If Doctors Learned to Cook, They Might Give Better Advice | Hacker News Reader

If Doctors Learned to Cook, They Might Give Better Advice

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81 pointssethbannon76 comments

Teaching people how to eat better is a laudable idea. Using doctors to provide that information is absolute insanity. The division of labour is not a new or controversial idea; you don't need seven years of medical training to teach basic nutrition.

The British NHS lifestyle education programme is called Change4Life. The programme uses advertising, social media and partnerships with schools, local government, food retailers and community groups. The idea is to provide information in small but frequent doses and in ways that are immediately actionable.

Convenience stores are encouraged to sell more fresh fruit and vegetables with free Point of Sale promotional material. Employers are encouraged to run healthy lifestyle challenges to help their employees eat better, get more exercise and reduce their alcohol intake. Free smartphone apps provide nutrition information and exercise ideas.

http://www.nhs.uk/change4life/pages/overview-policy-backgrou...

Using doctors to provide that information is not insanity, because it's likely that people will take it more seriously if it's from doctors. "Lifestyle educators" aren't trusted like doctors are.

When I was doing primary care, I actually enjoyed talking to patients about nutrition. I can expound on the topic for hours at the drop of a hat. I went to Med school at Tulane (where Dr. Harlan is). But even in the closed system of active duty military, it's hard to believe the time paid off because I rarely saw the patients again. They'd schedule follow up and no show. My clinic schedule would change. They'd deploy. I'd deploy.

Do I eat better? Yes. My family? Probably. Anyone else? Long term? Studies say maybe, but I just don't know.

At least in the US, unless the nutritionist is a doctor, they can't legally diagnose or prescribe medicines or treatments. That also don't usually have binding orders for blood tests either, to find nutritional deficiencies.

And there's always a 'reduce alcohol' message. Even if things like distilled alcohol have no negative and a slightly positive effect on someone with diabetes. But alcohol is "sinful" and those teetotalers will shame it whenever they can.

Yeah, I can see it being an essential skill for nutritionists, but I don't think e.g. surgeons need to know how to cook.

> At least in the US, unless the nutritionist is a doctor, they can't legally diagnose or prescribe medicines or treatments

That's not true; all (or nearly all) US jurisdictions give general prescribing authority to more than just physicians (including MDs and DOs in that label) -- e.g., PAs and NPs.

i live in santa monica in west LA, one of the "healthiest" places in the western world if not the healthiest (you can go literally days without seeing an obese person), and every single doctor i've been to in the past 10 years has advised a healthy diet and exercise first and foremost. many advocate low carb or paleo diets. it's not fringe here - it's mainstream. the medical community here is slowly but surely being taken over by a new guard of young up-to-date professionals who understand the changing science.

But see also "Making Every Contact Count", where obese people who see a doctor are encouraged to think about losing weight (and sometimes given three months free on a weight loss programme) or people who smoke are encouraged to give up (and given access to smoking cessation services) or people who drink too much are encouraged to cut back a bit.

They used to teach this exact same class to every 8th grade student -- it was called home economics. There is a very close relationship between home economics education and health. It is now called family and consumer science but political correctness put aside home economics describes it quite nicely.

The first woman to enter MIT, Ellen Swallow Richards [1], invented the field of home economics. After reading about her, I realized much of home economics is about health. Because we got rid of well defined gender roles doesn't mean we should get rid of home economics.

[1] https://en.wikipedia.org/wiki/Ellen_Swallow_Richards

It's still on the curriculum in England [1], though the class is called something like "Food Technology". I don't know how well it is taught though — do most children still actually cook themselves for this lesson? It seems the curriculum requires that.

[1] https://www.gov.uk/government/publications/national-curricul...

Again, the name changed - it used to be home economics in England too (or just home ec)

Both of my children cooked during the lessons although I don't think it's was as important as them seeing and helping us cook at home regularly.

Back when I did it (fifteen years ago admittedly) we would cook once a week when doing food technology, which was part of the technology rotation where we'd study a particular subject for six weeks or so. In practice that probably meant twelve weeks or so a year. At about 15 you had to choose a single technology subject to study, so those who weren't taking it further wouldn't do any more.

I seem to remember it being quite focused on commercial cooking - lots of theory on portion calculations and pricing everything accordingly, but we would end up cooking something relatively simple and worthwhile. The commercial side apparently became much more pronounced for those who opted to continue, one friend of mine must have spent several months cooking endless variations on cannelloni trying to optimise it.

I remember something similar to that, we spent a chunk of time designing a box for the food to go in. But that doesn't seem to be on the curriculum any more, so that's progress.

