'Hospitals with 100% Plant-Based Menus"
Globally, 11 million deaths are attributable to dietary factors each
year, placing poor diet ahead of any other risk factor for death in the world.
Given that our diet is our leading killer, you'd think it would be
emphasized in medical school, but there is a deficiency
of nutrition education in medical training.
A systematic review found that despite the centrality of nutrition
to a healthy lifestyle, graduating medical students are not supported
through their education to provide the necessary care.
It could start in undergrad. What's more important:
learning about humanity's leading killer or organic chemistry?
In medical school, students may average only 19 total hours of nutrition
out of thousands of hours of instruction, and they're not even being taught
what's most useful.
How many cases of scurvy or beriberi— diseases of dietary deficiency—
will they encounter in clinical practice? In contrast, how many of their
future patients will be suffering from dietary excesses: obesity, diabetes,
hypertension, heart disease? Those are probably a little more common.
More than 9 out of 10 cardiologists surveyed believe that their role includes
personally providing patients with at least basic nutrition information,
yet less than 1 in 10 feel they have an expert grasp on the subject.
If you look at the clinical guidelines for what we should do for our patients
with regards to the number one killer, atherosclerotic cardiovascular disease,
all treatment begins with a healthy lifestyle.
Yet how can clinicians put these guidelines into practice
without adequate training in nutrition? Fewer than 50% of medical schools
reported teaching any nutrition in clinical practice.
In fact, they may be effectively teaching anti-nutrition,
as students typically begin medical school with a greater appreciation
for the role of nutrition in health than when they leave.
This is the percentage of med students at different schools
indicating that nutrition is important to their careers
upon entry into medical school.
Smart bunch, about three-quarters on average.
Okay, but then after two years of instruction in medical school,
they were asked the same question.
And the numbers plummeted.
In fact, at most schools it was zero percent.
Instead of being educated, they got de-educated—
had this silly notion that nutrition was important washed
right out of their brains.
Preclinical teaching—meaning the first two years of medical school—
engenders a loss of a sense of the relevance of the applied
discipline of nutrition.
And following medical school, nutrition education during residency
is minimal, or more typically, absent.
Major updates were released in 2018 for residency and fellowship
training requirements, and there were zero requirements for nutrition.
So you could have an internal medicine graduate who comes out
of some prestigious program who has learned nothing,
literally nothing, about nutrition.
Why isn't diet routinely addressed already in both medical education
and practice, and what should be done about it?
One of the reasons for the medical silence in nutrition, sadly,
is that nutrition takes a back seat because
there are few financial incentives to support it.
What can we do about that? The Food Law and Policy Clinic at the
Harvard Law School identified a dozen different policy levers at all stages of
medical education, and the kinds of policy recommendations there could
be for the decision makers. For instance, the government could require doctors
working at the VA, at least, to get some courses in nutrition.
Or we could put questions about nutrition on board exams
so schools would be pressured to teach it.
But as we are now, even patients who just had a heart attack
aren't changing their diet. Doctors may not be telling them,
and hospitals may be actively undermining their future
with the food they serve the patients.
The good news is the American Medical Association (AMA) has passed a resolution
encouraging healthy food options be available in hospitals. What a concept!
The AMA hereby calls on U.S. hospitals to improve the health of patients,
staff, and visitors by providing a variety of healthy food,
including plant-based meals, and meals that are low in fat,
sodium, and added sugars; eliminating processed meats from menus;
and providing and promoting healthy beverages. Nice!
Similarly, in 2018, the State of California mandated
the availability of plant-based meals for patients.
And there are hospitals in Gainesville, Florida, the Bronx, Manhattan, Denver,
and Tampa all offering 100% plant-based meals to their patients
on a separate menu, and distributing materials to inpatients
to improve their education on the role of diet,
especially plant-based diets, in chronic disease.
Let's check out some menus. Mmm...a little lentil bolognese.
Here's Montefiore's: a little cauliflower scramble with baked hash browns
for breakfast. Mushroom ragu for lunch, and a white bean stew for supper.
Soup, salad, and fruit for dessert.
This is the first time a hospital menu ever made me hungry.
It makes me want to get appendicitis and stay for a few days.
The key to these transformations has been having a physician advocate
and increasing education of staff and patients on the benefits
of eating more plant-based foods.
A single clinician can spark change in a whole system because science
is on their side. Doctors have a unique position in society
to influence policy at all levels. It's about time we used it.