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Almost every day, at least one patient asks nurse practitioner Nicole Newman about Red Dye No. 3. If not that, it\u2019s microgreens powder, adaptogens, lion\u2019s-mane supplements, or some other esoteric ingredient or nutrient. \u201cPatients will come at me with these highly specific things,\u201d said Newman, who practices family medicine in rural western Michigan. \u201cTell me what you know about this,\u201d they demand. \u201cAnd usually, the answer is \u2018nothing,\u2019\u201d she told me.<\/p>\n
She can offer generalities: eat leafy greens, drink water, that sort of thing. \u201cBut people don\u2019t want that,\u201d Newman said. When it comes to nutrition, \u201cthey want, \u2018Well, what really am I supposed to be doing?\u2019\u201d They want specifics. She empathizes with her patients. Most seem to be earnestly seeking out ways to improve their health through diet \u2014 and they\u2019re doing so by asking an actual health-care provider for advice instead of relying on podcasts or TikTok. \u201cIt should be a reasonable ask from my patients, that if they want help with their nutrition, I would be able to support them,\u201d Newman said. \u201cI\u2019m like, \u2018That\u2019s not really what I do.\u2019\u201d<\/p>\n
By now, most people have heard that health-care providers tend to receive little education in nutritional science during their training. Some say this fact has become something patients like to throw at them in a knowing tone. \u201cMy doctor knows nothing about nutrition,\u201d complained<\/a> one user on the r\/carnivorediet sub-Reddit, linking to a study that backs their own claims (and refutes their doctor\u2019s) as proof. \u201cThey don\u2019t learn about nutrition,\u201d one patient told me. \u201cIt\u2019s not even any fault of their own. It\u2019s just not part of their medical training.\u201d<\/p>\n They do have a point. A 2018 study<\/a> found just under 14 percent of physicians felt adequately prepared to discuss nutrition with their patients. As for nurse practitioners like Newman, whom you are increasingly more likely<\/a> to see than a doctor, 75 percent of the top programs failed<\/a> to meet the recommended hours of nutrition training. Forty years ago<\/a>, the National Academies published a 141-page screed for prospective donors on the dismal state of nutrition education in the United States, recommending a 25-hour minimum requirement. It\u2019s considered the bare-minimum benchmark for nutrition education, and most medical schools still fail to meet it.<\/p>\n But there\u2019s an obvious yet overlooked problem here, one that helps explain both providers\u2019 reluctance to dole out dietary advice and why nutrition isn\u2019t emphasized in most medical training programs: So much of the nutrition research their patients are asking about just isn\u2019t very good.<\/p>\n \u201cFor every study that exists out there that says there\u2019s some benefit to wine or to coffee, there\u2019s another study that points to one of those things being problematic,\u201d said Dr. Skyler Johnson, a researcher and oncologist at the University of Utah Huntsman Cancer Institute. Most<\/a> published studies in nutrition are observational; they can find associations between diet and health but can\u2019t pinpoint cause and effect. And most nutrition studies rely on self-reporting, or gathering data by asking people what they ate the previous day (or week or month or year, depending on the intended time frame). The obvious problem is it\u2019s not easy to remember everything you ate, say, last Thursday. It\u2019s also possible that, when asked to report their dietary habits in the context of a nutrition study, some people may embellish. \u201cThe only way to know what people are eating is to feed them and lock them up so they can\u2019t cheat,\u201d said Marion Nestle, professor emerita at New York University and a longtime critic of shoddy nutrition science.<\/p>\n Such studies do exist, but they\u2019re expensive, and dietary research has historically not been well funded. According to a November 2024 report<\/a> from the National Institutes of Health, from 2019 to 2023, less than 5 percent of the NIH budget went to nutrition science. That means many nutrition studies are small and short term<\/a>, making them less reliable and thus more likely to be contradicted by other (similarly small and short-term) studies.<\/p>\n Johnson\u2019s patients are often desperate to find something they can do to improve their chances of surviving cancer, for example. Isn\u2019t there a supplement or particular food that could help? Sometimes they mention a study they\u2019ve found that supports the dietary change they have in mind and are frustrated at Johnson\u2019s skepticism. \u201cThere are just so many confounders in these nutrition studies that the data is so mixed that there\u2019s not a clear recommendation,\u201d he said. \u201cI often tell my patients that I\u2019m equally frustrated.