One of the things that was clear from reaction to this week's front page story on good nutrition (and how little it is taught in medical schools) is that readers are hungry for clear, reliable information.
The story was shared on social media hundreds of times, and readers -- patients and physicians both -- emailed me with questions.
In Tuesday’s story, which looked at the lackluster levels of nutrition education among physicians, I referred to a 2003 published report which found that that the majority of internists and cardiologists who responded to the survey did not know a low-fat diet would increase the level of triglycerides in the blood. High triglycerides increase the risk of heart disease.
Several concerned readers emailed, thinking I’d made a mistake. “In fact, my cardiologist told me just the opposite,” wrote one.
“I always thought that the trigyclerides would decrease with a low-fat diet,” wrote another. “Is your article correct?”
The confusion among both consumers and doctors illustrates why many are pushing to incorporate more nutrition education into the medical school curriculum.
SOURCE OF CONFUSION
It’s easy to assume a low-fat diet is the healthy way to go, especially since a diet low in saturated and trans fat was recommended by government agencies back in the 1980s.
And studies have shown it’s beneficial to cut out saturated fat and completely avoid trans fat, both of which definitely will help to lower elevated triglycerides.
HERE WAS THE CATCH
But a trade-off can occur when other, healthier fats such as vegetable oils are replaced with certain carbs -- something that commonly occurs when people switch to a low-fat diet.
Increasing carbs, especially the starchy or refined type, tends to increase triglycerides -- and lower HDL (the ‘good cholesterol.’)
A better way to go, according to a study I cited in the article, is a Mediterranean diet.
Getting results out of dietary changes depends not only on what you stop eating, but also what you replace it with.
WHAT THE MEDICAL SYSTEM LEARNED
The other lesson that became clear while reporting this story was a growing realization that misunderstandings about nutrition can arise for simple reasons: It isn't taught all that much.
As we showed this week, the number of hours medical schools devote to teaching nutrition to physicians over four years has only moved from 21 hours in 1985 -- when the National Academy of Sciences identified the shortfall -- to 22.3 hours in 2004.
Research suggests that physicians don't feel comfortable, confident or adequately prepared to give nutrition advice, I learned from Kelly Adams, a research associate in the department of nutrition at the University of North Carolina.
Plus, when patients learn they need to alter their diet for medical reasons, they've got a lot on their mind. It's a bad time to focus on details.
"The patients we see are in sensory overload — a new diagnosis, an evaluation of lifestyle, new medicines, perhaps recent procedures and then diet issues," said Dr. Clyde Yancy, chief of cardiology at Northwestern University's Feinberg School of Medicine.
What patients need most is coaching and support that can help them make lasting behavioral changes, but that's no easy task, Yancy told me. "We (physicians) may lead the team, but it does take a village and requires having access to good information and an expert dietitian," he said.
Happy to help with the information.
-- Julie Deardorff