Myth: Doctors Aren’t Taught Much Nutrition

Myth: Doctors don’t learn much about nutrition in medical school.

False. Doctors learn quite a bit- starting from the most elemental level of chemistry, organic chemistry, biochemistry – to how foods are processed in the human body and where (anatomy and physiology). In addition we learn with the requirements for macronutrients and micronutrients of healthy and sick people.  It is physicians who must put together the “total iv nutrition” –for those who cannot eat or use their guts for food.

When someone is critically ill in a hospital what you don’t see is a physician calling up the local health food store to get advice from the person behind the counter.  Nor do you see a physician calling a gym and asking a personal trainer to tell us what to give and how much.

Background:
How often do we hear this myth? Doctors don’t treat with food, but pills because of some grand conspiracy with “Big Pharma.” But in fact, doctors learn quite a bit about nutrition, from the most elemental scientific part of it, to the sickest patient that needs our nutritional care.  And when some say we only treat with pills – our response is often, because we can. Because we know what works, we know how those drugs interact with most people, and we have gone to eight years of school beyond high school, and then three to five more after that to learn how to treat and heal disease.  The reason that your local health food store guy can’t treat with drugs – he can’t practice medicine without a license. Giving food isn’t medicine- in fact, it is protected if you don’t use food or market food as a treatment for a specific disease.

Hippocrates said, “Let food be thy medicine, and medicine be thy food.” That was 2000 years ago when there wasn’t good medicine, beyond a few plants – and some of the “medicine” killed more than it cured.

There are plenty of quotes from people who talked about how food is better than drugs. Most of those quotes were from years ago when doctors had no science, and only anecdotes, and the medicine was just as likely to kill you as the disease.

How Doctors Used to Train:
Doctors used to get their medical degrees in as little as six weeks, but all that changed in 1910  when the “Flexner Report” was published. The report was critical of medical education in the United States and Canada.  It caused a number of medical schools to close down, and to eliminate the questionable teachings, such as that of homeopathy. It changed medical schools to the German model – of rigorous scientific thinking. Now, before one can even get into medical school, most require a degree from college. Medical school is now four years- two years of teaching basic medical science and two years of clinical teaching.  When graduating from medical school graduates then take an internship (1 year post medical school) and then specialize in a residency (2-7 years).

Food can kill you, but it can’t cure you.
People who eat healthy can get heart disease, cancer. People can eat processed food, and appear to have all the essential micronutrients, and can do poorly. But, you cannot cure heart disease with diet, nor can you cure cancer with diet, nor can you cure appendicitis with diet, nor can you cleanse the liver, or cleanse the colon. You can become obese eating healthy foods.  We have been seduced into thinking that since the Scottish Surgeon, James Lund, did the first experiment showing that citrus reversed scurvy that diet is the answer to all ills.

How Surgeons Learned Nutrition:
Surgeons are the ones who see the worst disasters when it comes to guts. We have to sometimes take out guts that have cancer, or infection, or are mangled in car accidents, or blown into bits by guns.  Or even patients who cannot eat for a while after having surgery, they need nutrition. It was surgeons who developed the first nutrition that could be given by an IV. It was surgeons who formulated the first great shakes for people who have feeding tubes into their stomachs, or their bowel. It was surgeons who discovered that you need fat as an energy source in food other the liver can become, paradoxically,  filled with fat.  It was surgeons who discovered that if you leave out chromium the patient’s blood sugars will become unstable leading to diabetes. It was surgeons who formulated how much protein a person would need, and that it would change depending on if they had a stress, like a burn, trauma,  or if they had surgery.

smoothies for health

This surgeon loves smoothies- great nutrition.

So when someone tells you that a doctor just doesn’t learn much about nutrition, you should ask, “compared to whom?”

Doctors in the Kitchen

When not on television or doing research, my practice is devoted to helping people who are obese lose weight.  Part of this is surgery- but the bigger part is nutrition. I spend more time teaching people how to cook than I do operating on them. Now this new field of  “culinary medicine,” has taken off- with courses offered from Harvard through the Culinary Institute of America.

Many doctors are teaching patients how to cook, which means they have to learn about ingredients, how they combine together, and how to cook them properly. They learn what is healthy, what can cause disease. They learn when it’s time to throw out food because it can cause disease. They develop an appreciation for food.

I tell every new patient who seeks to have weight loss surgery, “above all, I want you to be the cook. I want you to be the one that when someone is having a party, they want you to do the cooking. I want to turn you into a food snob. I want you to find chain restaurants not as interesting as restaurants that serve made-to-order food.”

