Lack of nutritional education in PA curriculum

Why aren’t we taught about nutrition?

I was talking to my boyfriend last night who told his doctor about what his diet consists of based on macronutrient (proteins, fats, carbs) amount per day.  His healthcare provider had nothing to say or add.  They were clearly not well versed on the topic.  And I can’t blame them.  It isn’t something we are taught (at least in PA school– I cannot speak for medical school)
BUT WHY are we not taught about the one singular thing that sustains us to live? (well that and hydration) on a very basic level.  Yet, we are teaching medical providers absolutely nothing about it (that I know of at least–someone correct me if I am wrong :).  
What do we learn as first line treatment for EVERYTHING? “diet and lifestyle changes”.  Right?!
Yet, America overall is so very sick. What is causing this and how do we on a small individual level begin taking steps to mitigate this issue? 

1. Set a positive example

I think that a portion of lack of nutritional and lifestyle counseling comes from either lack of personal knowledge or providers who do not follow the advice they would like to provide their patients. 
I’m not suggesting this is always the case or that the majority of health care providers are overweight and know nothing about nutrition. I’m simply suggesting there is a gap. Between what most providers need to know and what knowledge they have.
 
We need to set an example of responsibility for health and wellness in our own lifestyles so that we are comfortable discussing nutrition and exercise with patients. The best boss I have ever had led by example, and it made me want to work harder and be more of a team player.  I know it isn’t exactly the same, but hopefully the concept is appreciated. 

2. Put the patient in control

When anyone is approaching change, they determine where they are ready to begin.  Meet your patient wherever they are in the change process.  Frequently as helpers we seek to “fix” and tell patients how they need to be “fixed”. 
 
I am SO guilty of this!  “do this not that” “avoid this and do this”. 
 
Recently, I have taken on some different language.  
 
“What changes are you willing to make to achieve a healthier lifestyle/weight/etc?”
 
“What are your reasons that are meaningful for you to seek out these changes?
 
“What goals do you have for your health?” 
 
WHAT IS YOUR “WHY”?
 
Talking to a patient about exercising 5 days per week when they do none or maybe they don’t WANT to do that is going to only lead to frustration. 
 
Baby steps.  I love the quote “slow is smooth and smooth is fast”.  Once they are able to make 1 or 2 things they want to make habit and a lifestyle, start suggesting additional small changes.  Small things ADD UP!

3. Seek out knowledge

There is an ABUNDANCE of educational materials and courses on nutrition available out there.  As providers, maybe we have a responsibility to learn some basics (I know don’t we go through enough school).  I am not suggesting we attempt to take on the roll of a clinical dietician or nutritionist. 
 

What is the purpose/function of each macronutrient (protein, fat, carb)? How does each one serve our body and needs in a different way.  We need protein, fats AND CARBS (yes you need those) on a CELLULAR LEVEL. Our cell walls are comprised of all three. Our cells make up our tissues, tissues make up our organs and our organ systems make up our WHOLE BODY.  NOTE: There are variations of needs for each individual based on coexisting disease, goals, desires and basically how you FEEL.  Some people do great eating vegan: good for you.  Some people count macronutrients: good for you.  Not every way of feeding and honoring our bodies works for each person.
 

Learn the basics of some of the major types of nutrition programs (macros, paleo, keto, vegan, vegetarian).  I am definitely victim to pigeon holing myself into IIFYM (if it fits your macros)– because it is what works for me (disclaimer: this does not mean one eats only donuts because “it fits my macros”).  Admittedly, I’ve had a judgemental approach in the past towards other nutritional approaches.  Until I realized we are all not the same round peg going into the same round hole. And as long as your nutrition supports your body and wellness, I’m taking the approach of “good for you!” 
 
Personally, the nutritional approach I follow is IIFYM (if it fits your macros).  Precision nutrition is the certification that my nutrition coach attained and most of the coaches who work for the company.
Excuse my fine dinnerware 😉 
 
PLUG/RECOMMENDATION: if you are interested in learning more about the IIFYM approach visit http://www.workingagainstgravity.com or feel free to message me!  (I love to talk nutrition).  As an active mover– weight lifter, orange theory, crossfit, hiker, runner, etc etc and health care professional I FULLY endorse their approach and coaching.  Their blog also has so much information available for FREE!  Definitely check them out (I get nothing for recommending them!)
DISCLAIMER: I am definitely biased towards this approach because it has worked for me. 🙂
There is also a great deal of information available on podcasts which I have branched out to, and they are FREE!  I encourage you to listen to  nutrition based podcasts and also listen to the ones you may not necessarily agree with. This not only helps gain perspective of a patient or future patient, but also simply because you don’t agree with the entire basis of the program doesn’t mean you can’t take bits and pieces and make them useful 🙂
 
A simple quote that we can ALL live by no matter what nutritional approach you follow is the following:
 
“Eat real food, mostly plants, not too much” -Ben Bergeron
 
I am not advocating veganism or vegetarianism with this concept.
 
Eat real food. 
 
What does this mean? If it is on a shelf or has an expiration date > 2 weeks– its not real food. 
 
Mostly Plants.
 
Micronutrients are SO important and vital to maintaining health and wellness.  There are micro’s that you can only get from a diet that is rich in veggies! Magnesium, zinc, vitamins, etc etc.  Don’t get me wrong I love my steak once in a while, dairy and ALL sources of protein (if you don’t, that is ok, too!)
 
Not too much.
 
This means something different for everyone.  For most of our patients this can be simplified to prevent being overwhelmed:
 
1/2 your plate is veggies
1/4 lean protein
1/4 starch/carbohydrate
1-2 thumb size of healthy fat (nut butter, avocado, egg yolk, etc). 
 
I think if we can all follow those 3 principles and relay them to our patients we might instill some wellness! 
Example of what I bring to work to eat during a day 🙂

4. Encourage wellness instead of treating illness 

I listen to a podcast called “Pursuing Health” By crossfit games athlete and now medical doctor, Julie Foucher.  On one episode, she discussed where medicine is heading and I LOVE that she said that we are gearing more towards KEEPING PATIENTS WELL instead of treating illness. Instead of incentives for how many patients we see it will be based on quality and wellness. 
 
The problem with this: you can give patients all the information and tools, but if they don’t do the work– will we be getting “dinged” for their illness?  
 
I see both sides. I want to promote wellness, but we cannot FORCE people. I’m interested to see where this is going.  Also, definitely check out Julie’s podcast!  She was the first CF athlete I cheered for and love seeing what she is doing!

5. Advocate change

This is more of a MACRO (as in large) concept.  I would love to hear if people actually THINK nutrition needs to be incorporated and on what level into PA (and/or medical) school curriculum.  Are there people out there who encountered nutrition as part of their pre-req’s or in PA/Med school?  I’d love to hear experience and/or opinions about this!  (Especially because I know I tend to be really biased about wellness/nutrition/exercise 🙂

2 thoughts on “Lack of nutritional education in PA curriculum

  1. Yes! Thank you for this post! I was dumbfounded at the lack of nutrition related education we received in PA school. It comes up in nearly every patient encounter and is such a huge part of preventive medicine! I will definitely be looking into the resources you listed to start expanding my nutritional knowledge.

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