all stages of the life cycle, including pregnancy, lactation, infancy, childhood, adolescence, older adulthood, and for athletes. Plant-based diets are more environmentally sustainable than diets rich in animal products because they use fewer natural resources and are associated with much less environmental damage. Vegetarians and vegans are at reduced risk of certain health conditions, including ischemic heart disease, type 2 diabetes, hypertension, certain types of cancer, and obesity. Low intake of saturated fat and high intakes of vegetables, fruits, whole grains, legumes, soy products, nuts, and seeds (all rich in fiber and phytochemicals) are characteristics of vegetarian and vegan diets that produce lower total and low-density lipoprotein cholesterol levels and better serum glucose control. These factors contribute to reduction of chronic disease.”
Be aware, it can take time for position to translate into practice.
Four. Be wise: Your medical provider may be outsourcing diet information by way of material from a related health association such as diabetes, heart, or cancer. Two warnings and a kudos. One, some groups assume people won’t fully embrace a healthful diet, so they don’t suggest it as optimal. Two, associations have been heavily sponsored by animal food producers, therefore have included this bias in their materials content. Now the kudos, many of these organizations are bringing their diet recommendations closer to evidence-based optimal diet. Still, and even as progress is made, lots of outdated health association materials are currently circulating in clinics and offices across the country.
Five. If your doc or med team suggests you consider the Keto or Paleo diet, please beware. I suggest doing some digging regarding the side and long-term effects. I personally would not pursue these diets and view them as risky. The physicians that I follow (Barnard, Klaper, McDougall, Esselstyn, Greger among them) note that these diets can produce short-term benefits, but have serious long-term health implications.
– Cindy Pearson Cole
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