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Do Doctors Make the Grade?

Doctors and other health professionals were put to the test for their nutrition knowledge regarding diet and heart disease.

September 3, 2011 |
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Transcript

For me, the most disturbing finding in the latest update on last year on the status of nutrition education in U.S. medical schools, was that  compared to the last survey in 2004, the percentage of medical school instructors who think more nutrition education is even needed dropped, from about 9 out of 10 down to about 8 out of 10.

 Is it possible that doctors think they know more than they really do? Doctors may think they know enough about nutrition, but do they? Doctors were asked a list of simple questions on diet and cardiovascular disease.  Some simpler than others. True or false, does walking and gardening increase physical activity levels?  (95% got that right). Good.

 On the other hand 71% of health professionals and final year medical students, incorrectly thought that avocadoes had cholesterol.

So,  how did they do overall?

What was the average test score of doctors on question relating to diet and cardiovascular disease. Did they get an A+, 97-100% correct? If so, maybe they don’t need any more nutrition training. Or did they just get an A, A-, B, C, C-, D or an F, even, under 65% correct.

What do you think?

They didn't get an  A, B, or C. Or  even a D. 64% correct. They failed.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring watch the above video. This is just an approximation of the audio contributed by Dianne Moore.

To help out on the site please email volunteer@nutritionfacts.org

Dr. Michael Greger

Doctor's Note

Anyone have any stories of doctors failing to understand basic nutrition? I'm almost afraid to ask. Make sure to check out my previous video on the subject, Doctors’ Nutritional Ignorance.

For some context, please check out my associated blog posts: Physician-assisted suicide: when doctors give nutrition advice, Nutrition Education in Medicine: a Doctor a Day Keeps the Apples Away, Health Food Store Advice: Often Worthless or WorstStool Size and Breast Cancer Risk, and  Treating Breast Pain with Flax Seeds

  • http://nutritionfacts.org/members/mgreger/ Michael Greger M.D.

    Anyone have any stories of doctors failing to understand basic nutrition? I’m almost afraid to ask. Make sure to check out my previous video on the subject, Doctors’ Nutritional Ignorance, as well as my blog today, “Physician-assisted suicide: when doctors give nutrition advice.”

    • http://nutritionfacts.org/members/krasmuss/ krasmuss

      6 months after my boyfriend and I adopted a plant-based diet (after reading the China Study) he had his annual aviation medical. When he mentioned to the doctor that he was now eating mostly plant foods and was essentially vegan, he expected to hear at least some encouraging remark about how much better his heart health would be and how that might allow him to keep his commercial pilot’s license for a longer time, etc. However, the doctor only commented that “a study showed that a vegan diet causes a reduction in intelligence with aging and is a bad idea”. Fortunately, the doctor didn’t see ‘being vegan and suffering a gradual loss of intelligence’ as an impediment to passing the aviation medical…maybe that’s because the medicals are based on measurable indicators of health!

      Not that we believe it, but do you know if such a study actually exists?

      • http://nutritionfacts.org/members/mgreger/ Michael Greger M.D.

        Please ask that doctor for the study to which s/he refers. Or at least a citation? Too often I’ve found my colleagues just making “stuff” up, counting on patients to be deferential, unquestioning, and submissive (even though doctors may know less than their patients about nutrition).

        Certainly if folks aren’t getting enough vitamin B12 that can be a problem, but the longest running study on vegetarians in human history found that those eating meat (including poultry and fish) appear to have three times the risk of developing dementia compared to vegetarians.

        I have lots more videos on cognition. Maybe s/he was thinking about the tofu study?

    • http://nutritionfacts.org/members/raychel83/ Raychel83

      In mid 2008 my second child was about 9 months old. I was tiered and feeling bad so I went to my OB. She ran a blood panel and told me that I had PCOS. I didn’t agree so I did some research. It was pretty obvious to me based on the symptoms that I had insulin resistance, but most likely did not have full blown PCOS. I further researched diet and treatment and found that the medicine she wanted to put me on (Metformin) was not something I wanted to take for a long time. I made another appointment to speak with her and asked her about the nutritional research I did. She told me that changing my diet would most likely not do much good for this problem and that I just needed to take the medicine. I was shocked. How could something like insulin resistance not be treated by diet??? I began exercising again and drastically changed my diet and I haven’t had any more problems.

      • http://nutritionfacts.org/members/mgreger/ Michael Greger M.D.

        That is so fantastic Rachel! News studies have indeed found that a healthy diet can both successfully prevent and treat insulin resistance. You know I should really look into doing a video on PCOS–I’m surprised to look at the topics list and not find it. There are a bunch on diabetes, though, if you’re interested.