\u201d<\/p>\n Often, they bring him something they found on social media, where a simple and declarative 60-second video is more likely to capture attention than one made up of more accurate but comparatively dull caveats. Lately, Johnson\u2019s patients want to talk about posts they\u2019ve seen on the \u201cWarburg effect,\u201d named for the biochemist Otto Warburg, who observed over a century ago that cancer cells seemed to prefer consuming glucose. (\u201cLet\u2019s talk about the connection between sugar and cancer,\u201d begins a Warburg-effect-themed video<\/a> by a nurse practitioner with nearly 700,000 followers on TikTok. \u201cAnd if you think they\u2019re not connected \u2014 you\u2019re wrong.\u201d) Sometimes, Johnson\u2019s patients who\u2019ve seen content like this will worriedly ask him if they should adopt a ketogenic diet while undergoing treatment. \u201cWhat people don\u2019t understand is that cancer cells can use any form of energy, whether it\u2019s from sugar or not,\u201d Johnson said. Sugar isn\u2019t likely the single thing that caused his patients\u2019 cancer, and cutting it out isn\u2019t likely the single thing that will cure it. \u201cBut they have this belief that sugar feeds cancer, so they\u2019re cutting all sugar out of their diet,\u201d he said. It\u2019s not a bad idea generally to curb sugar consumption, but oncologists are wary of restrictive diets that can cause too much weight loss and negatively affect treatment. Sometimes, patients ignore his advice and go ahead with the strict diet they heard about online. (What do doctors know about nutrition, anyway?) \u201cYou could talk to any oncologist, and they will have seen people making these extreme dietary modifications,\u201d Johnson said.<\/p>\n This summer, Health and Human Services Secretary Robert F. Kennedy Jr. announced an initiative<\/a> urging medical schools to incorporate nutrition science into their curricula. (Kennedy and Education Secretary Linda McMahon set a deadline of September 10 for accreditors to submit detailed plans of their commitments.)\u00a0But this isn\u2019t just a MAHA cause: In September 2022, the Biden administration\u2019s White House Conference on Hunger, Nutrition, and Health included a national strategy calling for increasing nutrition education for medical professionals. And it isn\u2019t just an American problem, either. It is estimated that less than half of accreditation and curriculum guidance for medical education worldwide even mentions<\/a> nutrition. But how can increased medical training in nutrition help if so much of the research it would be based on is flawed? And even if more doctors did dole out dietary advice, would it really be what their patients were looking for?<\/p>\n The problem isn\u2019t that researchers know nothing about nutrition. It\u2019s more that what they know is really boring. Much of the dietary advice with the best evidence to back it up sounds a lot like common sense. This summer, for example, a randomized trial<\/a> that followed more than 2,000 people at risk for dementia for two years showed that the MIND diet \u2014 which stands for Mediterranean-DASH Intervention for Neurodegenerative Delay \u2014 along with other healthy behaviors like regularly exercising and socializing, led to greater improvement in cognitive performance. What foods are included in the MIND diet? Whole grains, leafy greens, and beans are a big part of it<\/a>, along with limiting butter and cheese as well as fried or fast food. Not exactly surprising.<\/p>\n That\u2019s just not what most people are asking their doctors about. They don\u2019t want the basics; they\u2019re looking for specifics. \u201cI do completely understand why a patient wouldn\u2019t want to pay a co-pay to come see me and me be like, \u2018Uh, eat more kale?\u2019\u201d Newman said. Dr. Dariush Mozaffarian, a cardiologist and the director<\/a> of the Food Is Medicine Institute at Tufts University, echoed this: \u201cPatients want to know, \u2018Look, I have joint pain. What food is going to help with my joint pain?\u2019\u201d Mozaffarian fields these kinds of questions in his social life, too: Earlier this year, a friend with a severe autoimmune condition started grilling him about broccoli, of all things. This person had come across research<\/a> suggesting a particular chemical found in broccoli might be a natural way to improve immune-system functioning. Could eating more broccoli help with an autoimmune condition? \u201cThat kind of science we don\u2019t have,\u201d Mozaffarian told his friend.