In the world of nutrition and dietetics, there is one small (very large) problem that is rarely and rarely talked about.
The fact is that a healthy and balanced diet is not only a vital necessity and a system of world knowledge. It’s also fashion. And fashion, as we know, is changeable – and each “stylist” has his own vision, which is often broadcast to the masses.
How to recognize in time the one whose “vision” can harm health? How big is this problem? When did she appear? Can you solve it?
Anton Shekhetov, a physician-nutritionist, chairman of the Public Association “Nutritionists of Russia”, told us about this and many other things.
– Anton, what do you think: the problem of pseudo-doctors – both in nutritionology and in dietetics – has arisen recently, or is it much older?
– It arose back in the 80s with the emergence of the so-called glasnost and the beginnings of a free market. At that time, unrefereed commercial publications began to appear in huge numbers, both in journals and in the form of pseudoscientific literature. These were different collections of diets – weight loss on soda, urinodetox and other nonsense. When I was little, I remember seeing similar publications from my relatives – we had a collection at home that included a yoga diet. Its essence is chewing dry rice according to the number of years: how old you are – so many grains. The highlight of the diet was hunger and daily enemas. Naturally, no one in my family practiced this, the book lay like a collection of jokes.
In the 90s, with the arrival of various manufacturers on the Russian market, the situation worsened. The so-called network marketing pushed companies into all sorts of gimmicks for the sake of sales. In principle, this can be seen even now – in the form of discount promotional codes for dietary supplements. Artists and stars advertised diets named after themselves, the main “trick” of which was a protein shake or a special (secret, Kremlin, Masonic, etc.) diet. Or a blood test, saliva, sweat, hair and other tests, which supposedly showed what foods you get fat from.
– How often in your practice do you encounter practicing doctors without strong medical education?
– In my environment, all doctors are highly qualified specialists in their fields. And thanks to the CME portal (this is a training platform for medical and pharmaceutical education from the Ministry of Health), the qualification level of medical workers, in my opinion, is good. It meets the current standards of medical care.
But in the modern world there is a problem – the high workload of specialists. Doctors have almost no time to attend conferences and participate in round tables. The CME portal cannot replace live communication and full-time training of specialists. Therefore, I think, almost every doctor would answer the question “how do you assess your knowledge”: “not enough, I would like to improve my qualifications, but there is no opportunity”.
If you do not take into account the specialists of the clinic of the Institute of Nutrition, then I very rarely came across doctors who are well versed in dietology. This is partly due to the fact that the subjects “food hygiene” and “dietetics” are given superficially at the university. And this is normal: it is impossible to “pack” all sections of medicine into a university curriculum.
– And how can a “mere mortal”, not a doctor, recognize a “specialist” whose advice is better to avoid? Top criteria for a poor nutritionist and a poor nutritionist, in your opinion.
– Applied to nutritionists. First and foremost – unproven, “alternative” views on nutritional science. All these transformer, preventive, integrative and other “specialists” are good at selling themselves and their products, but I categorically do not recommend trusting them with your health and the health of your loved ones.
Second – recommendations for hungry or unbalanced diets (carnivore diet, keto, paleo, etc.).
The third is the unreasonable exclusion of certain foods from the diet. For example, when, without visible indications, a specialist excludes dairy products or products containing gluten.
Fourth – guarantees for the reduction of body weight for a month from 5% and more.
And fifth, radicalism in relation to specialized food products (dietary supplements, sports food, etc.). Moreover, an indicator of unprofessionalism will be the complete denial of the need for such products, and their excessive imposition. All this applies to nutritionists and nutritionists.
But it is important to understand that a nutritionist is not a medical specialty: he has no right to prescribe drugs for you and guide you as a patient. Therefore, if a nutritionist prescribes medications for you, laboratory or instrumental diagnostics, stop any communication with him. A competent specialist will either not deal with the manifestations of the disease at all, or he will, but in tandem with the attending physician and under his strict supervision.
– Anton, can you give any vivid example of an absurd statement imposed on people by half-educated doctors and which has become a popular “truth”? For example, some trendy but absolutely stupid diet that everyone is trying.
– I can give such examples for a very long time.
History shows that different nutrients take turns falling into public disgrace. There were carbohydrates on this list – later they were “rehabilitated”. Then they began to exclude fats from the diet, and the keto diet appeared. Fortunately, over time, the hype for such things dies down. Now at the peak of “glory” – intermittent fasting. Before him there were medicinal, unloading, dry, wet and others.
– No one is particularly responsible for those who took short courses (for example, on Instagram), received a piece of paper and consults people. Why, in your opinion, is the problem not being solved legally? And is it possible to solve it at all.
– The problem is not being solved, because none of the legislators is interested in solving it. There is no order “from above”, people from below also do not particularly act. So why bother ministries – they already have enough things to do. We live in Russia. They may not do anything to the last, and then, instead of adequate regulation, they can take everything and prohibit it.
While there is such uncertainty, merchants make money from selling documents by distributing controversial training programs. At the same time, one group of people risks their finances and time by investing in such education, and the second – their health, turning to specialists with a dubious level of competence.
This problem can and should be solved. Moreover, officials should have a clear understanding that nutritional science cannot be tied to a medical specialty. It is very expensive and time-consuming to train doctors. There is now an acute shortage of competent nutritionists. Having healthy nutrition specialists without medical education can take some of the burden off medical facilities – and it will also improve life expectancy and reduce health care costs. A nutritionist is a specialist primarily in educational work. They are very much needed in educational and social institutions.
– Imagine that all your knowledge in medicine has now been zeroed out and never existed. What sources will you read to get verified information from real doctors?
– Reliable information, adapted for the general public, is published on their website by WHO, the Ministry of Health and Rospotrebnadzor. These are the resources I would read first. Moreover, not their social media accounts, but websites.
If I wanted to go deeper into the topic, I would join any living professional community that professes the principles of evidence-based dietetics and nutritionology.
The material was prepared by Alexandra Goryunova