Off with his bread!

Strange things stir us medical students up. We can look at pictures of mutilated heads and sloughing skin while sipping coffee. We can cut apart dead bodies while chatting about our weekend plans. But mention margarine and partially hydrogenated heck might break loose. Three of us spent five minutes the other day discussing our shock and surprise after a professor mentioned the nasty Napoleonic spread in a lecture (Napoleon’s nephew spawned margarine; fortunately, French cooking recovered nicely).

Margarine floated into conversation after we had an hour-long lecture on nutrition in Circulation, our first class of the second year. OHSU diet expert Sonja Connor gave the talk, and gave each of us a copy of her cookbook, to boot.  She mentioned that many of the folks she sees in clinic like to eat a little margarine on their bread, and counseled us on how to balance that desire with the need for the lower-fat, low-salt diet she recommended. Folks have been talking about the lecture since, from debating the wisdom of fat substitutes to rating the recipes.

The hour on eating is far from our only dietary lesson. We spent more hours discussing how cholesterol and fat fuel heart disease, and how diet can change that risk. Now, we’ve moved on to more salty knowledge, how sodium can affect the kidneys and high blood pressure. This winter, we’ll learn much more about the epidemic of diabetes and diet’s role in that. Food keeps coming up in our clinical experiences, too. I’ve already counseled patients on reducing salt and eating lean protein. I’ve seen older patients prescribed more salt and a daily dish of ice cream (yes, you read that right).

The point of all this is that diet matters, and matters a lot. Those of us lucky enough to eat each day may not pay much attention to food (that mindlessness may be one reason obesity is increasing). But food has a huge medical importance. And a huge social one, which is why doctors and patients and even med students get so worked up by fad diets or mentions of margarine. I am especially interested in diet, both as a person who needs to eat better and as an aspiring doctor with an interest in managing chronic conditions like diabetes, obesity and heart disease, ailments that require good nutrition as part of their treatment.

So I was excited to hear that the folks who own Bob’s Red Mill have pledged $25 million to OHSU to help fund research into how our diets affect disease – and how better nutrition can fight illness. I’m especially excited that this new institute will focus on how to involve the whole community in better nutrition. Community outreach is something health workers in general need to be better at, and something I wish we as students could do more often. And epidemics of obesity and diabetes fueled by U.S. lifestyles are only going to be fixed by social changes in how we think about and choose our foods. If imperial margarine got us into this mess, we might need a grass-roots food revolution – and a few spoonfuls of olive oil – to restore us to health.


For more information about the new Bob and Charlee Moore Institute for Nutrition and Wellness, check out the news release; an announcement from OHSU President Joe Robertson; the Bob’s Red Mill blog; and the OHSU Research News blog;

One response to “Off with his bread!

  1. Not only is diet critically important as one of the social determinants of health, food policy at a larger level is an essential topic for most physicians to be familiar with and actively involved in. The simple fact that the % of GNP in the US associated with food and health care was 15% and 8% respectively in 1975 and now is reversed (i.e., 8% for food, which is cheaper because of questionable government subsidies but more highly processed and much less healthy, and 15% for health care, primarily because of dramatic increases in chronic illnesses, especially preventable ones like diabetes and heart disease) should spur us to action.
    Staying informed and becoming active in promoting larger scale changes in food policy will have a direct impact on our patients and their health outcomes.
    See, for example, op-ed pieces in the NY Times by Mark Bittman ( or Slow Food’s website (

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