(Studying boxes could be useful though, for example noticing the different ways companies emphasize nutritional information.)

> Because we got rid of well defined gender roles doesn't mean we should get rid of home economics.

i would argue that it's a reason to encourage it more.

I'm intrigued as to why you think political correctness led to the renaming of "home economics", and why you think "home economics" is a better name.

You may be better qualified to judge political correctness than I am, but "economics" seems much closer to what's going on that "science" does. That is, there are probably no controlled experiments, but the value and economic use of ingredients is considered.

I took home economics in 1997 or 1998. Pretty much consisted of popping a container of Pillsbury biscuits or cinnamon rolls, placing them on a cookie sheet, and waiting 15-20 minutes to take them out of the oven.

I know how to cook because my mother cooked dinner every night of the week and encouraged me to help her.

It's not that people don't realize that proper nutrition is important. They don't want to give up their lifestyle of eating out at every trending restaurant or indulging in something not so good for you.

Stuff you shouldn't eat too much tends stimulate the release of mood altering hormones leading to an addiction.

After one or two decades of processed foods, people no longer know what to eat.

My doctor prescribes foods and it works really well. I'm really glad to see the industry is beginning to change.

A doctor friend says patients never listen when he tells them to lose weight.

"Eggs are good."

"eggs are bad."

"Coffee is good."

"Coffee is bad."

"Alcohol is bad."

"Red wine is good."

"Fats are bad."

"Fats are good."

Ad absurdum. What else do you expect when the nutritionists, doctors, and universities have horrifically conflicting data? The answer, to me, seems to be a tailored diet to the person... but with 10 minute doctor visits that's not going to happen. The best you can expect is "take a pill and move on".

Everything in moderation. That's a decent rule of thumb.

Everything? Even cigarettes? Of course not, so a better rule of thumb would be to avoid things which are known to cause health problems altogether, at least to an extent which is practical.

Sure, an occasional cigarette probably won't hurt much, all things considered.

Exercise (beyond a point) can cause health problems. I know of a guy who is a quadriplegic because he liked to bike on trails.

But health authorities won't say that; once it gets to the level of advice to laymen, it's been heavily filtered. A quick search returns this page, which claims that "there is no safe level" of cigarette smoke:

http://www.cancer.org.au/preventing-cancer/smoking-and-tobac...

Really? One cigarette per year (per lifetime?) will show up? Of course, what they mean is that, if you're in the population susceptible to nicotine addiction and you're trying to quit, some smoking will make it harder than not at all. But the claim is still false as taken literally.

Nope. Doesn't work in my case. At least in reference to carbohydrates (simple and complex). More carbs = higher blood sugar.

Currently, diabetes type 2 dietitians say I can eat up to 60g carbs per meal. Well, see for yourself and tell me if you think that's a good idea in my case:

https://mega.nz/#!JwcSEAwC!zPqA1zVhA3zcLwLLZRJucc6AtT9zlHfNY...

Pay attention to row 37. I started with 143mg/dL . I made a meal that was much higher than I had anticipated. My high was 182mg/dL and lasted for about 3.5 hours until returning to before food numbers.

And that was just 12g carbohydrates (2/3 sugar, 1/3 complex).

But doctors can be helpful.

I was once in poor health. Feeling tired, suffering from high cholesterol and gaining weight despite not eating much.

He told me to drop saturated fats, simple sugars and animal protein. And instead choke on complex carbs, vegetables and vegetable oils.

The doctor was fat himself, so the contrarian in me did the natural thing and went 180 on his advice: dropped complex carbs, vegetables and oils and instead choked on saturated fats, simple carbs (even sugar and candy) and animal protein.

I was once in poor health.

> gaining weight despite not eating much.

It doesn't work like that.

It really discounts the rest of your story.

Yeah outside of tapeworms, eating at a calorie deficit should always result in weight loss (although not healthy, sustainable weight loss).

Please don't pretend to understand nutrition if you don't. Doing this hurts people.

There's plenty of science showing that people with different gut bacteria can lose / gain weight while eating the same amount of calories.

That's neat - what does a typical day look like for you? I assume since you're allowing yourself simple carbs you're not in ketosis, what sorts of vegetables do you have with your meals?

The BBC has just run an interesting TV series where a doctor visits families in their homes and improves their health by changing their diets, and adding exercise. The results are both visible and -- importantly -- measurable.

http://www.bbc.co.uk/mediacentre/proginfo/2015/46/doctor-in-...

