In 1994, a 54-year-old female patient approached a local doctor with complaints of chest pain. Her physician advised her to monitor her nutrition by eating less salt and sugar. A few years later, she suffered a heart attack and underwent surgery to place five stents in her heart. She has since tolerated two neck surgeries to clear blockages in her carotid arteries, two stent placement surgeries, two surgeries to improve lower extremity blood circulation, and ear surgery to help with Meniere’s disease. A decade later, she is on five different medications.
The medications prescribed over the years have had numerous, unfortunate side effects. These include mouth sores, dizziness, lower extremity pain and nausea. Her arms and legs are covered in obvious purple and blue veins. She complains of swelling in her lower extremities and cannot delight in some of her favorite things including cooking and spending time with her grandchildren.
This is a common outcome for middle-aged and elderly patients. Her outcome was, in part, due to sub-par nutritional advice from her medical team. Her doctors had failed to inform her of the other components of her diet besides salt and sugar that could be contributing to her medical ailments. For example, they did not inform her of the possible benefits of a plant-based diet in reversing and preventing diseases such as heart disease. Had she been offered an appropriate nutritional plan, this patient may have avoided much of the pain and suffering that she has endured and continues to live with daily.
In scientific literature, nutritional science has been shown to affect health but the results are conflicting; partly as a result, nutrition is not a widely incorporated aspect of clinical medicine. The combination of nutrition and conventional medicine may make a positive difference in patient outcomes. Nutritional education would help physicians to optimize patient care, their own health and possibly decrease the prevalence of disease and the rising costs of health care.
The first step to using nutrition as a targeted treatment is understanding the biology of disease development and the interventions offered by certain diets. Doctors are problem-solvers who offer evidence-based solutions to assist their patients. If they were aware of the different mechanisms by which certain foods arrest disease progression and promote reversal; perhaps, they would approach patient care with a more holistic perspective. For example, a plant-based diet provides three different mechanisms that alter disease development and promote vascular endothelial cell health which include: prevention of vascular endothelial cell injury, prevention of low density lipoprotein (LDL) oxidation and prevention of macrophage activation. A plant-based diet consists primarily of natural foods including fresh fruits, vegetables, nuts, seeds, legumes, beans and intact whole grains. Whole, unrefined plant foods contain antioxidants, polyphenols and other plant bioactives that inhibit disease progression at several different stages of its development. The way to disseminate this type of scientific information to physicians is by performing studies that lead to consistent results and then adding this information to the current medical school curriculum.
Currently, nutrition is not being adequately covered in medical school curriculum. As one study states: “More than half of graduating medical students still rate their nutrition knowledge as ‘inadequate,’ and physicians report that they have not received adequate training to counsel their patients on appropriate nutrition.” Therefore, even if they wanted to, most physicians cannot offer adequate dietary advice to their patients. This lack of knowledge inhibits physicians in fulfilling their oath to provide the best possible care to their patients. This inadequacy leaves many patients searching the Internet for medical advice to obtain additional information. Despite searching the depths of the Internet, most patients do not have an adequate understanding of the relationship between nutrition and health.
A patient might also turn to the Internet for medical advice depending upon their physician’s health status. In other words, if patients sense that a physician is hypocritical in promoting a healthy diet while neglecting personal health, they may be a skeptical of the physician’s advice. Studies demonstrate that a doctor’s physique can actually play a role in determining the patients’ adherence to medical advice; in one study, the respondents were more likely to trust physicians with healthier weights and mistrusted overweight physicians. Patients who were offered advice by overweight patients were found to be less adherent to medical advice.
Although harsh, the results of the study signify the importance of the physician’s image and the the apparent bias. Nutritional education in medical school would not resolve issues of distrust between physicians and their patients since there are other contributions to the fraying relationship. However, the trust placed in physicians could be strengthened if studied nutritional science and incorporated it into their own lives. Living healthier can inspire patients to do the same as they will more readily follow advice from authorities who heed their own advice.
Lastly, nutritional education also has the potential to reduce the cost of health care. The health care industry generates a large profit from tending to unhealthy patients. Therefore, financial interest could be driving the disconnect between health and nutrition. A population of healthier individuals could potentially jeopardize large pharmaceutical companies that generate profit from a sicker society. The American Medical Association, the governing body of medical education, can be influenced by financial contributions from the pharmaceutical industry and other government officers, which could be a reason why medical schools have not adequately incorporated nutritional education into their curricula. While these industries do not necessarily encourage an unwell society, their financial interests can influence their initiatives to ignore non-pharmacologic treatments for disease.
While the cost of certain nutritional regimens might appear greater initially, a greater emphasis on nutrition as prevention will decrease health care costs due to decreased morbidity and need for pharmaceutical intervention. Every patient’s decision to make a nutritional change — weighing the initial cost against the long-term benefit — is of course individual. Regardless, all patients deserve to be informed of the potential benefits that proper nutrition can make in their long-term care.
Ultimately, “let thy food be thy medicine and medicine be thy food” is now an old adage leaving behind a disconnect between nutrition and medicine. Nutritional education, as an appendage to conventional medical education, has the power to close the gap by equipping physicians with more well-rounded knowledge to help patients manage the more unmanageable conditions.
At the end of her appointment, my patient stated, “If I would have known that certain dietary changes could have avoided any of the pain and anguish I have endured, I would have most definitely changed some of my habits. The thing is, I was never told, not even by a doctor”. Her story does not have to be the norm. Instead, nutritional education should become standard in medical school curriculum not as an alternative to medicine, but rather, holistic and preventive care. Until this approach is embraced by the future health care community, the paradigm, riddled by chronic disease, is unlikely to shift.
Pre-Medical Guest Writer
University of Tampa
Taylor Collignon is a pre-med student at the University of Tampa interested in endocrinology and dermatology. She plans to do research in the field of epigenetics and nutrigenomics. She will intertwine her love for nutrition and disease prevention with medicine in her future career as a physician.
