By Dominic D’Agostino, PhD
Every day, patients walk into clinics with diseases that, unbeknownst to them, stem from what’s on their dinner table — yet most doctors are ill-equipped to counsel them. That’s not for lack of care or effort, but for lack of training.
Today, most medical students receive fewer than 20 hours of nutrition training over four years of school — far short of the modest 25-hour minimum recommended decades ago. And much of that instruction is outdated. Medical education largely overlooks the latest science on metabolic health — how efficiently the body converts food into energy and keeps blood sugar in balance — to the detriment of both doctors and patients.
Poor diet is now estimated to be the nation’s leading cause of mortality, driving epidemics of obesity, diabetes, and cardiovascular illness.
That has to change.
Chronic conditions like heart disease, type 2 diabetes, and obesity are responsible for most deaths in the United States and for the majority of our healthcare spending. According to the Centers for Disease Control and Prevention, three in four U.S. adults have at least one chronic health condition — many diet-related. Our healthcare system is buckling under the weight of poor metabolic health and these preventable illnesses.
Yet our medical training prepares physicians to manage symptoms, not address causes. Doctors learn to prescribe medication — but most are not formally trained to help patients improve metabolic health by stabilizing blood sugar and correcting insulin resistance through diet.
Even those physicians who do advise patients on lifestyle factors, such as diet, often fall short because they rely on outdated dogma. Recommendations to “eat less fat” or “choose whole grains” overlook metabolic realities — and fail to address the underlying dysfunction driving most chronic disease.
Evidence-based nutritional interventions — including Mediterranean, low-carbohydrate, and especially ketogenic approaches in insulin-resistant patients — can yield dramatic health improvements. Ketogenic and other carbohydrate-restricted diets, in particular, have been extensively studied and shown to stabilize blood sugar, improve insulin sensitivity, and, in many cases, induce remission or major improvement in chronic metabolic diseases. Yet these dietary approaches are not taught to our future physicians.
The Department of Health and Human Services recently launched an initiative encouraging medical schools to integrate nutrition education into their programs. That’s an important step — but it’s critical that the content doesn’t reflect decades-old dietary dogma. Future physicians must understand the latest science surrounding diet and metabolic health.
If we truly want to make America healthy again, we must start with how we train the next generation of physicians.
Dominic D’Agostino, PhD, is an Associate Professor in the Department of Molecular Pharmacology and Physiology at the University of South Florida Morsani College of Medicine and an advisory committee member for the Coalition for Metabolic Health. This piece originally ran in the Tampa Bay Times.
