By Dr. Margaret Rundle
Dr Margaret Rundle is a Family Physician practicing at Malvern Medical in Scarborough. She completed her BSc in Nutritional Sciences, (UofT’85), Undergraduate in Medicine (UofT’89), followed by Family Practice Residency(UofT’91). Dr. Rundle founded the Rundle-Lister Lectureship in Transformative Nutritional Medical Education, which is a part of the Food as Medicine series at the University of Toronto. She, her husband and two boys, ages 27&24, enjoy very active, healthy lives.
There is little dispute among care providers that a person’s dietary habits influence preventative and treatment outcomes. Every year, there is more cutting edge research validating the role of food and therapeutic diets for chronic disease management and prevention. However, basic education on the role of nutrition and lifestyle has been a blind spot in the Canadian medical school system for a long time.
I have spent the past 27 years as a Family Physician, and I make it part of my clinical work to motivate and educate my patients around the role of nutrition in their health and well-being. My interest stems from my early school years when I participated in a variety of athletics and wanted good nutrition to support my involvement. I completed a four-year undergraduate degree in Nutritional Sciences with the intention to go into Medicine afterwards. In my four years of medical school, I was surprised to find that we were exposed to only about 20 hours of nutrition education. I recall it being primarily about knowing what are vitamins, minerals, carbs, fats, with nothing about the role of dietary interventions.
When I first started practice, I still cared a lot about the role of physical activity and nutrition but it was easy to get caught up in the day-to-day handling acute problems, making diagnoses, and writing prescriptions. What had happened to my passion in preventative medicine? It was after I attended a series of conferences that focused on advances in scientific research around food and nutrition that my passion was renewed. I literally got tingles as I sat in the audience. I was back! Since then, I’ve changed my practice to spend at least 15 minutes of a 45-minute physical talking to, and enquiring about, nutrition, exercise and lifestyle.
However, from the treatment point of view, many physicians still do not look into what we can do with nutrition. We share a basic understanding about diet, but food remains under-appreciated as an intervention point to empower patients about the treatment and prevention of disease.
Weaving food and nutrition into medical education
One problem is that in most medical schools, physicians are not being taught the latest concepts in nutrition science. Research shows that doctors currently don’t feel confident enough to counsel their patients about their diets; in fact, more than half of graduating medical students rate their nutrition knowledge as “inadequate”. Nutrition education simply isn’t prioritized enough in the medical curriculum in North America. Another study in Academic Medicine shows that only 27% of 105 medical schools in America met the minimum requirement of 25 hours in nutrition education.
There is demand from Canadian medical students for more nutrition education. In fact, 87.2% of the Canadian students surveyed in a study said their undergraduate medical program should dedicate more time to nutrition education. While a lot of these students said they were somewhat comfortable in their knowledge about the role that nutrition plays in disease prevention, they felt ill-equipped to counsel patients on dietary requirements across all stages of the patients’ lives. They also said they have trouble identifying credible sources of nutrition information.
Medical school faculties need more staff who are qualified to teach nutrition. I believe that understanding the role of food as treatment should not be relegated to a few more hours or as a separate course, but woven into the entire medical curriculum. We should talk about nutrition when students study pre-natal health, pediatrics, ophthalmology, oncology, or orthopedics. Fortunately, this has already begun at the University of Toronto thanks to the guidance of a team of physicians including Dr. John Sievenpiper, and to the very generous donation from Johanna & Brian Lawson for the creation of the Centre for Child Nutrition at the university.
A trusted and reliable education resource for physicians and patients in nutrition
What about the physicians who are already practicing? I’m currently working with the University of Toronto on accredited nutrition education for practicing MDs and have founded the Rundle-Lister Lectureship in Transformative Nutritional Medical Education. This lectureship is part of the Food as Medicine Series and provides an annual award to a clinician recognized for providing an outstanding contribution to the role of nutrition in patient care. The conferences help to address the knowledge gap in continuing medical education in nutrition; for example, our first Food as Medicine conference focused on the impact of gut microbiome in health and disease. There is a saying that “we are what we eat”. While there is truth to that, I also believe that as more research is tackled, we will further understand how the foods we eat affect our microbiome and consequently, the impact of those changes on our health.
Patients and physicians alike also look to the internet for educational assistance. For doctors who do not have the time for nutrition counseling, or wish to refer patients to reliable and trusted websites, I envision a day when we can refer to a University-affiliated “go-to” web hub. The University of Toronto is one of the few Faculties of Medicine that has a Department of Nutrition under its umbrella. By developing such a website, the University of Toronto would be in an excellent position to become known as the place for physicians to update their knowledge and for patients to get safe, reliable information about nutrition.
I’m not asking doctors to become dieticians. But physicians are in a unique and powerful position because they can provide advice to patients during annual check-ups or at times of acute illness when it is most likely to resonate. For long-term change to really happen, the opportunity sits with redesigning medical education for future physicians. They can be taught about the value of nutrition in their clinical practices, and to position dietary approaches as a complement to traditional medicine for the maintenance of health and prevention of chronic diseases.