The series is going to be repeated in January so UK residents will be able to watch them.

http://www.bbc.co.uk/programmes/b06q6y95

Of course, medical advice on diet hasn't always been entirely correct, but I think there's a pretty broad consensus on Dr Chatterjee's approach -- cut out the fast food and processed foods, avoid added sugars, cut carbs, eat more veggies and fibre, eat a wider variety of foods etc. You don't really med school training to figure this out.

About 3 weeks ago, I was diagnosed with T2 diabetes. I was given the "take this pill and leave me alone" treatment most doctors do these days. The pill was Metformin.

I asked about food, since that is the only way I am getting nutrients in my body. His answer was, "If it tastes good, don't eat it."

I cook a great deal, as does my wife. If I can change my diet so that my blood-sugar level stays within healthy parameters, I'll gladly do it. And, I've done it.

There is a technique called "Eating to the meter", which tailors a diabetes diet to your body. I can see what foods do what. Those sugar-alcohols sometimes do and don't cause an effect. Malitol causes no spike, but xylitol does. Don't know why, but I know it does in me. And all of this is internet derived advice. But it's better; far better than what the doctor said...

'Take this pill and go away'

do some research into ketogenic diets. "if it tastes good don't eat it" mainly refers to processed sugar and carbs, not real food. for example, roasted chicken and cauliflower tastes delicious and i would certainly choose it over a donut any time of day. is chicken and cauliflower somehow off limits for diabetics? i'm no doctor, but probably not.

Unfortunately, that's the pablum my doctor said. I have not been following my doctor's advice, as it is generally scientifically bad. I haven't went all in what was said.

All meats are safe, as long as they are relatively unprocessed. When processing adds corn starch, sugar, or other carbohydrates is when the meats are not good for me.

Cauliflower is perfect for me. It's also how I make "mashed potatoes". Find a frozen bag of cauliflower and cook it. Let it dry out a bit, and add butter and heavy whipping cream, and blend. 0g carb mashed potatoes.

Also, How I have been testing food is "test -> eat -> blood glucose test every half hour for 3 times". Now that I have data on about 70% of what I normally eat, I don't have to test those foods.

I'm much healthier now that I'm following a low carb diet of my own design. I'm eating about 0-15 g carbs a day. Surprisingly, it's similar to Atkins, but with the blood-glucose meter component. I can scientifically say that I'm doing better with regards to that dimension.

try buying a whole head of cauliflower and roasting it for 45 minutes at 350F with some olive oil and salt/pepper on it. i just eat it like a steak.

> All meats are safe

Meat, processed or not, is a large risk factor in diabetes. See:

Meat consumption, diabetes, and its complications.

http://www.ncbi.nlm.nih.gov/pubmed/23354681

Association between dietary meat consumption and incident type 2 diabetes: the EPIC-InterAct study.

http://www.ncbi.nlm.nih.gov/pubmed/22983636

Oxygen-carrying proteins in meat and risk of diabetes mellitus.

http://www.ncbi.nlm.nih.gov/pubmed/23778318

Relationship of dietary saturated fatty acids and body habitus to serum insulin concentrations: the Normative Aging Study.

http://www.ncbi.nlm.nih.gov/pubmed/8338037

Also, fruit and vegetables are all "carbs", so a diet with 0 carbs is utter insanity, and a recipe for poor health and disease.

this guy always chimes in with this kind of thing - he's pushing a vegan agenda.

You have been warned by moderators before to tone down your rhetoric regarding my posts; I'm simply presenting some worthwhile research, which you should reply to on its merit, not your preconceived notion that any evidence you disagree with must be part of some agenda. That you keep painting me with a "vegan" paintbrush in order to downplay or even dismiss me gives credence to the fact you haven't actually got a scientifically tenable argument to retort with.

Frankly, I don't care about what percentage of the population gets X. Or Y. Or might get Z.

In the end, those studies are nigh worthless, because they are about some statistic. When you're a doctor, a statistic is nice because they can be partially right. I want custom medicine tailored to me!

Instead of meat-hating studies, show me tests I can conduct that can validate your assertions about my own body. What tests can I run reasonably? I can obtain the appropriate equipment.

(I replied here because reply was off. Deleted for a proper response)

I absolutely understand where you're coming from. What about measuring LDL cholesterol (should be <75), BMI (<25), triglycerides (<150), fasting glucose (<100), and blood pressure? I think those are great biometrics for general health. Note, my posts do not constitute medical advice - I am simply sharing my experience and findings which I'm happy to have challenged.