    • http://nutritionfacts.org/members/kaspry/ kaspry

      Thanks for posting the video. Lack of nutrition knowledge among physicians is a serious problem in this country. Most are unable to truly counsel patients with CAD, HTN or cardiometabolic risk, and 1 or 2 sessions with a dietician is insufficient as patients need reinforcement and specific advice at each visit. There is no one solution, but here are my thoughts (from a cardiologist with 2 degrees in nutrition): More intensive nutrition education in medical school, delivery system redesign that incorporates non-physician providers trained in diet and lifestyle counseling, and another round of Nutrition Education Academic Awards from the NIH/NHLBI.

  • http://nutritionfacts.org/members/TimTango/ Tim Tango

    I would like to say I’m shocked. But I’m not.

  • http://nutritionfacts.org/members/jmerrikin/ jmerrikin

    Great video Dr. Greger, pathetic results!

    As I’ve been getting healthier over the last year, one of the conditions I have battled is that of high triglycerides which for the last two decades averaged over 1,000. Yes I consider myself lucky to still be here and as of late my levels are now coming in at around 400. Still too high but getting better.

    My doctor’s recommendation for treating this at first was Lipitor. After having my gallbladder removed about 18 months ago I had finally awoken, changed my diet radically and now eat no meat or dairy products and consume very low levels of fat. I took myself off of 12 out of 13 medications I had been taking and was feeling better than I can ever remember.

    When I went back to my doctor a year later he was impressed with my achievements but still saw that my triglyceride levels were too high. Knowing how I was trying to use natural methods he prescribed Niaspan for me. However I could not stand the flushing effect if created so he then put me on Lovaza (fish oil) for omega-3 EFAs. After a while I could no longer stomach that either so I took myself off of it.

    What really perturbs me is that during this entire course of diagnosis and treatement he never once mentioned anything about nutrition. It was not until seeing Jeff Novick’s Oil to Nuts DVD that I learned about the ridiculous levels of omega-6 saturation that Americans have and how the body only has so many enzymes available to convert omega-6 and omega-3 into their usable parts. Could it be that my omega-6 levels were so high that the omega-3 was not working? Was my body too saturated with omegas?

    I don’t really know yet but I am feeling better. However, I am afraid to go back to my current doctor to get more of the same bad advice and drug remedies. I need to find a doctor who understands nutrition AND allopathic medicine.

    • http://nutritionfacts.org/members/NouhAlaoui/ Nouh Alaoui

      Very inspiring, keep up the great work and don’t forget to spread the word.

      • http://nutritionfacts.org/members/jmerrikin/ jmerrikin

        Thank you Nouh, I appreciate your support! I myself went vegetarian about 18 months ago, then turned vegan about 1 year ago. Since the vegan phase, I have lost 109 pounds total however, I still have about 65 pounds to go to get to my goal weight of 170. I sleep better, have way more energy, and much better focus. I exercise around 2 to 6 times per week depending on my work schedule.

        Congratulations on your accomplishments as well! I am trying every day to spread the word through blogs, Facebook, face to face discussions, etc.

        • http://nutritionfacts.org/members/JenniferEldred/ Jennifer Eldred

          That is amazing congrats on the weight loss. I’ve been a vegetarian for 12 years now and gone vegan off and on, but it’s time to do it for good and I hope to drop the weight just like you are doing.

    • http://nutritionfacts.org/members/mgreger/ Michael Greger M.D.

      Thank you so much for taking the time to share this story. I wish I could say that it was atypical, but unfortunately nutritional ignorance (and then often the arrogance to not admit they just don’t know) is all too common my my profession.

      In terms of your triglycerides it sounds like you’ve made some tremendous strides but may need to go the extra mile and cut out refined grains. See my Great Grain Robbery and associated videos.

      And please write back to give us an update!

  • http://nutritionfacts.org/members/EricNeeds/ Eric Needs

    This is why I don’t understand how doctors tout the most respectable nutrition advice. Someone like myself with a degree in nutrition couldn’t hold peanuts to a doctor. However, I hold a bounty of knowledge in regards to preventive disease. Where’s my parade?

    • http://nutritionfacts.org/members/mgreger/ Michael Greger M.D.

