22.10.2014 Natural Health

Better Medicine

Health researcher Peter Dingle PhD sees an urgent need to improve doctors' understanding of nutritional and lifestyle medicine

"Never confuse education with intelligence." – Albert Einstein

I met two couples recently, one in their 60s and the other in their late 70s. The younger couple were on more than 12 medications between them each day, including statins, beta blockers, warfarin, aspirin and so on. It cost them around $25 a week as most of the drugs were subsidised and the doctor said they were doing well. They complained of constant fatigue, muscle and joint pain, memory problems, severe bruising, found it hard to get out of bed and hard to sleep at night and experienced long bouts of negative thoughts and depression. They had also just been diagnosed as pre diabetic but the doctor said it was okay and normal at their age. This couple underwent half a dozen medical procedures a year at only a minimal cost to them so they felt pretty lucky.

The other couple in their late 70s took no medication, were active for 60 minutes each day, ate a lot of home cooked meals with fish, fresh salad and fruit. They took around 10 supplements a day and literally had no health complaints. They had two grams of vitamin C, three grams of omega 3 oils, a couple of digestive enzymes and some apple cider vinegar with most meals, a couple of teaspoons of super green powder and a multi vitamin mineral mix each day. It cost them around $25 a week and the doctor said they were wasting their money. This couple visited the doctor once a year for a regular check up and each year refused to take medication "because it might help".

Unfortunately, the medical and health care system in Australia and the US is not only letting the public down but is seriously misleading them and putting them at risk. We are constantly reminded to go see our GP for advice on health, yet most of our GPs are not trained in health. This is not a criticism of GPs, as they have the best intentions in the world and we have the best doctors in the world for acute illness like burns, breaks and bacteria. But unknown to the public our doctors receive almost no training in nutrition, lifestyle, environmental or preventative medicine. I have a number of doctors as friends and I personally know dozens of doctors who agree with me and have encouraged me to get this information out to the public. They are, however, simply victims of a larger system that encourages excessive treatment and the overuse of dangerous and expensive drugs.

Our system appears to be run by large vested interests that make more money from being sick and treating symptoms for a lifetime than curing patients. We treat many conditions with drugs that could be resolved much cheaper, simpler and quicker with no negative side effects through nutrition and lifestyle interventions. Unfortunately, what your doctor doesn't know can hurt you.

Professor Dean Ornish at Berkley University has published research showing you can reverse arterial plaque instead of undergoing a high risk, expensive operation costing tens of thousands of dollars and drug treatment for the rest of your life. His treatment is so well recognised that his program receives a Medicare rebate in the US. One success of the program was Bill Clinton who literally got sick of having high risk heart operations every two years to reduce his arterial plaque and risk of heart attack. Professor Ornish has also shown the same program reverses prostate cancer and many other chronic conditions.

Good Nutrition = Good Health

Millions of people in every Western country suffer illnesses caused by lifestyle and environmental factors, which account for up to 80% of health care costs (1). It is well documented that dietary and lifestyle choices are a major factor in preventing, managing and treating chronic health conditions such as obesity, heart disease, stroke, obesity, hypertension, diabetes and cancer (2,3,4,5). In addition to managing obesity and preventing major diseases, optimising nutrition is known to improve outcomes in a variety of health specialties, from elderly care to orthopaedics (2,6). Nutrition and lifestyle are the most controllable risk factors affecting long term health and the influence of dietary risk factors should be understood by primary care providers (7). Good nutrition is a major component to enjoying good health.

There is no doubt that health professionals, such as General Practitioners (GPs), play a vital role in health promotion and are viewed as an important source of health information by patients and the community (5,8,9,10,11). Studies show that 80 -90% of the public consult their GPs in any one year. According to the Australian Medical Association (AMA), appropriate nutrition is the key to the prevention of malnutrition, overweight and obesity and is urgently required from health, social and economic perspectives (12). Most GPs agree that nutritional training is important and should be an integral part of the treatment for their patients.

Nutritional advice from doctors and other health workers is held in high regard by the general public. It is important, therefore, to ensure that the advice given is sound and safe. GPs are seen by patients as the major and most reliable source of nutrition guidance (13,14). In one study, 76% of the doctors agreed that nutrition greatly influenced health status, and 96% agreed that doctors' attitudes and advice influence their patients' diet. Overall, family physicians had positive attitudes toward the potential effects of nutrition counselling on patient behaviour, and they believed that most of their patients would benefit from nutrition counselling.

Poorly Prepared

Yet despite the significance of nutrition and lifestyle advice, GPs around the world are inadequately prepared to provide that advice. A study of health system performance in Australia, Canada, New Zealand. the United Kingdom and the United States found that between onehalf and threequarters of patients in the five nations said they had not received advice or counselling on weight, nutrition or exercise from their GPs (15). In an Australian study, only 38% of Australian adults reported having received any advice from their GPs on weight, nutrition and exercise (15).

