As a medical educator and member of a medical school curriculum committee, I know firsthand that nutrition is embedded in a lot of the coursework and that there are members of the care team that include people whose entire profession is nutrition!
Kevin puts out such great content. I did not realize how nuanced and complicated nutrition science is until I started following him. His work and others in his field of expertise are sadly overlooked, which leaves a space for misinformation grifters to thrive.
Thanks for the shout out to RDs! But let me point out that we must have 4 years from an accredited undergraduate program that includes chemistry, biochemistry, physiology, biology, food science, and medical nutrition therapy. We then must get an MS degree, complete a clinical internship and then pass the RD exam. Like many health professions, we must earn continuing education credits. Are we healthcare’s best kept secret?
So basically, there are better resources of nutrition information than a “functional medicine” practitioner who took a few week-long course where only part of it was “nutrition”?
Not a secret, but maybe not the first people we might think of when making a referral for weight loss or help with patients who have metabolic syndrome. RDs need to remind PCPs what they can offer their patients, and assure them that they are not proselytizing for a vegan lifestyle or selling dietary supplements.
I agree. One of the biggest problems with many RD’s, health influencers, and nutrition researchers is that we all eat, we all have our health and fitness styles and routines that they think is what everyone should be doing. Too many practice “Be like me medicine”. I always stressed to my students - “this isn’t about you, we’re not here to make ‘mini me’s’"
First- hope you are feeling better!Mahalo for sharing Dr Klatt’s thoughts and yours on the recently released HHS Competencies for Physician Education. I share most of the same concerns. Physicians are not RDs or farmers. Much of this guideline as you point out is impractical and inappropriate.
I would be careful though not to be passing judgement on medical practitioners from a previous era from the perspective of the current time period. As the saying goes “hindsight is 20/20.”
I also have a different definition of modern medicine, as I think it is not finite posture but a constantly evolving paradigm, progressing as our knowledge base changes. I see a danger at any point in a practitioner that forgets this and focuses on one algorithm as the key to health.
Also anecdotal evidence is evidence. It is the basis for all traditional healing traditions. It is important to remember that much of current modern standard medical practice is rooted in knowledge from times before double blind placebo controlled trials were a thing or knowledge was passed down in written form.
As new tools develop a good ethical practitioner makes use of them being willing to critically revise their practice accordingly. Certain principles of traditional medicine remain sacrosanct for all healers across the spectrum, including first, do no harm; and the avoidance of capitalizing on the misfortune of others.
I would be careful to laser criticism on an avenue of medicine outside my own lane as it displays a lack of knowledge regarding current educational and practice standards in those fields. I would point out that most alternative medical schools of thought have come about in response to periods where standard medical practices were not particularly effective and pretty dangerous in their application.
My practice and progression as a healer started from that of the traditional kahuna role in Hawaiian culture. To that I added the basic scientific understandings of my time. Then a lifelong pursuit to know more so as to have the broadest educational treasure chest possible and be the most effective at sharing this with my community for the increase of health and minimization of pain and suffering. This has included being a fully licensed and board certified family physician and a teacher of medical practice.
As there is much we do not know about both the animate and inanimate parts of our world, spiritual dimensions and the universe at large I think it is important to keep an open mind, apply tools like the scientific method as we come by them but not be boxed in and limited in thinking and questioning by contrived constructs that may have flaws or the possibility to be misapplied due to our human fallibility.
Thank you, Dr. Steier. All great points. I would only add my umbrage that, at same time 30 years of tracking food insecurity in America has been killed at the USDA with the demise of the annual Food Security Report, the critical need for a physician to detect food insecurity in a patient has been ignored in the Kennedy recommendations.
The use of a simple food security measurement tool, like the validated two-question Hunger Vital Sign, was the #2 competency on the JAMA 2024 list of 36 med ed nutrition competencies recommendations. It is nowhere to be found in the Kennedy list of 71 competencies, nor is food security mentioned. The health of a patient is at risk if food insecurity or hunger are present, right?
I really like the JAMA 2024 list. It is patient centered and teaches the doctor how to treat in close consultation with nutrition experts. I see little resemblance to Kennedy list, some of which is outright bizarre to contemplate in doctor training. More thoughts if you are interested at https://www.eatinginamerica.co/p/medical-education-nutrition-training.
Great piece! I think the missing portion of any MAHA plan is any understanding of the social and political determinants of health. Their ideas are ideology built around an outdated concept of rugged individualism. Meanwhile, society only functions when we pull each other up by our “bootstraps.”
It’s almost as if… being a dietician is a PROFESSION in itself? Hm…
Exactly! And severely under appreciated.
"Functional medicine" is an insult to the entire field
As a medical educator and member of a medical school curriculum committee, I know firsthand that nutrition is embedded in a lot of the coursework and that there are members of the care team that include people whose entire profession is nutrition!