      Virtual confetti for Eric!: * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * :)

  • http://nutritionfacts.org/members/louisef/ LouiseF

    My boyfriend has been on a plant-based diet since May 14th, the day he saw “Forks Over Knives” (I am already vegan).
    He went for his annual check up two weeks ago and he told the doctor that since seeing the documentary and reading “The China Study,” that he had become vegan.
    His Harvard educated doctor, although very smart, had never heard of the China Study!
    My boyfriend’s numbers came back and his cholesterol and dropped 60 points and his blood pressure is very good.
    Maybe this will teach the doctor something! We are sending him a copy of the study.

    Thanks for your wonderful website.

    • http://nutritionfacts.org/members/mgreger/ Michael Greger M.D.

      Oh, LouiseF, you just made my day! Thank you so much for sharing your story. You know, people always ask me to recommend a doctor knowledgeable about healthier eating, and I advise them to stay with their current doc and teach them!

      Doctors have good hearts. They really do want to see people get better, but may be situated within a system (such as managed care here in the States) that demands they see 5 patients an hour and may feel all they have time to do is whip out their prescription pad. The most convincing thing to a doctor is not a book, movie, or website, but one of their own real-life patients getting better before their eyes. Doctors are so resigned to the notion that chronic disease patients will just continually get worse, that when they see the kind of clinical reversal of disease that can accompany lifestyle change, that is what’s going to get them to apply that knowledge throughout their practice. Just think how many people your boyfriend helped by showing that doctor the power of a healthy diet.

  • http://nutritionfacts.org/members/mgreger/ Michael Greger M.D.

    I am indebted to Dr. John McDougall for pointing out that the doctors may actually have been technically right! Avocados do have trace amounts of cholesterol. How trace? Based on a cited 1975 study, one avocado may have up to 0.6 mg of cholesterol. To put that in perspective. one big egg has more cholesterol than 371 avocados. That… is a lot of guacamole.

  • http://nutritionfacts.org/members/NouhAlaoui/ Nouh Alaoui

    I know a cardiologist who has got high blood pressure and high cholesterol, he is overweight ( and is trying to lose it) and what scares me the most is that he has got more “customers” than probably all the nutritionists in the building ( there are many ).
    Since becoming a vegan, I’ve never been to a doctor, which surprises all my family and makes them think about the reasons ;)

  • http://nutritionfacts.org/members/JenniferEldred/ Jennifer Eldred

    I remember one doctor my hubby had she was very overweight and every step she took sounded like she was going to collapse from breathing so hard. Though she didn’t tell my hubby about any kind of nutritional advice surprise surprise lol

  • http://nutritionfacts.org/members/shani/ Shani

    Thanks Dr Greger! Is there a way to find out what the other questions were? I’d be dying to know how the drs answers the other questions and would love to share this in some talks that I give about nutrition. I would love to get a lot of these studies, but paying $30-45 for each of them can get quite expensive over the long haul. any chance you could email or post the remaining questions on this survey?

    Thanks
    shani

    • http://nutritionfacts.org/members/mgreger/ Michael Greger M.D.

      I’m so glad you didn’t spend the money. Unfortunately they just gave a sampling of questions in the paper. I’ll try contacting the principal investigator and getting the full test–thanks for your interest Shani!

      • http://nutritionfacts.org/members/shani/ Shani

        Thank you so much Dr. Greger! I hope the full test also shows how the drs answered the questions too. This could be great entertaining info for my talks on nutrition! I’ll await your reply. My email is shanasyy@yahoo.com if you can send it to me. Again, THANK YOU SO MUCH! I just can’t figure out how you have time to do all that you do!
        But….you’re the greatest!

      • http://nutritionfacts.org/members/joel/ Joel

        Dr Greger, I too am highly interested in the questions and range of answers in this study and am hopeful you can obtain them for our perusal. I second all of Shani’s sentiments.

        Huge thanks for your efforts!
        Joel
        PS. I neglected to check the comment feedback box. Please forward further comments or check it for me. Thanks again.

  • http://nutritionfacts.org/members/StefanoEsposito/ Stefano Esposito

    The situation in Italy is probably even worse than in the USA. We don’t have an official document on vegetarian and vegan diet, like the ADA one. Mainstream doctors and nutritionists in TV still talk of lack of protein and iron, old myths. I heard stories of all kind on doctors’ advices, just mention one saying that beans are bad if you have diabetes. Medical degree (6 years) doesn’t include a serious nutrition course, only a very basic course. Luckily we have a great scientific vegetarian society gathering many physicians, but we talk about small numbers and low visibility, nothing like PCRM!
    The effect of this ignorance is that Mediterranean diet has become a terrible diet based on white pasta, bread, animal products, and vegetables as side. Few beans and nuts. A good point is that we surely have less commercial junk foods than you and probably some higher quality standard in general for food.