Of course, the biggest myths in food today are not that doctor’s don’t know about nutrition, but the false notion that certain foods will heal, or cure. I was shocked when I read that T.Collin Campbell, who is not a physician but a Ph.D. in physiology, was trying to convince some women who had the gene for breast cancer that they didn’t need to have an operation, but just to change their diet.  Steve Jobs came under similar influence- thought that by eating vegetables only he could turn off the cancer in his body, and not have surgery- eventually he had his surgery, a year after his diagnosis and who knows if it was done earlier if it would have saved him.

Dr. Terry Simpson About Dr. Terry Simpson
Dr. Terry Simpson received his undergraduate and graduate degrees from the University of Chicago where he spent several years in the Kovler Viral Oncology laboratories doing genetic engineering. He found he liked people more than petri dishes, and went to medical school. Dr. Simpson, a weight loss surgeon is an advocate of culinary medicine. The first surgeon to become certified in Culinary Medicine, he believes teaching people to improve their health through their food and in their kitchen. On the other side of the world, he has been a leading advocate of changing health care to make it more "relationship based," and his efforts awarded his team the Malcolm Baldrige award for healthcare in 2011 for the NUKA system of care in Alaska and in 2013 Dr Simpson won the National Indian Health Board Area Impact Award. A frequent contributor to media outlets discussing health related topics and advances in medicine, he is also a proud dad, husband, author, cook, and surgeon “in that order.” For media inquiries, please visit www.terrysimpson.com.

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Latest Comments

  1. Lynn says:

    Most women are likely to read in women’s magazines that eating or avoiding certain foods will reduce their risk of breast cancer by a specific percent, even though it would be impossible to determine if eating a certain food was the reason that the person avoided breast cancer. The majority of women do not develop breast cancer, no matter how long they live or what they eat. Because doctors will rarely tell women to eat certain colored berries or avoid certain types of meat to reduce their risk, when the magazines are quoting the “latest research”, women assume that doctors are simply clueless. This is added t o the fact that some supposed risk reduction behaviors such as giving birth at a young age and breastfeeding have been believed for many years but I don’t know how anyone can say that it reduces risk., especially if there is a family history or genetic mutation. Possibly nuns in convents had more breast cancer than other women in society, possibly because they sometimes died in childbirth.

  2. Alyssa says:

    From the research I’ve done, this isn’t true of most medical doctors. This study, for example, indicates that most medical schools do NOT provide much nutrition education:

    Adams, Kelly M. September 01, 2010. Nutrition education in U.S. medical schools: latest update of a national survey. Academic medicine 85, no. 9, (accessed February 06, 2013).

    Additionally, this paragraph doesn’t make sense: “The mistaken thought that healthy food keeps the body fit, and that if you eat poorly the body will do poorly – is true. But that one can prevent disease from eating well is untrue. There are no foods that “boost” the immune system.”

    If it’s true that “healthy food keeps the body fit, and that if you eat poorly the body will do poorly,” as you say, why is it a “mistaken thought”?

    Also, you say it’s untrue that “one can prevent disease from eating well.” Why is that untrue? Can eating well not prevent obesity or diabetes? Or heart disease? Are these diseases written solidly into our genetic code and not influenced at all by what we feed ourselves? If the “diseases of Western civilization” – or whatever you like to call the class of disease that is currently increasing at an alarming rate – are not caused in part by what we eat, then what ARE they caused by? How do you explain them?

    Also, you say that “food can kill you, but can’t cure you.” You leave out the important fact that plenty of medicines can also kill you, and they can usually kill you much more easily than food can.

  3. thedoc says:

    The one sentence was confusing, so I corrected it. Thank you. But perhaps that sentence is better explained in another post (click here).

    All medical schools have some basic requirements, and those were outlined above. If you say that nutrition has nothing to do with chemistry, organic chemistry, biochemistry, and physiology then you could believe that survey. They were looking for a class called “nutrition” simply ignoring the standard medical school curriculum.

    You cannot prevent disease from eating well, but food can kill you. Heart disease is has two main causes in the United States – smoking (which isn’t eating) and the genetics of hypercholesterolemia (which isn’t eating). Diabetes can be type 1, which is not caused by obesity, and type 2 which is made worse with obesity. The point is food can kill you, but it cannot cure you.

    Yes, plenty of medicines can kill people, which is why doctors prescribe them – and yes they can kill you also, especially if they are not taken correctly. Thankfully you cannot get medicine from the local “nutrition” person at the health food store with their high school education. But you cannot find a better way to reduce cholesterol than the medicines in the group we call statins, and you cannot find a better way to reduce blood pressure than the medicines we have available, and you cannot find a better way to help diabetics than insulin, or some of the oral agents, and you cannot find a better way to fight a bacterial infection than an antibiotic. Food won’t work to treat any of those- medicine will.

