by Marion Nestle
Dec 8 2010

What should doctors tell patients about nutrition?

The November issue of San Francisco Medicine is devoted to Food for Thought: Practical Nutrition for Physicians (the entire issue is online).

It’s got a great collection of short articles, if I may say so myself.  A throwback to the days when I taught nutrition at the University of California San Francisco School of Medicine, my contribution, the first one, is called “Doctor’s Orders: What Should Doctors Tell Patients About Nutrition?”

I am a realist. I am well aware of the fact of time constraints, and my list of suggestions for what doctors should tell patients about diet and health is necessarily short. Fortunately, it doesn’t take long to tell patients that what they eat matters to their health. It takes only a minute to explain that healthy eating simply means attending to food variety, minimal processing, and moderation.

This collection is worth a read.  For example:

  • David Wallinga: An Unhealthy Food System: Suggestions for Physician Advocacy
  • Brian Raymond: Taking Action: A Health Sector Guide to Food System and Agricultural Policy
  • Kelly Brownell: How the Food Industry Drives Us to Eat
  • Narsai David: Eating Sensibly: Using Common Sense and Moderation
  • Shannon Udovic-Constant, MD, and Steve Heilig: Health Policy Perspective: Sugar Politics Versus Health

Take a look and use!

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  • All very good advice. But doctors can’t get some patients to take their medicine on time or at all, so is there a real hope that a friendly chat on ‘what to eat’ will work?

    The new buzz phrase in epidemiology is ‘what are the causes of the causes?’

    This area of work is finding a common thread linking smoking, excessive alcohol consumption and obesity – people are unhappy, tired, worried about money, worried about crime in their area, concerned about their kids future, fearful about health care costs and uncertain about what life will throw at them next. So they simply turn to something that will make them feel better, even if it causes health problems tomorrow.

    Thinking about eating healthily for a better tomorrow is harder when you can’t see past the problems of the present.

    The causes of the metabolic syndrome were established and well documented in the 1960s and 1970s. We are just waiting for the research to run out of steam and re-find the advice long forgotten when the answer to obesity remains elusive (exploding portions sizes in the 1980s aside, as obesity was starting to feature heavily on public health in the 1950s).

    The investors of obesity drugs are now turning their backs on future funding as the FDA closes the door on yet another failed drug trial.

    Perhaps everyone is looking under the wrong rocks. Perhaps the answer is not to fight the food industry, who after all fear nothing except a consumer that looks elsewhere to spend their dollars.

    Maybe we should look at the causes of the causes of obesity. If someone is unhappy and turning to food, why don’t doctors simply ask why their patients are so unhappy? There is nothing that will strike more fear into the hearts of a beverage company than a consumer that is content to quench a thirst with water because they don’t need a fix of sugar to calm their emotions.

  • B.

    Doctor’s shouldn’t tell their patients anything about nutrition-they are NOT qualified. Medical students are not required to take any classes on nutrition to graduate. Doctor’s should send their patients to Registered Dietitians for counseling.

  • Suzanne

    I have visited a Registered Dietician for nutrition counseling; I have Type II Diabetes. If I followed the R.D.’s advice, I would eventually be insulin dependent. The ADA’s advice for Diabetics does not work, and I’ve yet to find an R.D. that steps outside of that box.

  • Amy


    What was the RD suggesting that was so unhelpful? Did you find an MD that was able to do any better?

  • JudyThomas

    We are out of balance: it is not all about individual physicians advising individual patients to take “personal responsibility”: obesity and food-based, lifestyle illnesses are mostly about the harmful food system in this country and the destruction of a viable public health infrastructure to combat it.

  • Having been in the medical field (used to want to go to med school) and having been involved in the nutrition industry for 10+ years… there’s definitely a polarization between the 2 practices.

    Considering all the schooling, stress and detail physicians need to know already… learning about nutrition (which is fairly intricate as well) can be somewhat burdensome on physicians.

    And then with nutritionist, not having that formal medical school education doesn’t help either. There’s got to be someway the 2 disciplines can complement each other and work something out.

    And I do agree with edSanDiego that almost all humans (not just in America) want the quick-fix. I’m going to get some flack for this but in business one of the main principles is if there’s enough demand then give the people what they want. And people usually buy it. That’s just how people are, can’t change that (unless you change our evolution). And money talks… even with physicians.

