Letters from Maine

What to eat


Where did you learn about nutrition? Was it primarily at home supplemented by a few teachers as you navigated K through 12? Studies have shown that it probably wasn’t during medical school (“How much does your doctor actually know about nutrition?” American Heart Association News, April 30, 2018). A survey of one-third of medicals schools done in 1985 found “inadequate exposure to nutrition,” which prompted the National Academy of Sciences to recommend a minimum of 25 classroom hours. A more recent survey in 2013 discovered that 71% percent of medical schools fail to meet that benchmark.

various foods laid out diet


A health advisory by the American Heart Association published in the May 15, 2018, issue of Circulation entitled “Medical nutrition education, training, and competencies to advance guideline-based diet counseling by physicians: A science advisory from the American Heart Association” (2018 Apr 30. pii: CIR.0000000000000563) claims that physicians are failing to be adequate and competent nutritional advisors to their patients because medical schools continue to undervalue the importance of nutritional education. The AHA urges medical schools to consider innovative programs such as one at Brown University, Providence, R.I., in which medical students are paired with culinary arts students in activities such as hands-on, in-kitchen experience cooking low-sodium meals.

I certainly don’t recall receiving any teaching in medical school that was specifically targeted at nutrition. And to be perfectly honest I never felt that I had missed anything. It’s not that I don’t believe nutrition is important. What we eat joins exercise and sleep at the core of a healthy lifestyle. The problem is that I was never confident that I or anyone else knew what a healthy diet should be. I learned what happened if child didn’t eat enough fruits and vegetables or consume enough vitamin D. But the tide seemed to keep going in and out on how much of each category of food was optimal. What was the perfect nutritional pyramid? And then there was the whole apparent flip-flop on eggs. For myself, I tried to follow the old dictum “everything in moderation ... including moderation.”

Don’t misunderstand me. I think dietitians have a critical role in health maintenance and disease management and should be on the forefront of our efforts to seek the causes of those medical conditions that have yet to be fully explained. It would be a mistake to recommend a low-salt diet to a patient without encouraging him or her (and the family) to consult with a dietitian. However, is having a medical students spend an afternoon in a kitchen preparing a low-salt diet a worthwhile investment of 4 precious hours of their educational time? It sounds cool, and at the end of the day, the student will certainly have a better understanding of how difficult his dietary recommendations will be to follow. But if the student ends up being a pediatrician, how often will he look back on the kitchen experience as a positive?

Giving specific and detailed instruction on how to shop for and prepare a medically prescribed diet can be very time consuming, and it can’t be done well without close follow-up that might even include a home visit or two. In some practices, the best option is to have a dietitian on the team. As a minimum, each physician should have a dietitian or two with whom he or she has a good working relationship.

Dr. William G. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years.

Dr. William G. Wilkoff

However, when all is said and done, no matter how much training we or our favorite dietitian has accumulated, the tsunami of bogus nutritional advice spilling out of the television and the Internet every hour means that we are swimming up stream even when we have the best advice to give.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.” Email him at pdnews@mdedge.com.

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