Proper Nutrition Is the Best Medicine: Advancing the Practice of Clinical Nutrition

By Daniel L . Hurley, MD, FACE and Molly McMahon, MD, FACE

Nutrition is important from the young to the elderly, has a range that extends from overnutrition to undernutrition, and includes specialized issues related to health and illness. Healthy nutrition is important to promote bodily health, and to prevent and treat some common medical conditions. For instance, healthy nutrition can help decrease the chance of developing diabetes. Healthy nutrition is also an important part of the treatment program for patients with diabetes.

Overnutrition refers to conditions such as obesity and overweight. Choosing the appropriate diet is important for those trying to lose and maintain weight, or for those before and after weight loss surgery. Undernutrition refers to malnourished patients. Malnutrition may occur due to an inability to take in adequate calories as food or if the food eaten cannot be fully absorbed (i.e., malabsorption). Some malnourished patients require specialized oral supplement drinks or foods. For patients that cannot eat adequately by mouth, feeding through intestinal tubes (tube feeding) or intravenous catheters (parenteral nutrition) may be needed. Young children, pregnant women and older persons have special nutrition needs.

Nutrition is also important for patients with osteoporosis, elevated blood fats, high blood pressure, kidney disease, disordered eating (i.e., anorexia and bulimia), solid organ or bone marrow transplants, and cancer. Cancer patients may become malnourished because of their underlying disease or because of the effects of undergoing chemotherapy or radiation treatment.

Currently, many medical programs do not provide enough education in clinical nutrition for doctors in training. This lack of nutrition training applies to all levels of medical training, from medical school to medical specialties such as endocrinology. As a result, there are not enough doctors well trained in nutrition medicine. Yet nutrition topics are of great interest to patients, and a nutrition expert can help clarify information in the news that can be confusing.

The American Association of Clinical Endocrinologists (AACE) created and published a paper that outlines how important nutrition is to patient care and addresses how to improve the training of endocrinologists in nutrition medicine https://www.aace.com/files/positionstatements/nutrition.pdf). Endocrinologists already have an education in metabolism, and this background, combined with education in nutritional medicine, will prepare endocrinologists to provide expert nutrition care to both ambulatory and hospitalized patients.

For example, many people take dietary herbal supplements, in addition to vitamins and minerals, in hope of promoting their health and preventing disease. All of these conditions are commonly treated by endocrinologists, and nutrition education will allow physicians to better serve their patients’ nutritional needs. Patient education is important for healthy eating, and more knowledge is needed of different diets for people with different ethnic backgrounds. Safe instruction in physical activity is also important, both to initiate and maintain activity and in dealing with limitations for exercise. We work closely with other healthcare team and activity specialists to find ways to help you make nutrition changes a part of a daily approach to a healthy lifestyle.

AACE is advocating approaches to address the nutrition physician shortage and to ensure endocrinologists are well trained in nutrition by supporting medical education via web-based nutrition programs and courses. AACE also intends to work with other national medical groups on nutrition projects and education programs, an important process to assist all specialties in dealing with nutrition education, research and advocacy issues. Endocrinologists who are well trained in nutrition medicine will lead these efforts, which ultimately will result in excellent nutrition care for you, the patient.

In the meantime, be sure to ask your endocrinologist about best nutritional choices for your family—don’t be shy! To help get you going, here are some questions that AACE physician members commonly encounter and have tackled:

  • What is a reasonable weight goal for me to improve my diabetes?
  • Can you tell me about the Mediterranean diet benefits?
  • I have high blood fats – what is a good diet pattern for me?
  • How much vitamin D should I take after bariatric surgery?
  • Are calcium supplements safe, and which ones are best for me?
  • What supplement can help me gain weight after my hospitalization?
  • How much protein do I need now that I am on hemodialysis?
  • Is it safe to take melatonin?
  • I am confused about the types of fats. Can you help me understand?
  • My mother was advised to have a stomach feeding tube. Can you tell me more?
  • Should I take high amounts of vitamin E to prevent heart disease?

AACE has created a must-read guidebook to lifelong nutrition for anyone seeking the healthiest way to eat. For more information or to order a copy, visit https://www.aace.com/publications/bookstore.

Dr. Daniel L. Hurley is a consultant in the Department of Medicine and Division of Endocrinology, Diabetes, Metabolism and Nutrition at Mayo Clinic. He received his Internal Medicine and Endocrinology training at Mayo Graduate School of Medicine. Dr. Hurley was awarded the Randall G. Sprague Award for Outstanding Achievement as an Endocrine fellow, the Department of Medicine Teacher of the Year Award, and the Henry S. Plummer Distinguished Physician Award for the Department of Medicine. His clinical interests include metabolic bone disease, nutritional health, and mentoring endocrine fellows and staff physicians new to Mayo Foundation

Dr. M. Molly McMahon is a consultant in the Division of Endocrinology, Diabetes, Metabolism and Nutrition at Mayo Clinic in Rochester, MN. She is Professor of Medicine at Mayo Medical School. Dr. McMahon serves as the Medical Director for Nutrition in Endocrinology, the Medical Director of the clinical dietitians and the Nutrition Support Service allied health members. She also has a focus on wellness and healthy nutrition on campus and serves on the Wellness Executive Committee at Mayo Clinic. She co-chairs the Nutrition Committee for AACE.