Meet OUR NEW TEAM MEMBER SINEm

February 9th, 2018

Sinem Photo blog

Written by Sinem Kilinic

“let food be thy medicine and medicine be thy food”. Hippocrates 431 B.C.

Hi All!

My name is Sinem and I’m almost a final year medical student at Barts and The London. I’m currently intercalating doing an MSc in Global Health and Public Policy. My interest in diet and nutrition stems from my transition to veganism a year and a half ago and discovering the revolutionary wholefoods plant-based diet with innumerable benefits. After being absorbed in diet and nutrition related documentaries and books, I became disillusioned at the lack of inclusion of nutrition and lifestyle education within the medical curriculum. Nutritank, provides a fresh and innovative platform to create content about nutrition and lifestyle medicine and to share my knowledge and passion with other medics.

If you’re wondering why diet and nutrition is so important, then let me explain it in the words of Dr Michael Greger M.D. “if that’s all a healthy plant-based diet could do – reverse our #1 killer of men and women – shouldn’t that be the default diet, until proven otherwise?” Similarly, in the UK, cardiovascular diseases are our second leading cause of death with a cost of more than £6.8 billion to the NHS.14,15 In fact, we have all seen many family members, friends and patients suffering from preventable, treatable and even reversible diseases3-9 including, but not limited to, cardiovascular disease and diabetes. The perception that these diseases are inescapable and must be endured is a myth to be dispelled.

However, nutrition and lifestyle education in medicine is often considered as an inexact science that is not evidence based or something to be advised by dieticians only. GMC’s Outcomes for Graduates stipulate that doctors, in all sectors of the NHS, should be able to: relate the influence of nutrition and diet on health and disease, assess nutritional state and advise on nutrition at all stages of life for both over and under nutrition.1,2 However, nutrition in medicine education is largely neglected and mainly taught within the confines of metabolic pathways or as applied to specific diseases, such as glycaemic index for diabetics. Whilst pharmacological treatments have an overwhelming amount of reference to research and evidence based guidelines available this is not the case for nutrition, diet and other lifestyle interventions. In medical school, nutrition, diet and lifestyle interventions are virtually dismissed as opposed to pharmacology, where plenty of teaching and examination is dedicated to. For example, there are no OSCE stations to assess dietary and lifestyle advice, including exercise and sleep, given in the same way as smoking cessation and medication reviews. Since this realisation, I have decided to write my dissertation this year about the omission of nutrition from medical education and explore ways to tackle this.

Lifestyle interventions are already the first line management for obesity10, type 2 diabetes11, high blood pressure12 and cholesterol13, but its effective implementation is rendered impracticable through the lack of nutrition and lifestyle education and explicit guidelines for doctors. As shown in trials such as the BROAD study, dietary interventions can be extremely effective to drastically improve health, address the rise of multiple co-morbidities and polypharmacy and empower patients in the long-term as well as provide a cost-effective intervention to prevent premature deaths and disability.3-9

I believe the significance of diet and nutrition as a core component in health should be reflected in medical education and practise. As tomorrow’s doctors, it is also our responsibility and duty to bring this to the forefront and effect change!

References:

  1. General Medical Council. Tomorrow’s Doctors; Outcomes for Graduates (Tomorrow’s Doctors).London: General Medical Council; 2015. [Accessed 10 February, 2018]. Available from: https://www.gmc-uk.org/publications/undergraduate_education_publications.asp
  2. Academy of Medical Royal Colleges Intercollegiate Group on Nutrition. UK Undergraduate Curriculum in Nutrition. 2013. [Accessed 10 February, 2018]. Available from: http://www.aomrc.org.uk/wp-content/uploads/2016/08/Undergraduate_Curriculum_Nutrition_0213-2.pdf
  3. Esselstyn CB., Jr Updating a 12 year experience with arrest and reversal therapy for coronary heart disease. Am J Cardiol.  84:339–341.
  4. Ornish D, Scherwitz LW, Billings JH, Brown SE, Gould KL, Merritt TA et al. Intensive lifestyle changes for reversal of coronary heart disease. JAMA1998; 280: 2001–2007.
  5. Wright, N.; Wilson, L.; Smith, M.; Duncan, B.; McHugh, P. The BROAD study: A randomised controlled trial using a whole food plant-based diet in the community for obesity, ischaemic heart disease or diabetes.  Diabetes.2017, 7:e256
  6. Harland, J. and Garton, L. (2016), An update of the evidence relating to plant-based diets and cardiovascular disease, type 2 diabetes and overweight. Nutr Bull, 41: 323–338. doi:10.1111/nbu.12235
  7. L, Morton D, Hurlow T, Rankin P, Hanna A, Diehl H. Long-term effectiveness of the community-based Complete Health Improvement Program (CHIP) lifestyle intervention: a cohort study. BMJ Open. 2013;3(11):e003751. doi:10.1136/bmjopen-2013-003751.
  8. McMacken M, Shah S. A plant-based diet for the prevention and treatment of type 2 diabetes. Journal of Geriatric Cardiology: JGC. 2017;14(5):342-354. doi:10.11909/j.issn.1671-5411.2017.05.009.
  9. Estruch R, Ros E, Salas-Salvadó J, Covas M-I, Corella D, Arós F, et al. Primary prevention of cardiovascular disease with a Mediterranean diet. New England J Med. 2013;368:1279–90.
  10. Obesity: identification, assessment and management. 2014. [Accessed 10 February, 2018]. Available from: https://www.nice.org.uk/guidance/cg189
  11. Type 2 Diabetes in adults: management. 2017. [Accessed 10 February, 2018]. Available from: https://www.nice.org.uk/guidance/ng28/chapter/Key-priorities-for-implementation
  12. Hypertension in adults: diagnosis and management. 2016. [Accessed 10 February, 2018]. Available from: https://www.nice.org.uk/guidance/cg127/chapter/1-Guidance#lifestyle-interventions
  13. Cardiovascular disease: risk assessment and reduction, including lipid modification 2016. [Accessed 10 February, 2018]. Available from: https://www.nice.org.uk/guidance/cg181
  14. Office for National Statistics. Deaths registered in England and Wales (series DR): 2016. [Accessed 14 February, 2018]. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsregisteredinenglandandwalesseriesdr/2016
  15. British Heart Foundation. CARDIOVASCULAR DISEASE STATISTICS 2014. [Accessed 14 February, 2018]. Available from: ssehsactive.org.uk/userfiles/Documents/eonomiccosts.pdf

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