<\/p>\n If most people want nutrition science to deliver hyperspecific advice about a single food or nutrient, that\u2019s in part because of the way journalists have tended to report on the field. For 16 years, health-care journalist Gary Schwitzer logged examples of these stories on his site Health News Review, which critiqued the way journalists reported on health. Nutrition studies were a frequent target, and when we spoke this summer, Schwitzer dug through the archives to pull up a couple of examples. \u201cHold on to your chair here,\u201d he said, referring to a 2017 New York Times story about a study on walnuts and weight loss. It\u2019s a tiny study, following just nine people for ten days, and the setup is an odd one involving brain scans and pictures of either cake or veggies or rocks or trees. \u201cIf we told stories that way \u2014 because this was not well explained in the story \u2014 you would lose readership. You\u2019d lose following. You would be ridiculed, I believe,\u201d he said.<\/p>\n Last fall, Schwitzer was annoyed out of retirement when his wife sent him a story about a study on taking vitamin K for leg cramps. \u201cI\u2019m probably only two or three paragraphs down, and I just rise up and I\u2019m pissed. This is just garbage,\u201d he said. Within 24 hours, he launched a Substack, and he has published around 90 posts since. He said fewer journalists lately seem to be doing study-of-the-day stories; instead, health influencers on TikTok or podcasts have stepped in. To be fair, it turns out this way of understanding nutrition science \u2014 drawing a straight line from this specific nutrient to this specific health outcome \u2014 can be traced back to the way the research was originally conducted. The discipline is still less than 100 years old (the first vitamin was isolated in 1926), and its earliest days were focused on diseases derived from vitamin deficiency, like scurvy. \u201cIt\u2019s a very reductionist approach, breaking down food into nutrients,\u201d Mozaffarian said.<\/p>\n But it worked: A number of then-endemic diseases were successfully treated with dietary interventions. \u201cSo when we started studying chronic diseases around 1980, that same reductionist approach was taken,\u201d said Mozaffarian, who in 2018 co-authored a paper<\/a> in the BMJ tracing the history of modern nutrition science. By that time, fat was widely believed to be linked to heart disease, an association that has since been upended by multiple studies, including a huge randomized trial<\/a> in 2006 showing that women who ate a low-fat diet were just as likely to develop heart disease as women who ate a diet higher in fat. The original association between fat and heart disease could be, as some have argued, the result of the sugar industry\u2019s influence. But the studies were designed that way in the first place because of this precedence of pinning a disease on a single nutrient, Mozaffarian argues.<\/p>\n Some newer research is beginning to show that addressing chronic disease is more about understanding the effect of dietary patterns (like that MIND-diet study) as well as food processing. In a 2019 study, NIH scientists really did manage to lock up a bunch of study volunteers and control what they ate. They admitted<\/a> 20 participants to the NIH Clinical Center and kept them there for a month, randomly assigning half to a diet of minimally processed food and the other half to a diet of ultraprocessed foods. Those who ate the ultraprocessed foods gained more weight on average at the end of the trial; they also consumed more calories per meal. \u201cTo address chronic disease in this country, diet is absolutely core \u2014 and it\u2019s not about a single nutrient,\u201d Mozaffarian said. \u201cIt\u2019s a combination of complex things that are in minimally processed foods that we\u2019re just starting to understand.\u201d<\/p>\n Yet at the doctor\u2019s office, all of this so far still means providers are stuck making recommendations that can feel unsatisfyingly vague or even obvious to their patients. Never mind that most Americans don\u2019t actually do the obvious. \u201cThat\u2019s, to me, where we really have to move the field \u2014 how do we change our systems and our policies and our food environment to make that easier?\u201d Mozaffarian said. Newman added, \u201cThey don\u2019t do the basic things, but they\u2019re like, \u2018Oh, but you know what? It\u2019s $74 a month for this microgreen adaptogenic supplement I can get at the Costco. That\u2019s going to fix it.\u2019\u201d A dismissive way to think about the allure of superfoods is that people want a quick fix, which is no doubt often true. But people also want certainty and simplicity, particularly when it comes to terrifying health diagnoses. \u201cThey want some sense of control over their cancer,\u201d Johnson said of his patients who obsess over finding the single nutrient or supplement that will deliver them. They\u2019re looking for something to do. \u201cIt makes them feel like an active participant in their treatment,\u201d he said.