Journal of the American College of Nutrition, Vol. 18, No. 1, 4-5 (1999)
Published by the American College of Nutrition
A Nutritional Requirement: The Need for Research, Education, and Health Claims
David J. A. Jenkins, MD, PhD, FACN
Professor of Medicine and Nutritional Sciences
Department of Nutritional Sciences
St. Michael’s Hospital, University of Toronto
Toronto, Ontario, Canada M5C 2T2
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INTRODUCTION
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Nutritional knowledge that is relevant to the practice of all aspects of medicine and public health is growing rapidly. Controversies abound: are low-fat diets dangerous, especially for children; should we consume large amounts of protein for health; how much w-3 fatty acid do we need, and can we get it from plant foods (linolenic acid) or do we have to get it from declining fish stocks; does fiber work; should we take supplements (or should we—can we—get everything we need from a healthy diet), etc. Put a group of nutritional scientists in a room to debate these types of issue and the discrepancy of views may cause indigestion. Even apparent "gold standards" change names and sometimes numbers; RDA (US), RNI or RDNI (Canada) and now DRI—(the latest acronym, 1997), [1], which before too many people recognize this term should be replaced by the letters PR (neither per rectum nor public relations, but Provisional Recommendations—since all things are subject to change).
It is against this background that Professor Norman Temple has assessed the nutritional knowledge of a group of Alberta doctors and find that our medical schools, scholarly journals, the general press and government agencies have not equipped our doctors to give all the answers Professor Temple was looking for in his 16 question multiple choice "take home" test [2]. In defense of the doctors, they scored A+ where urgent action was required (folate and neural tube defects, thiamin and alcoholism, and antioxidant nutrition). They were less certain in some areas which were either relatively new (we are not told the length of time since the survey participants finished medical school) and/or controversial. These finding should come as no surprise. It is unfortunate that preliminary data from Dr. Temple’s study sparked articles in the Edmonton Journal and the Alberta Report entitled respectively, "Doctor put you on a diet? think twice before you try it." and "Your doctor’s dietary deficiency." The Alberta press aimed their guns at the conduit of information (the doctors) rather than the generators of information, (for which ironically, they, the press, together with universities and government agencies, have a responsibility).
In general, there is much public interest in nutrition and the public’s physicians are no different in this respect. Therefore, the real question is, how can we increase the quality and amount of information available to them?
There is no single solution but rather a sequence of events that must take place (Figure 1). Competition for time in the medical school curriculum is increasingly fierce. At present, the majority of medical schools do not provide nutritional education. Thus perhaps the first action should be a drastic "pruning" of all medical school teaching to create "space." Space for thinking (in unstructured curriculum time) and space for student electives. These changes would allow students to take nutrition electives with interested staff and permit in-depth exploration of complex nutritional issues. In the current climate such a move may prove more fruitful than attempts by nutrition teachers to gain conventional turf by simply displacing other disciplines from the "formal" curriculum. However, a much greater force for change must lie outside the medical school.
Statutory funding agencies must earmark considerably more funding for nutrition research in general, and for applied nutrition research in particular, specifically areas that impact on human health as prevention or therapy. The need for governments to recognize this serious deficiency is crucial. Only in this way will a clearer picture emerge from publication in the scientific literature which defines precisely the role of nutrition in medical practice. The importance of the data will then determine its adoption in clinical practice and thus its place in the medical school curriculum where evidence-based medicine is increasingly the goal.
Scientists on study sections, grants panels and the review process in general must show vision rather than personal bias.
The power of the food industry must be harnessed. Government agencies must provide clear and comprehensive guidelines that facilitate the use of sensible evidence-based health claims, both generic [3] and most importantly product-specific [4]. Given these opportunities, industry will be encouraged to invest in research and, through informative health claims, to provide physicians and dietitians with a more educated public.
Finally, the press must play their part in regular, responsible and accurate reportage of nutritional findings appearing in the scientific press and so contribute to the nutrition awareness of the community at large, both professional and lay public alike.
In short, it seems unlikely that an extra 5 to 10 hours of formal nutrition teaching inserted into the crowded medical school curriculum (desirable though this may seem) will equip physicians with the nutritional knowledge they will need 10, 15 or 20 years into practice. If our aim is ultimately to improve the health of the community we will have to do much more.
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REFERENCES
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- Institute of Medicine,
1997.
Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. Standing Committee on the Scientific Evaluation of Dietary reference intakes, Food and Nutrition Board, Washington, D.C., National Academy Press.
- Temple N: Survey of nutrition knowledge of Canadian physicians.
J Am Coll Nutr
18:
26–29,
1999.[Abstract/Free Full Text]
- House of Representatives.
Nutrition Labeling on Education Act of 1990. Washington, DC: House Report
101–538,
1990.
- "A Quick Guide to: Food for Specified Health Use". The Japan Health Food and Nutrition Food Association, Tokyo, Japan,
1995
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INTRODUCTION
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