California is often perceived as a state where healthy habits abound — with a yoga studio on every block and kale salads on every plate. Unfortunately, I know in my daily practice as a cardiologist that this is far from the truth and that diseases due to poor diet and lifestyle are abundant here in sunny California.

As a cardiologist, I’m especially concerned that California isn’t very heart healthy: Just like everywhere else in the country, our #1 killer is heart disease, and our state ranks third in the nation in per capita deaths from hypertension, or high blood pressure.

Poor diet quality has been identified as the leading cause of death and disability in the United States. But how many physicians know to tell their patients that eating more fruits, vegetables, grains and beans, and cutting out saturated fat from red meat and cheese can reduce heart disease risk by 40%? Or that a healthy lifestyle, including exercise and a plant-based diet, has the power to reverse coronary blockages in 82% of patients who already have coronary artery disease?

How many know that vegetarian diets are associated with lower systolic and diastolic blood pressures or that the American Heart Association recommends 4,700 milligrams of dietary potassium per day to reduce blood pressure? I’d like to see more California physicians prescribing meals that are lower in sodium and higher in potassium: oatmeal with a banana for breakfast; a spinach salad topped with avocado, beets, and black beans for lunch; pasta with marinara sauce and white beans for dinner; and watermelon for dessert to help patients reach AHA recommendations.

Of course, I learned most of what I know about nutrition through my own efforts, not in medical school or advanced cardiology training, so I understand why California’s physicians don’t know more about nutrition.

In fact, a recent survey of cardiologists found that 90% reported receiving no or minimal nutrition education during fellowship training, 59% reported no nutrition education during internal medicine training, and 31% reported receiving no nutrition education in medical school. Just 8% said they have “expert” nutrition knowledge, but 95% believe that their role includes providing patients with nutrition information.

It’s clear that physicians-in-training need better nutrition education. But to address California’s current nutrition-related disease epidemics, practicing physicians should be required to take continuing medical education (CME) focused on nutrition.

I think that most physicians would agree that they could use more nutrition education. In fact, 94% of resident physicians feel that nutrition counseling should be part of primary care visits, but only 14% feel adequately trained to offer it.

“Lack of nutrition education persists after completion of graduate medical education, where almost half of polled physicians had not received any nutrition continuing medical education,” according to the authors of a study published in the American Journal of Medicine. “Moreover, physicians were unlikely to be readers or consumers of nutrition education through studies, books or documentaries post-graduation. In fact, 67% of physicians read about nutrition less than once every three months.”

Here in California, the Medical Board of California requires physicians to complete at least 50 hours of approved CME every two years. But there is no requirement that any of those hours focus on nutrition. It’s a missed opportunity that the state needs to fix by requiring physicians to take nutrition CME to better help protect every Californian from the state’s top killer.

Heather Shenkman is an interventional cardiologist and author of The Vegan Heart Doctor’s Guide to Reversing Heart Disease, Losing Weight, and Reclaiming Your Life.

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