> I absolutely understand where you're coming from. What about measuring LDL cholesterol (should be <75), triglycerides (<150)

It's within the ideal range, as is HDL. My triglycerides were 290mg/dL, so High. The more studying I'm doing in this area points more towards Metabolic Syndrome as well, with T2 diabetes as a result of that syndrome. No proof as of yet, just uncorroborated hypothesis.

> BMI (<25)

38, but I don't look it. I'm 6'5", and I've always been off the growth charts. Now, with my current diet, I've lost 18 lbs down to 298 in 3 weeks. I am working on this. Ideally, I want 220lbs. I've been there before and I look great, lest the BMI be damned.

>fasting glucose (<100)

That's what I have it down to now. 3 weeks ago, it was fasting=161mg/dL . After switching to a highly restrictive carbohydrate diet, it took 6 days for my fasting to drop to 110-120mg/dL. I got sick, which is easily viewable from my data. It also corroborates from fellow Type 2's and 1's I know. Sickness causes blood glucose to get "screwy". Now, my fasting is 100mg/dL

> and blood pressure?

I haven't the money for an automated unit, but it is on my agenda. I do test moderately high (140/80, prior to T2 diagnosis).

> I think those are great biometrics for general health. Note, my posts do not constitute medical advice - I am simply sharing my experience and findings which I'm happy to have challenged.

I agree. I'm looking for even more, as well as writing software to analyze my results. Effectively, I want a system I can tell what food I'm eating, and how much. I want to do these analyses personally for me. Right now, outside of food, food quantity, speed of eating, temp, BP, heart rate, weight, and blood sugar, there isn't many ways I can get that great of data. Lab data is so sparse to be nearly pointless.

I hear allegations about all sorts of foods and supplements. I want proof. I'm willing to work with others, as well as being a guinea pig (to a point). But I want to see real results.

My data: https://mega.nz/#!JwcSEAwC!zPqA1zVhA3zcLwLLZRJucc6AtT9zlHfNY...

I had a peek at your data and must say I'm surprised and impressed you manage LDL cholesterol under 75 with the amount of animal products you consume. (I noticed you said it's "within the ideal range", but did not concede it was actually under 75). For context, a single egg already puts you close to the daily recommended cholesterol limit of 200-300 mg.

Anyway, I share your ambition to get "real results" and see how foods affect my biology as quickly as possible. Sadly, we just don't have the technology to enable us yet (I predict dietary biometrics will be a big trend soon). Until then, I can only reference my own independent research into and experience with whole food, plant-based diets void of animal products (strict) and processed foods (not as strict). I'm well over a year in and feel better than before, my blood work is great and I regret nothing. The only supplement I take is a B-12 vitamin once per week. A good jumping off point for me were the websites, http://nutritionfacts.org and https://cronometer.com.

i'm not retorting you, i'm simply stating that you're pushing a vegan agenda, which is true.

Fine, but your comment has no substance and makes for trite reading. So what if I promote a vegan diet? Are you genuinely so threatened by this fact that you find it important to chime in to let readers know every time I post? If you find what I have had to say to be inaccurate or otherwise alarming, please explain why and correct me, using facts and citations, not conjecture and personal anecdotes.

In fact, your post history reveals you have a keen interest in low-carb diets, so citing your evidence, reading mine, and generally having an intelligent debate on the matter of human health and nutrition seems like a more interesting way to spend the time, rather than aggressive name-calling and making dismissive generalizations.

Congrats on your accomplishments.

If I can change my diet so that my blood-sugar level stays within healthy parameters, I'll gladly do it.

In addition to what you have done, you might look up articles on diabetes and inflammation. They are linked. I have a condition that predisposes me to blood sugar issues and I have worked on consuming an anti-inflammatory diet. Addressing the blood sugar issues was not even on my radar. I had other concerns I was trying to address. My blood sugar is more stable than it has probably ever been in my life.

I think this is an excellent idea. I am a bit surprised at the reactions against this concept. The key statement to zero in on is that doctors feel they do not have sufficient training to provide advice. The operative words being "sufficient training" and "advice."

Providing a few classes in basic nutrition/cooking to doctors can go a long way in their ability to treat and prevent diseases. Tulane is not suggesting that doctors spend 4 years in France working their way up from a garde manger.

Food can and should be viewed by doctors as a form of medicine. This perspective aligns with the basic definition of medicine and the role of a doctor.

Nutrition has always been high on my list of important topics, and yes, they do teach the subject in medical school. It used to be that it was an elective set of courses, so true, not all medical students became well-versed in it. Not sure how much it's changed, though I suspect nutrition is still not widely enough taught.

