A conversation with Dr. Marion Nestle who talks about the subject of your doctor and nutrition.
This issue's column is an edited version of a conversation
I had with Marion Nestle, an associate dean and lecturer in
medicine and biochemistry at the University of California
School of Medicine in San Francisco, on what you need to know about your doctor and nutrition. Dr. Nestle teaches
nutrition to health science students, as well as to
resident physicians, and she coordinates nutrition
education within the School of Medicine. A Ph.D. in
molecular biology from the University of California at
Berkeley, Dr. Nestle is also a contributing editor of
Many people say that medical
schools generally ignore the area of nutrition science. Do
Yes . . . and even when the
subject is included in a curriculum, the classes tend to be
Well, first of all, many people
who teach biochemistry, physiology, or other "hard"
sciences are a bit contemptuous of nutrition . . . they
don't consider it a real science. After all, because of the
field's relative newness, nutrition researchers don't have
the huge body of well-controlled corroborating data that
most other sciences can call upon . . . so it's often
difficult to make a convincing scientific argument for the
importance of diet in medicine.
Is there any other reason why
many medical students receive little or no practical
Probably the biggest reason is
that we all—doctors and laypersons alike—tend
to view medicine as a curative, rather than a preventive,
science. Most people see a physician only when they're sick
and need immediate help. They don't come to get advice on
nutrition . . . they come to get treated for an illness.
Recently, I saw a quote by
Harvard nutritionist jean Mayer, who said—in
effect—that the average doctor knows little more
about nutrition than the average non-physician.
Well, perhaps that's a bit unfair
to physicians . . . most doctors are fairly well trained in
such technical subjects as carbohydrate biochemistry and
metabolic functions. But they generally don't know how to
apply that textbook knowledge in a way that's useful to
people. In other words, they fail to relate that basic
information to their patients' actual eating habits and
diets. They need to understand, for example, the importance
of the differences between foods that contain starch and
those that contain sugar. When a patient asks a question
concerning nutrition—about, for instance, which foods
are and are not beneficial to that particular
individual—the doc tor should be able to provide a
practical, meaningful answer.
Plus, since proper diet plays an important preventive and
curative role in many diseases, a physician should be
cognizant of what is known—and not known—about
dietary approaches to dealing with common chronic illnesses
such as heart disease, obesity, diabetes, and high blood
pressure. Nutritionists and dieticians are especially
trained to counsel patients on eating habits, so doctors
should know when and how to refer patients to such experts.
Isn't recommending a balanced
diet a commonsense first step?
Absolutely. The evidence is
increasingly clear that the dietary goals and guidelines
established by the McGovern committee and the U.S.
Department of Agriculture represent a unified approach to
both normal—that is, preventive—and therapeutic
diets. Generally, the same food regimen that's best for
health is also the one to recommend to people with heart
disease, diabetes, or obesity.
What, exactly, is this "unified" dietary approach?
It's simple enough: Eat
unprocessed foods that are high in complex carbohydrates
and in fiber . . . such as fruits, vegetables, and whole
grain cereals. Go easy on the fat, salt, and sugar. And eat
a wide range of foods. Variety is important because foods
differ in the kinds and amounts of nutrients they contain,
so consuming an assortment of comestibles—and I'm
speaking here of non-junk foods, with high nutrient
densities—can help a person be sure that he or she is
getting all of the necessary nutrients.
What do you mean when you say
"high nutrient density"?
That's just nutritionists' jargon
for a food that's rich in nutrients and low in calories.
Junk foods, of course, are just the reverse.
You mentioned to me once that
you require your medical students to record a 24-hour diet
inventory. How useful is such a practice . . . and what's
Well, the process is a bit
tedious, but it teaches a great deal about the importance
of watching what you ingest. You simply list everything you
eat and drink in one day, and afterwards look up the
nutrients present in each edible in standard food
composition tables. Then add up the daily totals, and
compare those figures with nutritional guidelines such as
the U.S. Recommended Daily Allowances. It's fascinating to
find out which nutrients are present in common foods. Many
people, for example, are surprised to find how much protein
is in vegetables.
What books would you recommend
for those who want to do a one-day, diet inventory?
Composition of Foods, and Laurel's
Kitchen. Composition is the standard source for nutritional
information. Laurel', Kitchen is a vegetarian cookbook with
a long and truly excellent section on the principle, of
nutrition . . . and the text is accompanied by very handy
food-composition tables. I just wish that the book included
more information for people who eat meat!
Do you have any advice on how to
shop for groceries . . . and how to determine which foods
are nourishing and which are not?
Yes. If you buy food in a
supermarket try to avoid the center aisles. All of the
real, unprocessed foods—the vegetables, fruits,
meats, and dairy products—are generally located
around the periphery of the store. But the low-nutrient
junk foods are usually kept in the center aisles, so stagy
away from those areas. And by all means, read the products'
labels. The information on such wrappers isn't always
complete, but at least it will tell you which products do
and do not contain undesirable ingredients such as sugar,
salt, fats, and additives.
One final question: Have your
own eating habits changed as you've learned more about
Yes, but it has been a gradual
process. For example, I'm still not a strict vegetarian,
but my family's diet has certainly moved increasingly in
that direction. And we haven't used salt in a long time.
Generally, I simply try to follow the same basic advice I
give to my students and others: Eat a variety of whole,
unprocessed foods in moderation. And above all, enjoy your
meals . . . a healthful diet doesn't have to be boring!
EDITOR'S NOTE: The U.S. Department of
Agriculture's Composition of Foods (Agricultural
Handbook Number 8) is available for $7.00 from the
Superintendent of Documents, U.S. Government Printing
Office, Dept. TMEN, Washington, D.C. Order Stock No.
001-00000768-8. Laurel's Kitchen: A Handbook of Vegetarian
Cookery and Nutrition by Laurel Robertson, Carol Flinders,
and Bronwen Godfrey can be purchased at most bookstores in
paperback (Bantam, $4.50) and in hard cover (Nilgiri Press,
Dr. Tom Ferguson's quarterly journal, Medical Self-Care, is available for $15 per year from Medical Self-Care, Dept. TMEN, Inverness, California. A sample issue costs $4.00. Dr. Ferguson's book, also titled Medical Self-Care, can be ordered — for $8.95 plus 95¢ shipping and handling — from MOTHER's Bookshelf® Hendersonville, North Carolina.