The Department of Health and Human Services (HHS) recently announced an initiative to improve nutrition education across every stage of physician education and training. As part of the effort, dozens of medical schools have pledged to include forty hours of nutrition training (or a competency-based equivalent) in their graduation requirements.
Those pledges take aim at a longstanding gap. Medical schools currently devote less than 1 percent of lecture hours to nutrition, and until recently, roughly three-quarters of schools didn’t require a dedicated nutrition course at all.
As a cardiologist, I welcome this initiative. Poor diet drives much of what I see in the clinic: obesity, type 2 diabetes, cardiovascular disease, and other metabolic disorders.
But adding hours alone won’t be enough. More nutrition education won’t meaningfully improve our nation’s chronic disease crisis unless medical schools also rethink what they teach. For decades, medical and dietetic societies, even the government, have promoted similar dietary guidance, yet metabolic disease continues to rise. Rather than repeat the same nutrition mantra, schools should focus on two priorities: teaching physicians how to evaluate nutrition evidence and translate it into individualized patient care.
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Since diet is first-line therapy for many of the most common chronic diseases afflicting Americans, physicians should be as comfortable evaluating nutrition evidence as they are interpreting the science behind the medications they prescribe. That starts with understanding how nutrition research differs from many other areas of medicine.
A conventional drug trial can often isolate a single intervention and compare it with a placebo under tightly controlled conditions. Nutrition rarely fits that model. Researchers cannot realistically control every meal, behavior, and environmental influence over the years in which chronic disease develops.
Nutrition science therefore relies on observational studies, controlled feeding trials, mechanistic research, and clinical interventions. Each has distinct strengths and limitations, but taken together, they generally provide a much lower quality level of evidence than the randomized controlled trials used for drugs.
Medical schools must teach future physicians how to weigh these different forms of evidence and understand what each study design can, and cannot, tell them. Otherwise, they risk treating tentative associations as settled science or dismissing useful clinical evidence because it does not resemble a pharmaceutical trial.
For instance, an observational study linking eggs to heart disease can generate catchy headlines. A well-trained doctor needs the skills to assess confounding variables, healthy-user bias, effect size, and other limitations.
Evaluating the evidence is only half the job. Physicians also need to know how to apply it to the patient in front of them. For decades, major medical groups have recommended a one-size-fits-all approach to healthy eating: reduce saturated fat, increase whole grains, eat less, and move more. But that conventional advice has failed to stem the rise of metabolic disease.
Today, approximately 90 percent of Americans show at least one sign of suboptimal metabolic health, while obesity and type 2 diabetes have steadily increased. It’s increasingly clear that a dietary strategy that works for a metabolically healthy patient may not be the best starting point for someone whose body is struggling to regulate glucose and insulin.
Consider a person living with type 2 diabetes and significant insulin resistance. Advising that person to eat more grains and plants while cutting back on highly bioavailable protein from animal products and healthy fats may lead to blood sugar and insulin swings, which can contribute to increased hunger and cravings without addressing the metabolic dysfunction driving the disease.
Future physicians need a toolkit that recognizes a range of evidence-based dietary approaches. For instance, research routinely shows that low-carbohydrate and ketogenic diets can improve glycemic control, weight, and other metabolic markers for many patients. Mediterranean-style or plant-based dietary patterns that emphasize whole, nutrient-dense foods can also offer benefits (and can even be incorporated into a lower-carbohydrate plan tailored to an individual’s needs).
Medical schools must therefore teach future physicians how to match the right strategy to the right patient, accounting for what’s likely to improve metabolic health and what the patient can realistically adhere to over time. They must then evaluate nutrition interventions as they would any other therapy: through measurable clinical outcomes.
Did HbA1c improve? Did fasting insulin fall? Are triglycerides, blood pressure, liver health, and body composition moving in the right direction? Is the patient taking fewer medications? Just as importantly, how does the patient feel? Every physician should be able to monitor the clinical response, adjust the plan as needed, and know when to refer to a registered dietitian or other specialist.
With this initiative, HHS has created an opportunity to rethink nutrition education for the next generation of physicians. Now it’s up to policymakers and accrediting bodies to ensure that the new requirements define competencies, not merely hours, and to make sure we don’t repeat the same mistakes nutrition advice has made for decades.
Get that right, and those forty hours can produce better doctors, and healthier Americans.
Bret Scher is a cardiologist.