<\/p>\n An underreported recent finding is that medical schools do address nutrition, at least for the newest generation of physicians. In a survey<\/a> of med schools released this August by the Association of American Medical Colleges, 100 percent of respondents reported covering nutrition in some form, up from 89 percent five years ago. Fewer than half of those respondents required their students to take multiple nutrition courses, and just 17 percent integrated nutrition information across all years of training. But it\u2019s not true that doctors are taught nothing about nutrition. \u201cIt was always exercise and diet \u2014 that was the first recommendation you would make for somebody who had, say, prediabetes,\u201d Johnson recalled of his own courses in primary care.<\/p>\n Even if primary-care providers could answer the kinds of questions their patients throw at them, who has the time? Newman sees patients every 15 to 30 minutes; national surveys<\/a> suggest physicians see 20 patients a day on average. Already, primary-care providers would need an estimated<\/a> 26.7 hours a day to follow all the recommended care guidelines. \u201cThe single overriding issue in all of this is that they don\u2019t make any money if they spend any time on nutrition,\u201d Nestle said. \u201cEven if you knew everything there was to know about it, you can\u2019t do it and you\u2019re not going to be paid for it. The best they can do is find a dietician who\u2019s really good and refer their patients.\u201d (The term registered dietician nutritionist, or RDN, is often used interchangeably with nutritionist, but they\u2019re not the same thing. Becoming an RDN requires<\/a> a graduate degree along with a supervised practice program and an exam. But many states, including California and New York, have little to no regulatory restrictions<\/a> around who can call themselves a nutritionist.) True, a registered dietician may provide much of the same advice that can be found on an information sheet handed out by a general practitioner. But, best-case scenario, they\u2019ll be able to spend more time talking to the patient and understanding their lifestyle and preferences, which they can then use to craft a dietary plan the patient will actually follow. \u201cYou want somebody who knows how to work with people from where they are, who isn\u2019t going to impose ridiculous stuff about calcium and vitamin B6 and all that other stuff \u2014 just talking about food,\u201d Nestle said.<\/p>\n Meanwhile, the perception that providers know nothing about nutrition can itself be detrimental. If people don\u2019t think their doctors are knowledgeable about diet, they won\u2019t consult them when they decide to make a change. Johnson\u2019s cancer patients, for example, need to maintain a high calorie intake to keep making the immune cells that are potentially impacted by chemotherapy. In extreme cases, he has had to stop the treatment to address a patient\u2019s rapid weight loss \u2014 sometimes with a feeding tube. \u201cIt\u2019s rare,\u201d he said, \u201cbut it is a real phenomenon.\u201d In part because of what he has witnessed, he\u2019s lukewarm about the idea of physicians getting more nutrition training. \u201cDo I wish we learned more about nutrition? Yes and no,\u201d Johnson said. \u201cI think it should be more emphasized.\u201d Then again, what\u2019s the use, he wondered, if the findings he\u2019d have studied back then were based on small or unreliable datasets?<\/p>\n Dr. John Ioannidis, a professor of medicine at Stanford and a vocal critic of bad nutrition science, suggested an alternative: Instead of loading physicians-in-training up with nutrition courses, maybe spend some of that time hammering home how to properly digest a medical study. \u201cBy the time they graduate, the evidence may be different. And by the time they finish their residency, it will be, again, completely different,\u201d he said. Evidence evolves over time, but by training physicians to better assess it, they\u2019ll be better equipped to follow it as it changes. But that still lands providers in the unenviable position of fielding their patients\u2019 questions about the flashy new research they heard about on TikTok and trying to turn the conversation back to sensible leafy greens. \u201cWe\u2019d be learning about, you know, apples,\u201d Newman said. Meanwhile, her patients are asking about ashwagandha. \u201cIt\u2019s not what they\u2019re looking for.\u201d<\/p>\n Stay in touch.<\/p>\n Get the Cut newsletter delivered daily<\/p>\n Vox Media, LLC Terms and Privacy Notice<\/p>\n