    I strongly believe in medicine, but also in teaching people how to cook. I talk about that here.

    The best thing I can do for the long-term success of my patients is change their lifestyle – but they cannot lose weight without the surgery. So it is a combination. But good food alone does not cure obesity.

  4. Leslie M. Sejdak, DDS, CHt says:

    I am a Hypnotherapist and see clients for weight loss and exercise motivation. I advocate 3 small meals and 3 small snacks daily…protein, vegetables (mostly green) and complex carbohydrates. However, I have a client who is a surgeon and frequently he must go without food for a 6 hour surgical procedures. Help! what should he eat before he operates?
    Leslie

  5. Linda Hansen says:

    I wound up on this site as I was trying to find out more about the education requirements doctors have in nutrition. I still don’t know. What percent of the credits earned are nutritional education. I read statements here that protect the authority and high standard of knowledge doctors hold in our culture. But I don’t find an answer to the question. Aside from the chemistry needed to understand processes, etc. I know they sometimes make nutritional recommendations but wondered if this was based in nutritional education, which of course would include some of chemistry as well. But there is so much more to food and nutritional understanding. I know doctors go through a lot of school and work to be in their profession. I respect that, but I also have had doctors who have given bad information or none at all. They don’t know everything.
    If you put something in your mouth it will be used by your body if available or not. Either way something in your mouth travels through your digestive tract and may have effects within your body. If we are calling it food or medicine before it goes in, what’s the difference? Doesn’t medicine comes from a plant, animal (which is likely fed on a plant) or mineral source? My point is everything comes from the earth in some way and how it reacts inside us is the effect whether we chose to call it food or medicine. I believe then, if medicine can heal, so can food. Learning to cook is not learning about nutrition. I do know that food can make all the difference in how I feel and both food and medicine can cause many complications.

  6. thedoc says:

    Here are a few simple points:
    (a) There is a difference between medicine and food. Medicine is generally purified so we know the ingredient that is responsible for the action. For example, you can take the bark of a willow tree and have a derivative of aspirin. But how much do you take? A lot of bark, a little bark. Or, you can purify the compound- salicylate, and modify it- aspirin – and then we have an ability to determine dosage and use. That is the difference- one is quite unscientific and guessing, the other is compounded, purified, and the ability to dose it means we know where the risks are– where as with the bark of a tree we have no idea if it has any ingredient, too much, etc. It is far riskier to assume because something has some active ingredient that it is “better” or “as good” as when we know what it is, purify it, regulate it, and test it.

    (b) I am not saying every doctor is good- or every doctor has a great education. The basis of nutrition is chemistry, organic chemistry, biochemistry, physiology, and anatomy. The people who defined nutrition in very sick patients were doctors. Every doctor has that basis. When you look at the curriculum for registered dietitians, they have some of those basic undergraduate requirements, but nothing advanced beyond that. In fact, their chemistry class is not as rigorous as standard chemistry – they don’t take organic chemistry, they don’t take much biochemistry. They take courses in food service management (which physicians or undergraduate pre-med students don’t take). Medical students have broader education in food borne illness, medical students and residents have broader exposure to the use of nutrition.

  7. Billy says:

    Oh please … really? Unless a medical student studies nutrition on his or her own time, maybe, but it is a myth that doctors know much of ANYTHING about nutrition. Western medicine focuses on the treatment of disease, not the prevention. Really, you are insulting people who have a brain … your arrogance is nauseating.

  8. Dr Simpson says:

    Not certain the medical school you went to. When you say we don’t focus on prevention – what about vaccines, that have expanded the lifespan of people by a number of years, or sanitation which led to clean drinking water, or antibiotics that prevent the spread of infectious diseases. But as a surgeon- yes, I cannot prevent trauma – although our studies on impact has led to better cars – but once someone has an accident and their guts are open they do come to us to sew them up.

  9. BunnySJM says:

    Its not that doctors get none its that they dont get suffient, in canada a med student only gets 23.5 hrs of nutritional training and this is confirmed by government sites, and the average american doctor is only gets 19.5

  10. Dr. Terry Simpson says:

    Funny how people use a statistic when here I am – someone who has actually been to medical school and teaches in one. Some are clearly worse than others- but nutrition starts with biochemistry, anatomy, and physiology, and that is the basis. A basic “nutrition” course is useless without that as a basic sense.

  11. Ar Pe says:

    I am a Registered Dietitian that have worked at Stanford Hospital for over ten years. I have NEVER been asked or questioned by any doctor on staff on how to feed a patient through a tube! I have also NEVER seen a doctor calculate the amount of nutrition a patient needs when not eating via mouth, and not even when the patient can eat using the digestive tract. This article is absurd, and this doctor is not telling the truth, but I’m not sure why he would lie so blatantly.