Interestingly, when I was a kid in the 8th grade it was standard practice to have the boys and girls switch shop/home ec classes a few times during the school year. It was certainly educational for me. Actually the students rather liked doing this, and no doubt quite an enlightened policy for the time.

As for behavior modification, no reason a doctor wouldn't be able to be skilled and assist patients needing help with dietary management, etc. Doctors have to do a lot of that sort of thing anyway since many conditions and treatments require "lifestyle" changes. Of course, some doctors will be better at it, and others not so adept. But that's pretty much the case re: certain skill sets among those in any given occupation.

> when I was a kid in the 8th grade it was standard practice to have the boys and girls switch shop/home ec classes a few times during the school year

Growing up in Norway, "home ec" was a mandatory subject, 2 hrs/week, for everyone in 6th grade and again in 9th grade. Shop class was also mandatory for everyone: I remember in 10th grade everyone made their own outdoor knife (well, we made the sheaths from leather, the handles from wood, and then we got the blades and joined them in; no blacksmithing).

In 9th grade we also had outdoor cooking (on a fire) for a rotating 1/4 of the class every week, summer and winter. Fun times, smelling so badly of campfire that the 1/4 of class was shunned by others for the rest of the day.

There is an upcoming field called "nutrigenomics", where genetic information is combined with foods and dietary supplements to address a wide range of topics, from (chronic) diseases, to aging. See [2] for a practical example.

[1] https://en.wikipedia.org/wiki/Nutrigenomics

[2] https://www.bulletproofexec.com/the-mthfr-gene-mutation-and-...

Most doctors can cook yet, and most doctors give a good advice yet, so the title is bad. A fake starting point to arrive to an obvious statement.

And the claimed benefits are not so clear. Doctors that give better advice probably just spend more time studying and practicing and less time doing maccaroni. If this people would need to pay money to be teached how to cook as a part of their really long way to being doctors, they will probably advertise food brands in the end to compensate the loses.

A great deal of medicine seems to be curative rather than preventative. We ll know exercise is good for us, but you wouldn't expect your doctor to design your training schedule. Then again both nutrition and exercise seem to have a large "common sense" element to them in my opinion.

I would expect my doctor to tell me to hit the gym and eat better.

So doctors will teach patients how to cook in 5 minutes?

Without reading the article I already have so many questions. Why all this speculation!? How many doctors who have learned how to cook does it need to test this hypothesis and aren't those easy to come about.

What is well documented beyond any doubt is that nutrition is more important for your health than nearly anything else in life, so there is no doubt that getting his patients to eat more helthy food is one of the most important things a doctor can do.

One of the point of the article is that doctors that can cook may be able to give nutritional advice to their patients that they can relate to, and that does not get too abstract.

I had similar concerns, what new breed of superdocs are they hoping to create, considering that doctors before them certainly did have some level of meal preparation ability? But fortunately the article is more nuanced, i read it as "when general household skills are in decline, young doctors may be bottlenecked by that when talking about nutrition, some cooking classes might help".

I see that as a refreshing break from the usual pattern of naive "if there are numbers (no matter which) it must be true"-empirism that holds the medical profession in a stranglehold. (even the antiscientific alternative medicine people do most of their arguing by blowing numbers out of proportion, people rarely become doctors because they were particularly good at maths)

Preposterous!! they should also be trained to give behavior modification advice too? This too could save lives. People need to use common sense, learn what's good for yourself and practice that. At this rate the author will soon want them to learn to code too!

I can't tell if you're being sarcastic or not.

Wouldn't a doctor be a good person to ask what's good for you? amazon has about 50,000 different diet books, it's really not obvious what's "right". Even the glorious USDA has a lot of industry influence in what it recommends/accepts. The food plate is better than the water, kale, and doughnut diet, but it has its own issues.

so, yeah, for a general practice they should probably talk about quitting smoking, getting exercise, avoiding being overweight, guns, etc. pretty much anything on the top 10[1] seems like a good idea.

[1] http://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm

I didn't see guns on the list you linked to. I did see that Heart Disease and Cancer account for nearly twice the number of deaths as the remaining eight items on the list.

What am I missing?

Actual causes of death, table 2: http://www.csdp.org/research/1238.pdf#page=3

I hope they are trained to give behaviour modification advice.

Otherwise schemes like " Making Every Contact Count" are useless.

http://www.makingeverycontactcount.co.uk/

https://www.england.nhs.uk/wp-content/uploads/2014/06/mecc-g...

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