Nutrition and your doctor

There are certain things that doctors are great at. How to prescribe medications? Yes. How to do surgery? Yes. Nutrition and weight loss? No, definitely not. You might be a little stunned to hear that admission, coming from a highly trained medical specialist like myself. But, it all comes down to a physician’s training and what they see as their circle of competence.

Medical training extends over more than a decade, and there is barely any attention paid to nutrition or the equally thorny question of how to lose weight. Medical training begins in medical school, where standard curricula include a mandated number of hours for nutrition which varies depending upon where you did your training. Generally, during the 4 years of medical school, it is about 10-20 hours. I did my medical training at the University of Toronto and the University of California, Los Angeles (UCLA) but my experience was not unlike most other schools in North America.

Medical school consisted of nutritional lectures discussing things like biochemical pathways of vitamin K metabolism or learning the pathway of vitamin D activation in the kidney and skin. Yes, perhaps you might consider them nutrition, but they are really much closer to biochemistry. Vitamin D becomes 25-OH vitamin D in the kidneys and then becomes activated in the skin during sun exposure to the active 1,25-OH vitamin D. So very useful knowledge when trying to understand how to help patients lose weight.

We also learned about such common everyday diseases such as scurvy (Vitamin C deficiency) and pellagra. Gums bleeding and hair follicles that are corkscrewed? Avast ye mateys. Your bloody gums are a-fouling my pirate ship, you scurvy dog. Knowledge of scurvy certainly came in handy during exams, and also for the last patient that I diagnosed with scurvy, with was, uh, never. That’s probably because I am a modern-day physician and not a pirate of the Caribbean.

The medical school, however, considers them nutrition lectures and I came through medical school with essentially zero knowledge of nutrition as most people know it. The questions that people really want to know are things like – should I eat more carbs? Less carbs? More fat? Less fat? Is sugar bad? How often should I eat? How do I lose weight? Those important health questions, apparently were not considered the purview of the medical school teachings. Medical school, with dozens of professors and academic doctors apparently were not interested enough in these questions to give much more thought to it than referring to the Canada Food Guide or the American Dietary Guidelines.

Medical school provided less training in real life nutritional questions than most health clubs or gyms. As a result, doctors are trained to believe that nutrition and weight loss are simply not part of the problems that doctors should deal with or care about. Medical students model their own self-image as a doctor on their mentors they meet in medical school. And those doctors and those researchers didn’t give a rat’s ass about nutrition or weight loss.

This contrasts starkly with the medical knowledge that they learn. Everybody, and certainly every medical student knows that obesity plays a dominant role in metabolic diseases like type 2 diabetes and the metabolic syndrome. In turn, these metabolic diseases raise the risk of heart disease, stroke, cancer, kidney disease, blindness amputations etc. Doctors understood fully the importance of weight gain for disease. They just didn’t care to know any more about how to lose weight or what we should or should not eat.

Here’s what a normal person would think.

  1. Weight gain leads to metabolic disease and then heart attacks (or type 2 diabetes, or joint pain or a million other ailments related to weight)
  2. What can I do to prevent or reverse weight gain (the root cause)?

Here’s how a doctor is trained to think:

  1. Weight gain leads to metabolic disease and then heart attacks
  2. What drugs or surgery should I give to patients after they have their heart attack?

You would be entirely correct here in thinking “WTF?”

Everybody knew full well how obesity and metabolic disease are destroying our nation’s health, medical schools were not teaching medical students how to treat this. Instead, they gave the unmistakable message that weight loss was not something doctors should care about, learn about, or try to achieve with their patients. Doctors often tell patients to lose weight What they don’t often tell patients, however, is how to lose weight.

The entire medical school curriculum about weight loss was about as insightful as your latest issue of Cosmopolitan magazine. Eat less. Move more. Cut about 500 calories per day and you will lose about a pound of fat per week.

If this were a new drug, for say, lung cancer, then doctors would immediately want to know – does it work? For weight loss, we learned about this calorie cutting method, but nobody seems to ask out loud – does it work? We already knew that it did not. After all, everybody had already tried this weight loss method for the last 50 years and it worked for nobody.

There were controlled trials of the calorie restriction method for weight loss. Every single study failed. There were thousands of real-world patients who tried it. The success rate was about 1%. Doctors were trained to give weight loss advice that had an expected failure rate of 99%. What boggles the mind is why doctors don’t stop and think why they are giving advice that is expected to fails 99% of the time. The most unfair part is that when patients do return, unable to lose weight, the doctor then blames them for their failure. It’s so much easier to blame the patient than the find fault with the standard medical advice of cutting calories.

Medical students are subjected to an enormous unconscious bias. They see that all the doctors they know, all the doctors that teach them, all the doctors in the hospital don’t care really about nutrition or giving weight loss advice. Therefore, they understand that this is not something that doctors ‘do’. We give medications. We do surgery. We don’t ‘do’ weight loss. Even if it is the root cause of most of the disease we see today.