  12. Dr. Terry Simpson says:

    Good to have a dietitian here – but lets be specific – you do not have a license to order tube feeds for the patient, they have to be signed off by a doctor. It was surgeons who invented tube feeds – such as Dr. George Block or Dr. Joseph Fisher being the pioneers. In terms of calculating – most of the calculations were originally formulated by a botanist (Harris) and a physiologist (Benedict) and they have been modified by trauma and burn surgeons. Now they are essentially an app that we give to medical student so they can calculate what they need. Not sure where you would say that I have lied.

  13. Terry Simpson MD says:

    Calculating nutrition through the Harris Benedict equation to determine patient needs is done by a common app and requires as much of a nutrition degree as filling out the information. It was surgeons, not dieticians, who invented tube feeds – it was surgeons, not dieticians, who perfected the equations for trauma and burns. Calculating is easy – fill in the numbers. The Stanford doctors and residents have better things to do

  14. jon says:

    this is all a big lie. purposely meant to mislead people…its kinda of obvious when you read an article discrediting any natural remedy saying drugs are better especially when its a doctors name signed to it…the motive is obvious…do you really think people are not smart enough to see through this?

  15. Dr. Terry Simpson says:

    As soon as a “natural remedy” is proven do you know what we call it — medicine. If you want to show something works you test it. This is often lost – since Big Nutra is a big business that is unregulated so they can make general claims and never test a one of them. What bothers most people about “natural” remedies when we call them into question is that we can speak science, and many are not that educated and simply make such claims “natural is better.” Such is the highest form of illiterate arguments – and make such individuals ripe for charlatans.

  16. Dr. Terry Simpson says:

    He studied animal nutrition at Cornell, and did his PhD research on ways to make cows and sheep grow faster so the American food supply could be pumped up with more and more protein, oddly enough. The wikipedia article makes it appear that he has three different Ph.D. – although that is probably because many people like the logical fallacy about appeal to authority. In terms of “healthy,” it always depends upon your view- are you looking at the micronutrient content of them, or the macronutrient content – or is your view that they should come from some source of food- like local, or organic, or plant-based, or vegan? If it is in terms of health – then what is the criteria and the research to back it up. Sadly – as we have shown, Campbell’s research had serious flaws in it, and now is regarded only in circles where they attempt to justify their diet.

  17. Dr. Terry Simpson says:

    Let me see – believe a YouTube video – or someone who has been to medical school (me) has taught in medical school (me) and has told you about the REQUIRED courses in medical school such as biochemistry, physiology, all of which are the basis of what we find.

  18. Dr. Terry Simpson says:

    I think my grandparents didn’t put up with any of that nonsense, and they survived just fine. The reason that teas and coffee and beer were good was because they got rid of germs – either through distillation or heat. So- come on to the 21st century and learn some science.

  19. Dr. Terry Simpson says:

    I am sorry that you ran into a nutritionist who gave you such bad advice and a physician who gave you none. A highly processed carbohydrate-rich diet is horrible advice. What you found, eating a diet that has more fat, works much better. Then again, this is what I was taught in my medical school some thirty years ago (high fat not highly processed foods)

  20. Dr. Terry Simpson says:

    The diabetic experts, and the recommendations that we teach our patients is to avoid those foods that cause large spikes in blood sugar – to use proteins, fats, and resistant starches. Lots of vegetables, and avoid grains. Sounds like the diabetic experts were not food people- just insulin people.

  21. Dr. Terry Simpson says:

    I recommend ketogenic and paleo diets to my patients as the best nutritional advice. Why couldn’t your doctor do that — I am not certain. But it is what science tells us, and in medical school – besides learning basic biochemistry and physiology, we were taught to keep learning. The ketogenic diet and paleo diet have passed the muster of studies so far.

  22. Dr. Terry Simpson says:

    First, there is no food that “boosts” the immune system. Second, Medical Schools are not funded by Big Pharma, nor are we given the pledge to Pharma when in medical school. Science is all we have- to make the speculation there is something there, when there is no evidence is a lack of science.

  23. Dr. Terry Simpson says:

    You can make a claim if you can validate the claim. Too often supplement and food companies make claims about cures that are not validated. Citrus doesn’t “wards off scurvy” but it provides vitamin C, that if not in a diet leads to scurvy. If you have scurvy you are not “cured” from it -and if Vitamin C is a drug (it is) then it does make up for the deficiency. The point of the headline was that foods do not cure you of heart disease or cancer.

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