From: km@speedy.cs.pitt.edu (Ken Mitchum)
Newsgroups: sci.med
Subject: Nutrition (Was Re: FDA still at large)
Date: 15 Aug 92 14:23:08 GMT
Reply-To: km@cs.pitt.edu (Ken Mitchum)
Organization: Computer Science Dept., University of Pittsburgh

In article <713764863.F00001@blkcat.UUCP> John.Willis@p123.f349.n109.z1.fidonet.org (John Willis) writes:
>
>Oh, come on guys.  Is it true "that nutrition education programs in U.S. medical
>schools are largely inadequate" (National Research Council, Committee on
>Nutrition in Medical Education, 1985) ?

"Nutrition" as a subject is hardly taught in medical schools. Most
doctors cannot tell you how many grams of fat are in the average
doughnut, or what the RDA for Vitamin A is. 

However, medical students do spend an enormous amount of time studying
energy production, metabolism, and digestion in great detail. It is
from studying these that they learn a certain orientation towards diet
and nutrition, which may or may not be true. This orientation
basically states that regardless of what you take in, foodstuffs are
utilized with incredible efficiency, that everything generally ends up
down the same metabolic paths, and that malnutrition is not a *common*
problem in this country, particularly in adults. Part of this
orientation is fostered by physiology: when you find out that the
average person has a three-year storage of vitamin B12 in his/her
body, you tend to emphasize the Recommended Daily Allowance of B12
just a little bit less. Nutrition is not studied nearly as much as
problems of dietary insufficiency and absorption in disease states -
medical students learn about B12 when studying pernicious anemia and
digestion rather than in studying nutrition per se.

From what I have experienced with patients over the years, it is this
somewhat cavalier orientation towards food that infuriates patients.
The common belief is that there is a much more direct relationship
between diet, nutrition, and disease or health than most doctors will
admit. When the patient asks how much B12 he/she should get every
day and the doctor laughs and says "it doesn't matter", the doctor
has good reason to say this, but the patient is not amused. But spending
more time on "nutrition" in medical school is not going to change this
orientation: it is a side effect of what you learn about the body
in medical school. 

In recent years, there have been more and more studies linking diet
to disease. Despite the weekly radio show reports of the latest
from the New England Journal of Medicine, the ultimate shakeout
from these studies is not yet known. Some of the information is
hard to put in perspective: I have never adequately understood
how dietary cholesterol has anything to do with the cholesterol
that my liver produces. And ultimately we will learn the answers,
and they will become a standard part of the information imparted
in medical school.

However, even after this happens, patients and the lay press will
continue to be infuriated at the "ignorance" of doctors regarding
nutrition, and at their attitude. I suspect that most doctors,
like myself, will persist in the belief that relationship between
diet and disease is more indirect than the patient wants to believe,
that most people don't have to worry about the RDA of anything,
and that only kind of medically valid dietary advice is going to
be something fairly vague, like "avoid fats" or "eat as little
meat as possible". If you want more specific advice, you are going
to have to see a registered dietician, not a physician.

 -Ken Mitchum MD
 km@cs.pitt.edu