Does it change after medical school? Yes, it gets worse. Specialty training, internship, residency and fellowship is another 5 years of training after medical school. There is no formal curriculum and nutrition generally makes no appearance here. That is another 5 years where doctors learn that weight loss has nothing to do with them. Leave it up to Weight Watchers, Jenny Craig and magazines. It’s not real medicine.

Talk to your doctor about weight loss? Would you ask your plumber to remove your wisdom teeth? Would you ask your barista to check your vision? It doesn’t have to be this way, of course. The obvious thing to do is include more nutrition into the curriculum of medical school or residency training. It would also help if doctors learned a bit more of the physiology behind weight loss and weight gain. About the hormonal regulators of weight, and how to influence them using diet. Weight gain is a hormonal, not a caloric imbalance.

2018-12-04T14:40:18+00:0010 Comments

About the Author:

Dr. Fung is a Toronto based kidney specialist, having graduated from the University of Toronto and finishing his medical specialty at the University of California, Los Angeles in 2001. He is the author of the bestsellers ‘The Obesity Code’ and ‘The Complete Guide to Fasting’. He has pioneered the use of therapeutic fasting for weight loss and type 2 diabetes reversal in his IDM clinic.

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Patti A Johnson
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LURVE!!! Thank YOU soooo very much for THIS post, Dr. Fung!! Finally a clarification for folks about all of this confusion with relying on medical doctors to know about nutrition and the best way to lose weight, etc… People MUST research and educate themselves with resources like you, Dr. Eric Berg, Dr. Jonathan Carp, Dr. Tim Noakes, etc…provide and become Their Own Health Authority! Your book, The Obesity Code CHANGED MY LIFE in such a marvelous way! YAY!! Healthier than ever and 110.8 pounds lighter through the power of a Healthy Keto & IF Lifestyle! Learning more and more each… Read more »

MERY
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MERY

You are a genius, thank you Dr. Fung

Danny Holifield
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Danny Holifield

As usual, Dr Fung is right. My Doctor fits his profile perfectly. Thanks being there.

Errol Bhagwandass
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Errol Bhagwandass

Thanks Dr Fung, I’m learning a lot from your books

Roger Fournier
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Roger Fournier

Dear Doctor Fung, Let me just start by saying that I appreciate very much your article on “Nutrition And Your Doctor”. I find it very educational and interesting. What troubles me a bit is the link of diabetes type 2 to obesity that most doctors associate this disease with. I do not deny that obesity is a very serious problem in our North American society, far from it. As I am not a doctor, I can be quite wrong of course, but it seems to me that there could be more than just obesity as what could be the prime… Read more »

David G
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David G

Dr Fung,

I read your blog on a regular basis. You have a done a great service with sharing your knowledge with the world. Thank you for that. Roger has some good questions here and I for one would like your take on them. Maybe on your next blog?

Thank you

Jonjuan
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Jonjuan

Roger – Google Professor Tim Noakes. Long time competitive distance runner, slender, got type 2 anyway. He believes now it was because of all the carb loading he did as a runner as that was accepted as best practice for runners. Best of luck in your journey

Jackie
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The following is what my local hospital weight loss options are besides of course all the possible surgeries. ” Learn about both the OPTIFAST® low calorie Full Fast plan for rapid weight loss and the “Opti-Mistic” Lifestyle Partial Fasting plan. Bring your questions, sample OPTIFAST® products, and complete the first step to getting started on either plan.” Pathetic my daughter and I went to a couple of these meetings a few years ago and we decided it wan’t for us. Besides the fact that it was very expensive to buy all the products and, the support system, I asked my… Read more »

Susan
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Susan

I laughed so hard! It was that way in nursing school. Studied the Krebs cycle enough to ace the test, and Never Used It Again, 30 years and counting. Memorized an awful lot of useless information. It was called Nutrition and it was difficult, but offered nothing actually useful in clinical practice. More effective as an exercise in hazing than for educating nurses.

Sandra
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Sandra

Hallo Dr Fung, I bought 3 more copies of The Obesity Code gifting it to the doctors treating my husband’s septic big toe which is in danger of being amputated (which they call “diabetic foot”). My husband lost his trust in my knowledge about diabetes and insulin resistance because his blood sugar reading has been going up since he discontinued insulin injections nearly 4 years ago. I have been suspecting that Carvedilol raises insulin, then this week found the following, confirming my suspicions. He was also prescribed Novonorm. https://www.omicsonline.org/open-access/carvedilol-can-replace-insulin-in-the-treatment-of-type-2-diabetesmellitus-2155-6156-1000726.php?aid=85838 Insulin resistant people can tell you how constant hunger feels. When… Read more »