Sue Ieraci: Food fallacies

OF all the myths about medical education that irritate me (and there are many) there is one that is more persistent than most.

“Doctors only get (x = small number) of hours of training in nutrition.”

In this postmodernist world, where expertise can be self-conferred aided by the ubiquitous internet, myths about diet and nutrition are rife.

The fact is, medical education doesn’t train doctors to prescribe diets — there is a dedicated allied health profession that specialises in this. Nutrition, however, is another thing altogether.

Education about nutrition goes from salivary glands to anal glands, including pancreatic function, metabolic pathways, the role of bile, the diseases of bowel mucosa and a huge amount more — from vitamin deficiency to toxicity, from glucose absorption to sodium excretion.

Overall, this spans hundreds, if not thousands, of hours, and involves all the clinical sciences: anatomy, physiology, pathology, diagnosis, therapeutics.

Medical practitioners assess and diagnose and, where appropriate, refer to allied health professionals, who apply their specialised training and skills.

Despite this detailed overall understanding of nutrition, we should no more expect a GP to provide a detailed dietary plan than expect them to do physical rehabilitation for stroke patients or speech exercises for children (although some GPs may have a special interest and training in these areas).

So what motivates the community to see the medical profession as all about medication, and not about lifestyle? Is there a grain of truth here, or are we subject to the hype of the multimillion-dollar “wellness” industry?

We now have lawyers writing about carbohydrate metabolism, celebrity chefs campaigning against water fluoridation and journalists becoming born-again nutrition experts.

Well written books that communicate well to a willing audience and present a simple message in directed language sell well. These latter-day experts are often highly critical of the mainstream dietary profession, blaming them for “outdated” advice.

And yet, as respected nutrition academic Dr Rosemary Stanton regularly tells us, the problem is not the advice, but failure to follow it, with people falling prey to the attraction and marketing of processed foods.

The sale of populist messages and the creation of celebrity neo-experts devalue the complexity of the discipline of nutrition science.

Then there is the sensationalisation by the media of individual articles, as occurred recently in relation to recommendations about saturated fat. Meanwhile, balanced interpretations of the data, in context, such as that of Professor Stewart Truswell in MJA InSight recently, receive little coverage.

Many who see the medical profession as neglecting nutrition in favour of pharmacology quote Hippocrates as having said “Let food be thy medicine and medicine be thy food.”

While diet clearly has an impact on many aspects of health and wellbeing, we must also consider two important points. First, in Hippocrates’s time, essentially all medicines were plant-derived; and second, we also know that diet isn’t the answer to everything.

We can encourage a wholesome diet, full of variety with lots of plant-based foods and aiming to balance both nutrition and energy, without blaming those who develop illnesses for not preventing it because of an “imperfect” diet.

We can also be role models in our own eating habits, in the way we educate others and in the way we use evidence. We must keep abreast of the science on nutrition and expose pseudoscience for what it is.
 

Dr Sue Ieraci is a specialist emergency physician with 30 years’ experience in the public hospital system. Her particular interests include policy development and health system design, and she has held roles in medical regulation and management.