The medical profession and health systems worldwide are often criticised for not moving fast enough to introduce the principles of lifestyle medicine in hospitals and general practice. And, when you consider that the term itself dates back as far as 1989, it’s understandable that so many still ask why its application hasn’t become common.
Surely, if the advocates of lifestyle medicine had had their way, medical colleges the world over would, by now, be explaining the critical need for adequate nutrition to ordinary mums and dads and fast-food junkies everywhere.
While some advocates allude to dark forces in this debate, we should also reflect that the message being propelled here isn’t easy to accept. Many national economies have been developed around the very thing causing the problem, and dealing with it puts livelihoods at stake and is politically sensitive in numerous ways.
Despite all the criticism, however, an examination of the progress made in the nutrition debate since the very early years does reveal significant progress.
The first stage began in the early 1900s in what’s now referred to as the Golden Age of nutrition. It included the discovery of vitamins, the elucidation of many of the basic nutrient requirements, and the teaching of basic nutrition principles in some medical schools.
During this era, the textbook Newer Knowledge in Nutrition (1918) was published, and energy values for carbohydrates, fats, and proteins were determined. Early understandings of the value of trace elements also emerged.
The biochemical approach
During the 1930s and ‘40s, many important micronutrients were isolated and synthesised, and medical educators taught students the biochemical and clinical aspects of nutrition (Darby, 1976; Todhunter, 1976).
UK Investigations into the cause of pernicious anaemia led to the identification of Vitamin B12 by 1948. Still, during the 1950s and 1960s, nutrition was relegated to a low priority in the curriculum and was no longer taught as an independent course. The Golden Age of Nutrition was over.
The rise in the number of subspecialties, each with its own claim on the medical curriculum, put nutrition on the back burner. Nutrition became fragmented and integrated into several basic science courses, and its relevance to clinical practice, although overlooked1, thankfully, was not completely forgotten.
Major advances in nutrition science and technology did occur during the middle of the last century, but these advances were not accompanied by an increased emphasis on nutrition in medical education.
By 1989, however, there was emerging epidemiological and clinical evidence linking nutrition to the etiology and prevention of disease and the implications of this knowledge for planning public health programs and policy.
“Economic and social factors are now influencing the ways in which medical care is financed, delivered, and perceived. These forces should serve to redirect the emphasis of health care delivery from therapeutics to prevention. As a result, it will be necessary to revise medical education to prepare future physicians for the new demands of their profession,” stated a review paper published that year.
A coming of age
Let’s fast-forward all this to a paper published in May 2013 in the National Library of Medicine, which states that “it is no longer new to regard lifestyle as an important factor in human medicine.”
The paper observes that lifestyle medicine is now “actively developing” in America, Australia, and several European countries and is starting to grow in countries like Japan, Taiwan, and India.
“Articles devoted to lifestyle medicine have been increasing, indicating that lifestyle medicine is becoming popular around the world.”
By this point, it had become well accepted that metabolic diseases are closely related to lifestyle, and chronic diseases, including cardiovascular disease, metabolic syndrome, obesity, type 2 diabetes, and some kinds of cancer, are “known as lifestyle-related diseases.”
However, let’s consider an article published in Time magazine in May 2023. Dr Jaclyn Albin recalls that by the time she graduated in 2009, nutrition’s relevance to disease states and patient care still hadn’t been addressed.
What we detect now is a growing level of frustration on the part of many medical professionals at the glacial progress being made at the coal face.
Australia’s Dr Darren Morten is one of them. “There are forces that conspire against this, and some of them are quite sinister,” he told Whole Food Living in September of last year.
Morten is one of Lifestyle Medicine’s most respected advocates, and he doesn’t pull punches when it comes to explaining where the current crop of medical professionals stand on the subject.
“When we look at medical doctors, what they are trained in is not a lifestyle paradigm. And you can sort of understand how it happens. Modern medicine earned its stripes in a time when infectious diseases were the biggest burden of disease.”
“We developed some really clever technologies, such as antibiotics and other medicines, that were very effective in dealing with infectious diseases. But we’ve become very reliant upon those medications and pills as the medical approach became predicated on them.”
An erroneous paradigm
Dr Darren is not opposed to medications where required, but “any approach to the management and treatment of chronic disease that does not prioritise lifestyle modification is founded on an erroneous paradigm,” he says,
Dr Albin: “Historically, nutrition education has been mostly rooted in biochemistry, pathology, and physiology with nutrient-focused content. For example, we would learn about vitamin C and how it impacts various pathways in the body, as well as what deficiency might look like. These things are important, but students then struggle to relate them to patient care.”
She says it’s challenging to translate an education hyper-focused on nutrients to a patient’s real-life questions about food.
However, that’s not true for respected husband-and-wife duo Dean and Ayesha Sherzai, whose Thoughtful 20 document presents an easily understood explanation of the foods related to good brain health.
Known commonly as The Brain Docs, their approach goes beyond basic statements like broccoli is good for you. They encourage patients to explore and learn for themselves as they impart knowledge about why specific vegetables, nuts, seeds, or fruits actually have value.
They also don’t overlook the importance of trace elements either, as they explain in the following audio segment.
Still, medical practitioners recognise a shortfall in nutrition training, and emphasis has been placed on it for decades. Unfortunately, the outcome has been disappointing to many.
A 2021 survey of medical schools in the U.S. and U.K., published in the Journal of Human Nutrition and Dietetics, found that most students receive an average of 11 hours of nutrition training throughout an entire medical program.
In 1985, the National Academy of Sciences recommended at least 25 hours of nutrition education in medical school, but a survey of U.S. medical schools in 2010 found that only 27% of programs met that recommendation. Lack of interest isn’t always the culprit, Albin told Time.
She directs UT Southwestern Medical Center’s culinary medicine program. The course offers online modules for students and practising physicians to learn about nutrition and understand how to apply that education to patient scenarios.
Action at the coalface
There is still considerable debate around patient delivery. In its broadest context, Lifestyle Medicine blends nutrition with other components of a healthy life, like stress reduction, social support, and physical activity. It’s taking time to manifest, but it could benefit both patients and doctors in the long term.
Overall, the general state of current nutrition education in medical schools is regarded as “still pretty sad” by many health professionals and there’s still the problem of how ‘get around’ and/or work with registered dietitians who have four years of training in the field.
There’s a clash here with many involved in WFPB nutrition who regard dietitians as “reductionists” because they tend to focus more on specific nutrient levels that most parents can’t easily translate into meals in the home. Teaching the public from that standpoint is considered complicated at best.
“It’s important to note that we are not trying to make doctors become dietitians, but rather to understand that our neglect of this topic has done harm and led to a very poor understanding of the underlying root causes of many diseases such as poor quality food,” Albin says. “We must move past this and prepare the next generation to prescribe food as medicine.”
Legislative action is seen as another road, but for people like Dr Darren Morten, the Sherzai’s and many other whole-food evangelists, the real push needs to come from the grassroots. It’s about empowering people to take charge of their own health and well-being.
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