Why are doctors so ignorant about nutrition?

whiteonion

I find it shocking how ignorant many doctors are about nutrition. Even in this day and age there are still many doctors who believe that saturated fats are dangerous and should be avoided. There are still many doctors who recommed diabetics to eat loads of carbs and then just compensate with insulin.

Why is it that so many doctors have no clue about nutrition?

Compak

whiteonion wrote: »

I find it shocking how ignorant many doctors are about nutrition. Even in this day and age there are still many doctors who believe that saturated fats are dangerous and should be avoided. There are still many doctors who recommed diabetics to eat loads of carbs and then just compensate with insulin.

Why is it that so many doctors have no clue about nutrition?

Most doctors Ive worked with got less than a weeks training in nutrition so what can one expect. Also most I work with believe they have enough to know and dont believe the nutrition onus rests with them

You need to find one with an interest ie done a nutritional medicine course or else they are not the port of call for nutrition.

BTW Id like to see evidence not to limit saturated fats, not calling you out but always interested, especially as that will be a key recommendation in one section of my next work.

Compak

Compak wrote: »

BTW Id like to see evidence not to limit saturated fats, not calling you out but always interested, especially as that will be a key recommendation in one section of my next work.

Ah just seen the thread in the forum on sat fats.

whiteonion

Compak wrote: »

Most doctors Ive worked with got less than a weeks training in nutrition so what can one expect. Also most I work with believe they have enough to know and dont believe the nutrition onus rests with them

You need to find one with an interest ie done a nutritional medicine course or else they are not the port of call for nutrition.

BTW Id like to see evidence not to limit saturated fats, not calling you out but always interested, especially as that will be a key recommendation in one section of my next work.

We have evolved eating saturated fat. Breast milk contains quite alot of saturated fat. It's the once who claim that we should avoid saturated fat who should prove their point. The idea that saturated fat is dangerous came from studies where Ancel Keys cherry picked data to get a correlation between heart attacks and sat fat consumption.

Where I'm from there is a correlation between icecream sales and people drowning but surely no one would say that increased icecream sales cause people to drown?

Compak

whiteonion wrote: »

We have evolved eating saturated fat. Breast milk contains quite alot of saturated fat. It's the once who claim that we should avoid saturated fat who should prove their point. The idea that saturated fat is dangerous came from studies where Ancel Keys cherry picked data to get a correlation between heart attacks and sat fat consumption.

Where I'm from there is a correlation between icecream sales and people drowning but surely no one would say that increased icecream sales cause people to drown?

Not quite as your example of casuality lacks biological plausbility. Where lab test has conclusively supported the generation of a hypothesis for saturated fat and cholesterol and insulin production.

The first mistake is to group saturated fat as a single unit. Depending on the chain length(s) the outcome can differ.

So while stearic acid will reduce cholesterol and not effect insulin, ans is quite the healthy fat. I appeal to anyone who defends HIGH saturated fat intake to find me one simple RCT where myristic acid was found to be safe in Types IIa and IIb hypercholesterolemia.

El_Dangeroso

Compak wrote: »

Not quite as your example of casuality lacks biological plausbility. Where lab test has conclusively supported the generation of a hypothesis for saturated fat and cholesterol and insulin production.

The first mistake is to group saturated fat as a single unit. Depending on the chain length(s) the outcome can differ.

So while stearic acid will reduce cholesterol and not effect insulin, ans is quite the healthy fat. I appeal to anyone who defends HIGH saturated fat intake to find me one simple RCT where myristic acid was found to be safe in Types IIa and IIb hypercholesterolemia.

Do you have a single RCT where reducing saturated fat (while not reducing anything else in tandem) has resulted in reduced CHD?

Compak

El_Dangeroso wrote: »

Do you have a single RCT where reducing saturated fat (while not reducing anything else in tandem) has resulted in reduced CHD?

I could post some but its a flawed question and I can manipulate the results


The sat fat taken out has to be replaced to keep a calorie homeostasis.
I can replace it with carbohydrates and then my established risk factors for CHD will increase. I can replace it with PUFAS and my risk factors decrease.

You see how such a trial can't work?

A controlled clinical trial of a diet high in unsaturated fat. Preliminary observations.

The Oslo Diet-Heart Study: eleven-year report.

Dietary prevention of coronary heart disease: the Finnish Mental Hospital Study

Test of effect of lipid lowering by diet on cardiovascular risk

Controlled trial of soya-bean oil in myocardial infarction

The first three all point to a positive effect from reducing sat fat, and the last two dont. So really it is a loaded question.

And to be honest mine prob is also, as while lab tests will exist Ive never come across an invivo, rct.

El_Dangeroso

Compak wrote: »

I could post some but its a flawed question and I can manipulate the results


The sat fat taken out has to be replaced to keep a calorie homeostasis.
I can replace it with carbohydrates and then my established risk factors for CHD will increase. I can replace it with PUFAS and my risk factors decrease.

