Working with your doctor to evaluate and discuss your nutrition

Nutrition influences our health and disease risk. So, why don't doctors talk about it? Here's how to get the conversation started and some "dos and don'ts" for the discussion.

Challenges in healthcare regarding nutrition

Before I share some of the reasons doctors may not jump to nutrition recommendations, I want first state that I understand the value of conventional medicine for disease diagnosis and management. There is a role for medication, surgery, and other conventional medical treatment. And, I would guess since you’re reading this, that you’re generally interested in options beyond conventional care, which is what I offer and have most experience with. It feels important to say this because I know that some of what I write here is critical of conventional care and training.

So, I am starting this article with a quick, personal story illustrating the general attitude in medical training toward nutrition before I get into some thoughts and action items that might help you.

A quick story

I sat quietly, attempting to keep a low profile in the back of the lecture hall of a medical school lecture. I had my notebook slanted, pen poised, ready for a couple hours of note-taking. No, I have never been a medical student; as part of my PhD research on subclinical hypothyroidism, I sat through a couple thyroid lectures at the academic medical center where I worked and went to school.

I listened intently as the physician-lecturer taught about the thyroid gland, its function, the pathophysiology of thyroid diseases, and then finally a brief slide on dietary goitrogens (foods that can have a negative impact on thyroid function). This physician professor had about a hundred captive, future medical doctors. He could have taught them something helpful for their future practices.

I’m guessing you can see where this is headed…

Instead of teaching about the nuance of dietary goitrogens (1) (e.g. cassava, soy, and cruciferous vegetables like broccoli, cabbage and others) (2), he taught that dietary goitrogens are bad, and—in reference to broccoli—“that’s why I completely avoid the stuff.” He got his few intended chuckles from the class, but his dismissive attitude toward nutrition definitely got my attention.

Such a missed opportunity, I thought. All these future doctors listening, and he chose to disregard one of the few nutritional aspects of the thyroid that made it into medical school training.

I’m not suggesting he should know everything about thyroid nutrition, but this story illustrates the general stance of conventional medical training toward nutrition. I have a sense this is changing with increased awareness of the importance of lifestyle for general health and disease prevention, but it has yet to reach the majority of doctors (as far as I’ve noticed in healthcare for the last 15 years).

And, this one instance isn’t going to have a make-or-break impact on those medical students’ future interest in nutrition. Of course, they had hundreds more hours of medical school lectures and training, but very little of that training is on nutrition. (3-5)

What he could have taught is that—yes—these foods have the potential to negatively affect the thyroid, but the amount consumed, the eater’s iodine status, whether the food was cooked, and likely other factors, all influence any affect these foods might have on thryoid hormone production and metabolism. (1, 6)

This is just one example of the limited nature (and general dismissal) of nutrition education in medical school. While this doesn’t fully explain why your doctor may not suggest nutrition or other lifestyle options for your health, I’ve listed other reasons that may contribute to their lack of conversation around nutrition. Below this list, I’ve shared my “do’s and dont’s” of talking to your doctor about nutrition along with a list of nutrition-specific labs I suggest clients request from their doctor.

Contributing factors to your doctor not discussing nutrition:

• Doctors have limited to no training (and limited knowledge): If your doctor received any training in nutrition, they may have gotten a lecture two in medical school. (3, 5)

• Little time and lots to do: Based on a 2007 study (7) Tai-Seale7, primary care physicians (PCPs) spent about 15 minutes in each patient visit, and I would wager to guess that they don’t spend more time now. A more recent study (8) suggests that 27% of PCP time is spent seeing patients face-to-face. One systematic review (9) shows that any one physician can be responsible for 1,100-1,400 patients at any one time.

• Doctors don’t believe nutrition is important: not only do doctors not have time for nutrition, many also don’t perceive nutrition as important, or if they think it’s important, they report they don’t have time to focus on it. (10)

• Poor insurance coverage: When doctors don’t think insurance will cover something, they often won’t recommend it. Medicare covers nutrition counseling by a dietitian if a patient has diabetes or end stage kidney disease. While insurance coverage of nutrition services is improving, it is highly variable between insurance companies and plans.

• Doctors don’t believe their patients will change: While doctors may know or believe that their patients’ lifestyles impact their health, many may not believe their patients can successfully make or sustain these changes. (11)

How you can help your doctor to address nutrition or order testing for you:

• Share your goals and values related to health and wellness. If PCPs know it’s important to you, they may help you get the help you want even if they can’t provide it.

• Ask to discuss your lifestyle (diet, physical activity, etc.) and how lifestyle factors impact your specific health/diagnoses compared to the medication they may offer. If they don’t have a lot of knowledge in this area, that’s ok. Ask them to refer you to someone who does.

• Ask what they see in your labs. If a reference range isn’t included, ask for a print-out or to view the “normal” range. It’s important to know where your lab results fall within (or outside of) the reference range. High- and low-normal results can be hints at future issues. In my world, we don’t want to wait until you run into big problems. We’re trying to catch things early.

• Ask for nutrition-specific labs. Remind them that XYZ symptom (e.g. fatigue) can be caused or exacerbated by a nutrient deficiency. I share my list below.

Here are the dos and don’ts of talking to your doctor about nutrition and the list of labs I often ask clients to request from their doctor.

Dos and Don’ts of Talking to your Doctor about Nutrition: