Re: Medical schools should be prioritising nutrition and lifestyle education
As a fellow medical student, I completely agree that my MBBS curriculum has been almost entirely devoid of education about diet and lifestyle medicine. However, I also think this problem stems from higher up in our delivery of healthcare. I have been party to many a consultation with Type 2 diabetic patients whose blood sugars are inadequately controlled, and the discussion revolved almost entirely around upping their Metformin dose, or trialing them on an additional anti-diabetic drug. Whilst the NICE guidelines advise ‘lifestyle and diet’ as the first line treatment step, I have not observed this to great effect, which makes it difficult to see how I would be able to implement this advice in my own medical practice in the future.
I also feel the information that is advertised to patients is somewhat conflicting, or at least not necessarily concurrent and up-to-date with the direction that nutrition research is heading. NHS Choices Eatwell Guide tells us to eat a balanced diet comprised of 5 portions of fruit and vegetables per day alongside making up over a third of the food we eat with starchy carbohydrates. Your average apple (150g) contains about 18g of sugars (1), so three portions of fruit per day to that extent takes us over 50g – well above the recommended limit of 30g of sugars per day. Add that to the bread, pasta and potatoes that we are recommended to make up the basis of our meals, and even with a ‘healthy’ diet we are literally feeding sugars to a population of Type 2 diabetics who are by definition resistant to their metabolism, and are often overweight or have co-existing cardiovascular disease. Much research has been done recently about the use of low-carb (sometimes called ‘ketogenic’) diets in individuals with a variety of cardiovascular and endocrine conditions. These have seen dramatic improvements in glycaemic control and weight loss in patients with Type 2 diabetes when compared to standard low-fat diets (2, 3, 4). Although many such studies are in early pilot stages, it seems there is a trend away from – or at least a questioning of the integrity of traditional low-fat high-starch diets which is yet to be reflected in the Public Health sphere, and definitely not something I have observed feeding down into clinical practice.
2) Saslow et al. An Online Intervention Comparing a Very Low-Carbohydrate Ketogenic Diet and Lifestyle Recommendations Versus a Plate Method Diet in Overweight Individuals With Type 2 Diabetes: A Randomized Controlled. J Med Internet Res 2017; 19(2):e36
3) McKenzie et al. A Novel Intervention Including Individualized Nutritional Recommendations Reduces Hemoglobin A1c Level, Medication Use, and Weight in Type 2 Diabetes. JMIR Diabetes 2017;2(1):e5
4) Rehackova et al. Efficacy and acceptability of very low energy diets in overweight and obese people with Type 2 diabetes mellitus: a systematic review with meta-analyses. Diabet Med. 2016;33(5):580-91
Competing interests: No competing interests