You see how such a trial can't work?

A controlled clinical trial of a diet high in unsaturated fat. Preliminary observations.

The Oslo Diet-Heart Study: eleven-year report.

Dietary prevention of coronary heart disease: the Finnish Mental Hospital Study

Test of effect of lipid lowering by diet on cardiovascular risk

Controlled trial of soya-bean oil in myocardial infarction

The first three all point to a positive effect from reducing sat fat, and the last two dont. So really it is a loaded question.

And to be honest mine prob is also, as while lab tests will exist Ive never come across an invivo, rct.

Risk factors are not heart disease.

In the Oslo diet heart study they vastly increased consumption of omega 3 fats, they gave them a vitamin D supplement and they increased consumption of fruit and vegetables. Not very well controlled.

Finnish mental hospital study: Trans fat intake was on average 13 times higher in the control groups than in the experimental groups.One of the control groups received more than twice as much of the antipsychotic drug thioridazine, which is known to be highly toxic to the heart.

I haven't read the third trial so thanks for bringing that to my attention, you don't have the full text do you? My university doesn't have access.

In any case increasing PUFA in favour of sat fat on balance doesn't seem to lower CHD, it trends towards increasing it:

http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=7930322&fulltextType=RV&fileId=S0007114510004010

Compak

El_Dangeroso wrote: »

Risk factors are not heart disease.

In the Oslo diet heart study they vastly increased consumption of omega 3 fats, they gave them a vitamin D supplement and they increased consumption of fruit and vegetables. Not very well controlled.

Finnish mental hospital study: Trans fat intake was on average 13 times higher in the control groups than in the experimental groups.One of the control groups received more than twice as much of the antipsychotic drug thioridazine, which is known to be highly toxic to the heart.

I haven't read the third trial so thanks for bringing that to my attention, you don't have the full text do you? My university doesn't have access.

In any case increasing PUFA in favour of sat fat on balance doesn't seem to lower CHD, it trends towards increasing it:

http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=7930322&fulltextType=RV&fileId=S0007114510004010

Sorry where does that paper state that? because if you have real evidence you are about to change nutrition as the world knows it so write a paper and get it published in the lancet.

" RCT that substituted n-6 PUFA for TFA and SFA without simultaneously increasing n-3 PUFA produced an increase in risk of death that approached statistical significance "

That quote means nothing, why would I solely increase an already excess of pro-inflammatory n6s.

Transform

getting back to the original question - doctors try to forget their nutrition asap as they get about 6 week on it in all their years of training and IMO are overly influenced by drug companies.

First do no harm - not sure if they all apply that moto

EileenG

My particular beef with doctors who are ignorant of nutrition is infant nutrition. On average, they get half an hour of education dealing with nutrition for healthy babies, which pretty much consists of "Breast is best and here's all the things that can go wrong with it". And after that, their eduction is almost exclusively from formula companies.

I have yet to see a single GP or doctor of any sort at any breastfeeding education event, it's always voluntary counsellors, midwives and PHNs.

And yes, breastmilk is full of sat fats!

El_Dangeroso

I know and work with many doctors and I in general find them to be conscientious, caring people who sacrifice a lot to help their patients. They're just as skeptical of the pharmaceutical industry and resent the system that forces an almost tayloristic structure of patient care.

At the end of the day their focus is fixing what is broken, so understandably, given limited time and resources, they don't get much nutrition training.

Transform

El_Dangeroso wrote: »

I know and work with many doctors and I in general find them to be conscientious, caring people who sacrifice a lot to help their patients. They're just as skeptical of the pharmaceutical industry and resent the system that forces an almost tayloristic structure of patient care.

At the end of the day their focus is fixing what is broken, so understandably, given limited time and resources, they don't get much nutrition training.

totally agree - they are soo busy plastering over the cracks its hard to get a patient to sit down and actually address their problems honestly.

Jasus thats something that comes up on this very forum every day so you can guess how doctors feel i suppose.

from my experience that can be the case for physios also - too busy treating pain rather than looking for the cause

japanesebanana

Transform wrote: »

from my experience that can be the case for physios also - too busy treating pain rather than looking for the cause

In acute injury yes, but not for chronic or somatogenic pain. I have a great physio though who treats both so I can't complain

Delighted to see proof that butter isn't bad, I think I instinctively knew all along, but it was being hammered into me that it's bad.

So how does someone with high blood cholesterol lower it?

El_Dangeroso

japanesebanana wrote: »

So how does someone with high blood cholesterol lower it?

Eat mostly fresh, unprocessed one ingredient food. Exercise, don't smoke, avoid transfats. Ensure an adequate daily dietary intake of magnesium, copper, niacin, vitamin C, E and K2.

Get sunshine whenever you can, avoid stress, get enough sleep.

The usual common sense stuff.

Remember that it can take some time for cholesterol levels to return to normal after weight loss.