Barriers to providing nutritional information to patients in Australia include lack of time and compensation, consistent with studies from other countries (16). Most GP visits take 15 minutes or less and often many health issues and disease processes may need to be addressed in that time (16). The inability for GPs to obtain nutritional materials to refer to and give to patients is also a barrier to improving nutritional advice offered to the public (17). In a study in which nutritional resource manuals were given to GPs, it was reported their confidence in their ability to provide specific nutritional information and recommend specific dietary changes improved considerably (18). Further to this, the number of GPs who used patient nutrition education materials significantly improved. This shows the importance of GPs having access to current nutritional materials to enhance their knowledge and provide sound advice to patients. Of great concern, in another study, 40 percent of GPs said their nutritional information came from magazines and newspapers (19), which are extremely unreliable and biased.

Nutrition Training Lacking

By far the biggest barrier, however, is that our primary health care professionals get very little if any nutritional training in their original studies. Ninety eight percent of medical schools report nutrition as a component of medical education. However, most schools do not have an identifiable nutrition curriculum. While there may be some hours of training devoted to biochemistry that covers some biochemical pathways and information, there is virtually none devoted specifically to nutrition and disease. Teaching the role of niacin in energy production is biochemistry, not nutrition; it says nothing about dietary needs, food composition, or clinical application (20)such as reducing conditions like muscular weakness and fatigue, insomnia, depression, schizophrenia and managing blood cholesterol. The bulk of nutrition education continues to be taught in the basic science courses or in an integrated format. This means that threequarters of the nutrition instruction in medical schools is not specifically identified as nutrition in the curriculum (20).

Nutrition training for medical students is identified as an important part of medical education by several organisations, including the American Society for Clinical Nutrition, the American Medical Student Association, and the National Academy of Sciences (NAS). However, many medical schools do not provide 25 hours of nutrition education, which was the minimum recommended by the NAS back in 1985 (21). Yet even 25 hours of nutritional training must be seen as inadequate given the extent of lifestyle illness and the need for good advice. One hundred hours is often seen as the level appropriate to be giving professional advice on a topic.

It is clear that GPs require more nutrition education. Many GPs feel impeded by a lack of education in the area (14) and many acknowledge they have no or little understanding and knowledge of nutrition (22). As a result, a number of surveys of GPs found over 80% felt they had inadequate knowledge and time to handle nutrition issues effectively in daily practice (23). Physicians surveyed persist in reported lack of confidence in basic nutrition counselling due to perceived inadequate nutrition training in medical school (20,24,25 26,27).

Furthermore, over the past decade, the majority of medical student graduates, 80% or more, reported inadequate time devoted to nutrition training (16). Nutrition training is still not an integral part of either undergraduate or postgraduate medical education (1,28).

But these are not new findings. Surveys from 1995 and 2005 reported practically identical barriers in GPs' ability to deliver dietary counselling; from inadequate teaching materials to lack of nutrition knowledge (5,9,29,30) yet remains unaddressed. Unfortunately, no one profits from lifestyle medicine, which is the major reason for its exclusion from medical education and practice (1).

Unchanged Curricula

The irony appears to have been lost on many medical institutions, which have not changed or quantified nutrition curricula for decades despite evidence indicating the high prevalence of diet as a preventative medicine, and the positive role doctors can fulfil (20,26). This situation is contradictory to health considering nutrition is the cornerstone of overall well being and health and, as such, should be considered the primary issue (32). It appears current teaching curricula within medical institutions is sacrosanct and closely guarded by organisers, whether it be due to their own self importance, vested interests or ignorance, making the addition of new lectures or course material (for example, nutritional science) incredibly difficult to implement (27).

Ironically, patients view doctors as experts in all areas of health, nutrition included, and may seek their advice. There is a large gap in lifestyle medicine training for those enrolled in all levels of medical education and, hence, the missed opportunity for increased quality of life for many patients.

For most GPs and health professionals, nutrition is not a core skill and in situations where some training has been provided, it has often been driven by the personal enthusiasm of the individual. In Australia, a group of GPs, the Australasian College of Nutritional and Environmental Medicine (www.ACNEM.org), runs courses on nutritional and environmental medicine for GPs. Yet family doctors who received expert nutritional training could treat their patients more professionally than those who did not receive such training (33). Similarly, awareness of nutritional issues is left to the interest of the individual medical student to incorporate into their education (22) - but if too much interest is shown it is squashed out of them.

Huge Savings

Despite the obvious economic and health advantages of lifestyle medicine and nutrition counselling, we continue to focus on the wrong end of health (15). Providing personalised lifestyle medicine to all patients diagnosed with the top five chronic diseases - cardiovascular disease, diabetes, metabolic syndrome (obesity), prostate cancer and breast cancer - could see a reduction in health care expenditures of around $930 billion dollars over five years, in the US alone (1). In addition, if lifestyle medicine was to be practised on a global scale, better health and improved quality of life across entire populations, could only lead to greater productivity, and far less pressure on struggling health care systems (1,34).

If GPs are to play a significant role in reducing the incidence of chronic illness and disease today, it is imperative that their nutrition and lifestyle medicine training be comprehensive, timely and, most importantly, ongoing. We need to move from disease management to preventative action (1,34,35).

DISCLAIMER: Dr Peter Dingle is a researcher, educator and public health advocate. He has a PhD in the field of environmental toxicology and is not a medical doctor.



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Peter Dingle

Dr Peter Dingle (PhD) has spent the past 30 years as a researcher, educator, author and advocate for a common sense approach to health and wellbeing. He has a PhD in the field of environmental toxicology and is not a medical doctor. He is Australia’s leading motivational health speaker and has 14 books in publication.