US med schools adopt mandatory nutrition training, experts urge science focus

Medical schools in the US are increasing the number of hours students study nutrition. Secretary of Health and Human Services (HHS) Robert F. Kennedy Jr. has formed an agreement with 53 schools to jump from two hours to 40 hours of nutrition education within the duration of students’ entire education.

Nutrition Insight speaks with the president of the Physicians Committee for Responsible Medicine, Dr. Neal Barnard, M.D., who stresses that curricula must be based on science.

He advises future doctors to “not to just tell people to ‘eat right’ or ‘follow a balanced diet,’” but provide specifics, based on science. 

He outlines several priorities for nutrition education:

• An eating pattern that emphasizes fruits, vegetables, legumes, and whole grains and keeps oily foods to a minimum is the best approach for maintaining a healthy weight and reducing disease risk. 
• There is no need for meat or dairy products, and people who avoid them are healthier. 
• Vitamin B12 supplementation (through fortified foods or supplements) is important for healthy nerves and healthy blood. 
• Type 2 diabetes is not a one-way street. With a healthy plant-based diet, it can improve and sometimes remit entirely.

Insufficient training

Most medical schools in the US do not provide sufficient nutrition education, notes the Physicians Committee. For instance, only 1 in 4 schools offers students 25 hours of nutritional training. 

Last year, the American Medical Association tried to increase nutrition training in medical schools. However, Barnard, who is also an adjunct professor of medicine at the George Washington University School of Medicine, says: “Adding anything to an already packed curriculum is a bitter pill for a medical school to swallow.”

“To make it work, the key is to integrate nutrition into what they are already teaching. For example, in the lectures on colorectal cancer, the causal role of hot dogs and other processed meats should be included. That takes very little time and transmits a vitally important message.”

He flags the issue of processed meats as they contribute to breast, colon, and other cancers, along with cardiovascular disease.

“It is also important to note that plant-based low-fat ‘processed’ foods, like breakfast cereals, breads, soymilk, and low-fat veggie burgers or veggie dogs, are associated with health benefits, including reduced risk of diabetes and heart disease.”

US medical schools expand nutrition hours so future doctors can prescribe food as a core part of disease prevention and care. “Recent evidence linking dairy consumption to prostate and breast cancer is eye-opening and important.”

Investing in future health care leaders

The HHS has also announced investing US$5 million in a multi-phase National Institutes of Health nutrition education challenge. This will support medical schools, nursery residency, nutrition science, and dietitian programs that integrate nutrition education in curricula. 

“Today’s announcement demonstrates that medical schools can put nutrition and prevention front and center as they train tomorrow’s doctors and health care leaders. It’s an honor to celebrate the dozens of medical schools stepping up to strengthen nutrition education — an essential but often overlooked aspect of public health,” says US Secretary of Education Linda McMahon. 

To clarify the purpose of nutrition education, Barnard adds: “Doctors do not need to do diet counseling themselves any more than they need to do physical therapy.”

“That’s what registered dietitians (and physical therapists) are for. But it is important to make sure that the dietitian is up to date, because they can fall behind, too. We set up the Preferred Dietitian Referral program for exactly that reason.”

Food is Medicine programs, which integrate nutrition with health care, are gaining traction in the US. Notably, the Rockefeller Foundation points out that they have slashed health care spending with medically tailored meals, estimated to potentially save US$23.7 billion annually while avoiding 2.6 million hospitalizations.

Grounded in science

Barnard underscores that ideologies should not influence nutrition curriculum content and instead should be grounded in evidence-based knowledge. “It is essential to go beyond one’s personal preferences and diet fads and focus on what science tells us.” 

“Plant-based diets are the best supported because they have gone through observational studies, randomized trials, and meta-analyses showing they work, along with tests of their sustainability, acceptability, and cost savings.”

Previous research has found that diets rich in plant-based products with low or no processing had a 40% lower risk of cardiovascular disease than diets lower in plant-based products and higher in animal-based ones.

A large prospective study also linked a healthy plant-based diet with a reduced risk of inflammatory bowel disease. 

Nutrition Insight unpacked the latest US dietary guidelines released by the HHS, where an expert flagged that the ideological undertones to the guidelines cannot be dismissed. They said the central dogma is to separate from anything to do with the former US president Joe Biden’s era — especially equity. 

“The Biden-era guidelines committee prioritized plant-based sources of protein, while these guidelines favor animal-based sources. This is a matter of ideology, not science.”

Previously, we explored the push for nutrition training in medical schools and why this is fundamental for patient support.