Let me set the scene; I was a diabetes dietitian working out of GP surgeries in early 2022. I realised that I hadn’t had any referrals from one particular GP surgery for quite a long time. Odd, I thought. I contacted the surgery to ask why this was, and I was abruptly told that they no longer needed a dietitian as one of their doctors was sorting nutrition out for their patients. I explained to them that as a dietitian, that really was my job and I would be happy to see those patients to ensure that the doctor can focus on their responsibilities. I was told that was not necessary and promptly hung up on.
Fast forward a few weeks. Patients from this surgery with diabetes began being admitted to hospital for various reasons; some in DKA (very high blood sugar levels causing an excess production of ketones, which make the blood acidic), some with extreme hypoglycaemia (low blood sugar levels), all rather acutely unwell. As I worked both on the wards and as a community diabetes dietitian, I went to speak with these patients. And what I found shocked me.
These patients were being given nutrition and dietary advice which was directly against best practice recommendations and guidelines for patients with diabetes. They were being told to avoid all carbs no matter what (which many interpreted as “even when blood sugar is low”), and to follow a strict, ketogenic /carnivore lifestyle by their doctor. To manage the significant lows some of them were experiencing on this diet, they stopped taking their insulin, leading to DKA.
Many of these patients had co-morbidities which are directly worsened by advice such as this; high cholesterol, a history of heart conditions, stroke or high blood pressure, and low and behold, when bloods were done, their results had significantly worsened than since before they adopted this new dietary pattern.
I was floored. How could this have happened? The answer? A medical professional working outside of their scope of practice and refusing to default to the professional who has the expertise in the field.
My Issue With Doctor’s Giving Non-Generic Nutritional Information
At the end of the day, a doctors role is very, very different to the role of a dietitian, and for good reason. It is not realistic or fair for us to expect a doctor to know everything about health, and so we have different specialisms (dietetics, physiotherapy, speech and language, occupational health etc) to allow doctors to focus on their strengths. This is a good thing; it allows more specialist care and for patients to get access to the experts in their fields. Just like we wouldn’t expect a cardiovascular surgeon to know how to do a hip replacement, we cannot expect a GP to know all about nutrition.
The issue with nutrition is, however, that everybody eats, and therefore almost everyone has an opinion on nutrition. Add to the mix that there are always conspiracy theories about nutrition floating around the internet, many people (including doctors) have grown a large distrust in nutritional science. Due to that, many people do not take the role of a dietitian seriously, and feel they can do it themselves, and do it better.
Unfortunately, this is truly not the case. Nutrition research is complicated, it’s messy, it’s 100 different shades of grey rather than black and white. Medical research on the other hand, whilst not black and white, can often be a lot more clear cut. Whilst medical research can be more easily double-blinded (for example, medicine trials); you cannot do that with nutrition. Whilst it is easier to do a crossover trial in medicine, you can’t do that with diet. It requires completely different skills to understand what good research is when it comes to nutrition. Therefore, many other medical professionals may struggle to interpret nutritional science; like I would struggle to interpret medical science. It is incredibly easy to find studies in nutrition which confirm your biases, and if you don’t know how to ask the question in an unbiased way (difficult to do without the background in nutrition research), you’ll likely come up with a biased answer.
Unfortunately, this is what had happened with the doctor at the aforementioned GP surgery. They had distrust in nutrition science, consistently saying “if the nutrition guidelines worked no-one would be overweight!” (despite less than 1% of the population following the guidelines as recommended), and this led them to seek other answers. They came across individuals online spouting a different rhetoric, did some “research” (which involved asking incredibly biased questions and finding studies to back up their opinion), and ran with what they thought was best.
Now, I am not criticising that doctor for doing what they thought was right; I admire their desire to do right by their patients. What I am criticising them for, however, is their complete lack of communication between nutrition professionals and themselves, refusing to listen to our reasoning, refusing to have an open conversation, and ploughing on with their recommendations even after numerous patients became unwell. This is dangerous practice, and numerous individuals suffered the consequences of the actions from a doctor they trusted.
The thing is, I see this online and in the mainstream all too often too. Many doctors, on social media and on TV, using their medical degree to add credibility to their claims; and people trust that they are right, because they are a doctor. Dr Oz is a prime example here, but there are hundreds of others you can find with just a simple scroll on your phone.
The Reality
Medical doctors do not get adequate training on nutrition and its role in health throughout their career. There is currently no requirement for medical degrees to include any nutritional training whatsoever, and many do not teach anything to do with nutrition across the course. Some medical degrees do, I’ll give them that; however this is the equivalent of between 5-10 hours across the entirety of the programme, which is 5 years long.
Compare this to a dietitian; we spend 4 years at university training in the field of nutrition, learning how to interpret nutritional research, understanding requirements and recommendations for individuals with specific conditions or nutritional needs, and learning how to disseminate this information into easy to understand and practical advice for patients. We spend over 2,000 hours on placement to learn practically and on the job (unpaid, by the way). We then have to do, at a minimum, 40 hours additional learning every year we have qualified (the equivalent to over a full weeks work) to ensure we stay up to date, and most dietitian’s I know easily double or triple that.
We cannot compare a doctors knowledge to that of even an entry level dietitian. Dietitian’s live and breathe nutrition and nutritional science. It is all we are focused on. Many doctors simply do not have the time to dedicate as much time to nutrition as we can, as they have a million other responsibilities.
Of course, some doctors do learn more about nutrition throughout their career; doctors in gastroenterology often have to learn about the dietary management of many conditions like IBS and IBD; those in diabetes will learn about carbohydrates and how they can impact blood sugar management; those in cardiovascular medicine will learn about the link between nutrition and heart disease. But whilst they will know more than their counterparts, they will still not know as much about that area of nutrition as a dietitian in that field will; and they shouldn’t be expected to.
The Caveat To This Message
I have spoken in length here about how you should not rely on doctors (or other healthcare professionals for that matter) for nutritional advice. However, there is a caveat here.
There are many doctors, such as Dr Idz, Dr Ally Jaffee, and many others, who have undertaken additional masters degrees or further education specifically in the field of nutrition. This additional education allows them to better understand nutritional research, better disseminate this information to patients, and overall, have a better and more rounded understanding of the complexities of nutrition.
The ironic thing is, that many of these doctors who have nutritional training will still likely refer on to another, more experienced nutrition professional (such as a specialist dietitian) if they feel that the advice that is needed is out of their scope of practice. This is a sign of a good (and responsible) nutrition professional. One who understands the limitations of their knowledge and will refer to those who know more.
The doctors I have talked about previously who do not have nutrition education often will not do this. They will not often understand what they don’t know, and will not see the importance of referring on to others when they have reached their scope of practice. It is exactly individuals like this which cause the issues discussed at the beginning; patients being placed in active harm.
My main message is this; be discerning about who you get your nutrition information from. Don’t just rely on medical credentials and appeal to authority for your nutrition information; do your research first and ask, does this person have any formal nutrition training? If the answer is no, they likely won’t be the best person to ask.
Diets Debunked 