    Who knows, maybe physicians can instruct their patients (assuming the patient ASKS the physician what they should eat) with… “there is no quick-fix for this, it will be a complete lifestyle change. If and only if you’re willing to make these changes, I’ll still recommend working with a nutritionist” or something along those lines.

    But what do I know, I just play a doctor on TV

  • CW


    Type II diabetes is a progressive disease and as beta-cell function decreases in the pancreas (decreasing its ability to secrete insulin) blood glucose lowering medicine, which would included insulin, will often need to be combined with nutrition therapy to reach blood glucose goals. Unfortunately many people with Type II diabetes will require insulin or other medication as their disease progresses. Having to take insulin or other diabetes medication is not evidence that the nutrition recommendations for diabetes do not work–as the evidence is strong that medical nutrition therapy is effective and vital in the management of diabetes.

    –CW, MPH, RD, LDN

  • Suzanne

    For the concerned RD’s that responded, thank you.

    I don’t consider the advice that I received unhelpful, everyone has been sincere and committed that I’ve spoken to.

    The one item I would note as completely ineffective for me is the “plate method” advice. If I fill up one quarter of my plate with complex carbs, one quarter with a protein source, and one half with produce, my blood sugar is going to skyrocket. Medicated with Byetta and Metformin, or not. And it won’t return to a healthy range for a day or more, with or without pharmaceutical intervention.

    In contrast, if I eat one or two servings of animal/seafood protein, a serving of fat such as olive oil, olives, avocado, etc., plus leafy greens, my blood sugar escalates only minimally (20-30 points), and then returns to normal within 1-2 hours. Like it is supposed to. With no medication. If I eat like this at every meal, my fasting blood sugar hovers around 120 when I wake up. Again, no medication.

    I won’t accept that insulin is inevitable. I will manage for as long as I possibly can with exercise and nutrition. I’ll continue to follow low carb. And I have to accept the fact that carbohydrates of most types (with the exception of low g.i. veggies) are contraindicated with the way my body functions. And are there moments when I feel socially isolated and at a loss eating this way? Absolutely.

    I don’t understand why the ADA is so opposed to low carb and anti-saturated fat.

  • Suzanne

    I’ve received very little advice from medical doctors, except “Eat Vegan to reduce cholesterol”.

    It’s my own extensive research and trial and error that has helped me manage my condition.

  • Roxanne Rieske

    Suzanne: My Father is 60 and has had type II diabetes for about 15 years now. After YEARS of trying to manage his diabetes w/ a low-carb diet and mostly failing and seeing his cholesterol and blood pressure continue to rise, my sister and I finally convinced my parents to radically change their diet to a strict vegetarian, mostly raw food methodology. Within 4 months of making the change, he lost 40 lbs.; his blood sugar went back to normal; his cholesterol dropped to normal ranges, and his blood pressure also went down; and he was able to completely stop his insulin therapy. His diet is mostly centered on leafy greens, beans, low-sugar fruits such as apples and berries, and small amounts of nuts. My sister, who is a hard core fresh produce vegetarian, designed the diet and helped my Mom execute it easily. The center of the diet is the green smoothie, at least 32 oz everyday. A quart of green smoothie provides about 15 servings of leafy greens and fruit everyday. He also has a big green salad everyday w/ fresh veggies and beans. Dressings are homemade heart heathy vinegar based dressings made w/ walnut and high quality olive oils. He also includes fresh tofu, and unsweetened high quality soy milks. Your body will get more than enough protein on a high quality vegetarian diet that you really don’t need animal protein, which causes inflammation in the body and makes insulin resistance worse.

    It wasn’t until he listened to his daughters (both of us being high quality vegetarian diet advocates) and stopped listening to the RD he was sent to that he made real progress in reversing the disease process.

    For information on this diet read “Eat to Live” by Dr. Joel Fuhrman, M.D. Dr. Fuhrman has been treating severely obese Type II diabetics successfully for a number of years, with strict vegetarian diets.

  • Roxanne Rieske

    Oh, and I forgot to add that if my Father continues having normal to excellent blood work for another 2 years, he will be officially diagnosed as non-diabetic. He has another 20 lbs. to loose to gain his normal weight, and I have no doubt he can do it. His doctor is frankly amazed at the progress he has made and had no idea that such a diet could drastically and so quickly reverse Type II diabetes.