Opinion | Can an Apple a Day Keep the Heart Disease Away?

The U.S. has had the same leading cause of death since 1921. Today, one person in America dies every 34 seconds from this disease. This disease doesn’t care about your demographics — men, women, and most racial and ethnic groups are all affected. The disease in question is none other than heart disease.

We’re surrounded by daily advertisements for methods of combating heart disease. Additionally, the U.S. spends around $229 billion annually in heart-disease related healthcare services, medicine, and lost productivity due to death. The good news? This disease is largely preventable.

The Role of Nutrition Education

When physicians educate and counsel their patients in nutrition, this has the potential to decrease healthcare costs for patients and the healthcare system alike. Prescribing healthy foods, coupled with ensuring access (which can be supported through policy interventions such as subsidies for healthy foods), can decrease the potential for heart disease and other metabolic conditions, such as diabetes. In fact, increasing nutrient-dense food consumption and overall healthy eating (such as fruits, vegetables, whole grains, nuts, and seeds) over a lifetime would save the U.S. over $100 billion in healthcare costs, according to one modeling study. Not to mention the nearly 3.3 million heart disease events and 120,000 cases of diabetes that could be prevented in the process.

However, we must consider whether standard medical education offers physicians sufficient training in nutrition and counseling to help combat heart disease.

Prior to entering medical school, I (S. Ryan Pierson, MS, RDN) earned a degree as a registered dietitian nutritionist. I spent years achieving an education that could help patients overcome health problems through nutrition, and I assumed physicians were already well equipped with this knowledge. Now, as I near the completion of my medical doctorate degree, I am reflecting on what I have learned about nutrition during medical school. Frankly, I have learned nothing new.

Nutritional science encompasses a vast array of topics and is commonly integrated into medical courses, such as biochemistry or gastrointestinal medicine — but it is rarely the focal point of the course. After discussing the topic with my peers, they could openly recall little to no nutrition education, other than a few basic topics required for medical board exam licensure.

I considered that perhaps the problem lies with which medical school we attend or a change in medical education over the past several years. But after performing a literature review, it appears that this minimal amount of nutrition education has been the status quo among medical schools across the U.S. for several decades. In fact, physicians have identified inadequate nutrition training as an education issue since the 1950s. Furthermore, medical schools devote a widely variable number of hours to nutrition content over a 4-year curriculum, ranging from 0 to 70 total hours and averaging around 20 hours total.

The curricula at medical schools are changed frequently. About 85% of medical schools are in the process of making a change, are planning on making a change, or have implemented a change to their curriculum within the past few years. Clearly, these programs are attempting to provide better and more accurate education for their students. So why hasn’t there been significant progress on greater nutrition education when the need clearly exists?

Since nutrition education is not included in these changes year-after-year, one could argue medical educators don’t believe nutrition education is important. However, when surveyed, practicing physicians state that their nutrition background is inadequate for promoting good nutrition among their patients, and only 21% of family physicians experience personal gratification in counseling about dietary issues. Perhaps if they had more training and experience with this type of counseling, they could more effectively help patients improve their eating habits, and therefore may achieve greater gratification from it.

A fundamental change is needed for our medical education system to increase the focus on the power of nutrition as medical therapy. Perhaps an apple a day to keep the doctor away isn’t too far off the mark.

S. Ryan Pierson, MS, RDN, is a registered dietitian nutritionist, certified strength & conditioning specialist, and fourth year MD/MBA student at Dell Medical School at the University of Texas at Austin. Kristie Loescher, MPH, DBA, is a professor of instruction for the Value Institute of Health and Care at Dell Medical School.