Kevin puts out such great content. I did not realize how nuanced and complicated nutrition science is until I started following him. His work and others in his field of expertise are sadly overlooked, which leaves a space for misinformation grifters to thrive.
I'll add that most medical students don't need to go to a farm and practice soil sampling. Nor do they need to understand crop rotation.
Just another grandstanding & performative thing by jr.
Thanks for the shout out to RDs! But let me point out that we must have 4 years from an accredited undergraduate program that includes chemistry, biochemistry, physiology, biology, food science, and medical nutrition therapy. We then must get an MS degree, complete a clinical internship and then pass the RD exam. Like many health professions, we must earn continuing education credits. Are we healthcare’s best kept secret?
So basically, there are better resources of nutrition information than a “functional medicine” practitioner who took a few week-long course where only part of it was “nutrition”?
Not a secret, but maybe not the first people we might think of when making a referral for weight loss or help with patients who have metabolic syndrome. RDs need to remind PCPs what they can offer their patients, and assure them that they are not proselytizing for a vegan lifestyle or selling dietary supplements.
I agree. One of the biggest problems with many RD’s, health influencers, and nutrition researchers is that we all eat, we all have our health and fitness styles and routines that they think is what everyone should be doing. Too many practice “Be like me medicine”. I always stressed to my students - “this isn’t about you, we’re not here to make ‘mini me’s’"
First- hope you are feeling better!Mahalo for sharing Dr Klatt’s thoughts and yours on the recently released HHS Competencies for Physician Education. I share most of the same concerns. Physicians are not RDs or farmers. Much of this guideline as you point out is impractical and inappropriate.
I would be careful though not to be passing judgement on medical practitioners from a previous era from the perspective of the current time period. As the saying goes “hindsight is 20/20.”
I also have a different definition of modern medicine, as I think it is not finite posture but a constantly evolving paradigm, progressing as our knowledge base changes. I see a danger at any point in a practitioner that forgets this and focuses on one algorithm as the key to health.
Also anecdotal evidence is evidence. It is the basis for all traditional healing traditions. It is important to remember that much of current modern standard medical practice is rooted in knowledge from times before double blind placebo controlled trials were a thing or knowledge was passed down in written form.
As new tools develop a good ethical practitioner makes use of them being willing to critically revise their practice accordingly. Certain principles of traditional medicine remain sacrosanct for all healers across the spectrum, including first, do no harm; and the avoidance of capitalizing on the misfortune of others.
I would be careful to laser criticism on an avenue of medicine outside my own lane as it displays a lack of knowledge regarding current educational and practice standards in those fields. I would point out that most alternative medical schools of thought have come about in response to periods where standard medical practices were not particularly effective and pretty dangerous in their application.
My practice and progression as a healer started from that of the traditional kahuna role in Hawaiian culture. To that I added the basic scientific understandings of my time. Then a lifelong pursuit to know more so as to have the broadest educational treasure chest possible and be the most effective at sharing this with my community for the increase of health and minimization of pain and suffering. This has included being a fully licensed and board certified family physician and a teacher of medical practice.
As there is much we do not know about both the animate and inanimate parts of our world, spiritual dimensions and the universe at large I think it is important to keep an open mind, apply tools like the scientific method as we come by them but not be boxed in and limited in thinking and questioning by contrived constructs that may have flaws or the possibility to be misapplied due to our human fallibility.
Thank you for sharing your story and perspective.
For those of your readers who don't know how *unserious* functional medicine is...
https://thescamdoctor.substack.com/p/what-is-functional-medicine?r=6hgshq
Thank you, Dr. Steier. All great points. I would only add my umbrage that, at same time 30 years of tracking food insecurity in America has been killed at the USDA with the demise of the annual Food Security Report, the critical need for a physician to detect food insecurity in a patient has been ignored in the Kennedy recommendations.
The use of a simple food security measurement tool, like the validated two-question Hunger Vital Sign, was the #2 competency on the JAMA 2024 list of 36 med ed nutrition competencies recommendations. It is nowhere to be found in the Kennedy list of 71 competencies, nor is food security mentioned. The health of a patient is at risk if food insecurity or hunger are present, right?
I really like the JAMA 2024 list. It is patient centered and teaches the doctor how to treat in close consultation with nutrition experts. I see little resemblance to Kennedy list, some of which is outright bizarre to contemplate in doctor training. More thoughts if you are interested at https://www.eatinginamerica.co/p/medical-education-nutrition-training.
I hope you are feeling much better!
Great piece! I think the missing portion of any MAHA plan is any understanding of the social and political determinants of health. Their ideas are ideology built around an outdated concept of rugged individualism. Meanwhile, society only functions when we pull each other up by our “bootstraps.”