    • http://nutritionfacts.org/members/mgreger/ Michael Greger M.D.

      Molto terribile! I’m actually putting together a few videos about the Mediterranean diet, so stay tuned. And benvenuto Stefano!

  • http://nutritionfacts.org/members/RobertCross/ Robert Cross

    When I had a significant coronary blockage, both my internist and cardiologist recommended a prompt stent procedure. My own research led to Dr. Esselstyn’s Prevent and Reverse Heart Disease. When I asked my docs about the dietary treatment, neither had heard of Dr. Esselstyn, and both said not to bother. I did bother and reversed my symptoms almost immediately. 18 months later, a follow up nuclear heart scan showed no blockage. My cholesterol dropped from the 290′s to now the 130′s. My LDL from 212 to 39.

    My internist was interested and referred one of his surgery colleagues to me for (successful) similar intervention. My cardiologist was not interested, and speculated that perhaps the initial diagnosis was somehow wrong – despite clear symptoms and a positive nuclear scan. It’s true that you will “never convince a man against his salary.” Amazing.

  • http://nutritionfacts.org/members/caw/ CAW

    I have no doubt that the state of nutrition education for medical professionals is lacking universally, but how should we understand the implications for U.S. doctors of a study in Cape Town, South Africa? Might U.S. doctors do better?

  • http://nutritionfacts.org/members/cloa513/ cloa513

    Not surprising- Basic doctor education is without direction- its overloaded with medical information- a lot of them just have to cram and forget a good deal of it. One common year with wide experiece to judge which area is right and then specialisation should be the norm- then only general doctors need great general nutrition training- other areas might specific nutition training.

  • http://nutritionfacts.org/members/akenney06/ akenney06

    You asked about stories of doctors not knowing basic nutrition. After being diagnosed with colorectal cancer 27 months ago, I switched to a macrobiotic approach for health. I have re-learned about nutrition and its importance. All along the way, primary physicians, gastro doctors, oncologists, and every doctor I have met has no clue about nutritiion for health, and for healing. They instead act with narcissim, arrogance and snootiness. I spent an hour talking with a hospital nutritionist about why the hospitals diabetic diet menu creates diabetes. I don’t think it fazed her at all.

  • Marylou Hunter

    I am a certified nutrition Coach, and Holistic Health Therapist and My client came to me asking about my weight loss/health program which incorporated whole foods with proper supplementation and she felt the need to ask her doctor and he advised her that seeing me would not benefit her. I was blown away by the Doctor’s response!

  • Michael Greger M.D.

    For some context, please check out my associated blog post Nutrition Education in Medicine: a Doctor a Day Keeps the Apples Away!

  • Eatyourbroccoli

    6 months ago my endocrinologist doc strongly recommended statins because of my high cholesterol,atherosclerosis and Berkeley heart lab lipid profile. I responded that i will make lifestyle changes recommended by Dr Greger to become vegan instead. He strongly opposed my preference and dutifully noted in writing his prescription and my refusal to adhere (a CYA letter-Cover Your Ass)
    Now six months later I’m 40 lbs lighter, my triglycerides and cholesterol are now within the low end normal range, my glucose levels have normalized and the Berkeley lipid profile indicates a tremendous shift away from the bad (small ldl lipids) that build ip as atherosclerosis.
    Go vegan, eat your flax and chia,
    Take your d3,b12,magnesium, probiotic,coq10, eat garlic and of course…eat your broccoli!
    Thanks Dr G !!!!

    • http://www.DonForresterMD.com/ Don Forrester MD

      I hope you have shared your outcome with the physician you mentioned. You might also include the other benefits you have probably noticed… your blood pressure is probably improved as well. You could recommend s(he) read The China Study. Physicians given the systems they work in have a difficult time keeping up with the literature and often don’t see the folks who have had dramatic improvement due to diet as they don’t see physicians very often. Congratulations on your success.

  • tavit

    I saw my doctor drinking coca cola… oh and when I was a child she recommended for me to eat potato chips and drink coke for diarrhea. I bet there is better source of sugar and salt then junk food.

    • http://www.DonForresterMD.com/ Don Forrester MD

      Given the current environment most physicians work in it is very difficult for them to learn about the advantages of a the best nutritional approaches. I had some training in Medical School but that was in the 1970′s… fortunately we have learned alot since then. Your physician probably doesn’t know about the benzene and phosphorus in soft drinks. I find keeping current is easier if you follow NutritionFacts.org and other good commercial free sources such as PCRM and John McDougall’s monthly newsletters. You are correct there are much better sources of sugar and salt for treating diarrheal illnesses.