How bad is it? One study “assessing the clinical nutrition knowledge of medical doctors” found the majority got 70 percent of the questions wrong. And they were multiple choice questions, so they should have gotten a fifth right just by chance. And the “wrong answers… were not limited to difficult or demanding questions.” For example, less than half could guess how many calories are in fat, carbs and protein; only 1 in 10 knew the recommended protein intake; and only about 1 in 3 knew what a healthy BMI was. I mean, this is like super basic nutrition knowledge.

And what’s worse, not only did the majority of medical doctors get a failing grade, but 30 percent of those who failed had “a high self-perception of their [clinical nutrition] expertise,” meaning not only were they clueless about nutrition, they were also clueless that they were clueless about nutrition, a particularly bad combination given that doctors are trusted and influential sources of healthy eating advice.

“Only [a quarter of doctors surveyed] correctly identified the American Heart Association[’s] recommended number of fruit and vegetable servings per day, and fewer still… were aware of the recommended daily added sugar limit[s]…”. So how are they going to counsel patients on it? Yet, again, of the doctors who perceived themselves as having high nutrition knowledge, 93 percent couldn’t answer those two basic multiple-choice questions.

“Medical education must be brought up to date. For physicians to be ill trained in the very area most impactful on the rate of premature death at the population level is an absurd anachronism.” “The mission of medicine is to protect, defend, and advance the human condition. That mission cannot be fulfilled if diet is neglected.”

Maybe one place to start is for “physicians and health care organizations [to] collectively begin to emphasize their seriousness about nutrition in health care by practicing what they [at least should be preaching]. Is it appropriate to serve pizza and soft drinks at a resident conference while bemoaning the high prevalence of obesity and encouraging patients to eat healthier? A similarly poor example exists in medical conferences, including national meetings, where some morning sessions are accompanied by foods such as donuts and sausage.”

"Unfortunately, doctors suffer from a severe nutrition deficiency—in education. Most doctors are just never taught about the impact healthy nutrition can have on the course of illness, and so, they graduate without this powerful tool in their medical toolbox."

"Now, there are also institutional barriers—such as time constraints, and lack of reimbursement. In general, doctors aren’t paid for counseling people on how to take better care of themselves. Of course, the drug companies also play a role in influencing medical education and practice. Ask your doctor when’s the last time they were taken out to dinner by Big Broccoli—it’s probably been a while."

Fewer than 50 percent of medical schools reported teaching any nutrition in clinical practice. In fact, they may be effectively teaching anti-nutrition, as students typically begin medical school with a greater appreciation for the role of nutrition in health than when they leave.

This is the percentage of medical students at different schools indicating that nutrition is important to their careers upon entry into medical school. Smart bunch — about three-quarters on average. Okay, but then, after two years of instruction in medical school, they were asked the same question. And the numbers plummeted. In fact, at most schools it was zero percent. Instead of being educated, they got de-educated. They had this silly notion that nutrition was important washed right out of their brains. "Preclinical teaching [meaning the first two years of medical school] engenders a loss of a sense of the relevance of the applied discipline of nutrition."

And following medical school, nutrition education during residency is minimal or, more typically, absent. Major updates were released in 2018 for residency and fellowship training requirements, and there were zero requirements for nutrition. So, you could have an internal medicine graduate who comes out of some prestigious program who has learned nothing — literally nothing — about nutrition.

Why isn't diet routinely addressed already in both medical education and practice, and what should be done about it? One of the reasons for the medical silence in nutrition, sadly, is that nutrition takes a back seat because there are few financial incentives to support it.