 Globally, 11 million deaths are attributable to dietary factors each year, placing poor diet ahead of any other risk factor for death in the world. Given that our diet is our leading killer, you'd think it'd be emphasized in medical school, but there's a deficiency of nutrition education in medical training. A systematic review found that despite the centrality of nutrition to a healthy lifestyle, graduating medical students are not supported through their education to provide the necessary care. It could start in undergrad, but what's more important, learning about humanity's leading killer or organic chemistry? In medical school, students may average only 19 total hours of nutrition out of thousands of hours of instruction, and they're not even being taught what's most useful. How many cases of scurvy or berry-berry diseases of dietary deficiency will they encounter in clinical practice? In contrast, how many of their future patients will be suffering from dietary excesses—obesity, diabetes, hypertension, heart disease? Those are probably a little more common. More than 9 out of 10 cardiologists surveyed believe that their role includes personally providing patients with at least basic nutrition information yet less than 1 in 10 feel they have an expert grasp on the subject. If you look at the clinical guidelines for what we should do for our patients with regards to the number one killer, atherosclerotic cardiovascular disease, all treatment begins with a healthy lifestyle. Yet how can clinicians put these guidelines into practice without adequate training and nutrition? Fewer than 50% of medical schools reported teaching any nutrition in clinical practice. In fact, they may be effectively teaching anti-nutrition as students typically begin medical school with a greater appreciation for the role of nutrition in health than when they leave. This is the percentage of med students at different schools indicating that nutrition is important to their careers upon entry into medical school—a smart bunch, about three quarters on average. Okay, but then after two years of instruction in medical school, they were asked the same question, and the numbers plummeted. In fact, at most schools it was zero percent. Instead of being educated, they got de-educated, had this silly notion that nutrition was important, washed right out of their brains. Preclinical teaching, meaning the first two years of medical school, engenders a loss of a sense of the relevance of the applied discipline of nutrition. And following medical school, nutrition education during residency is minimal or more typically absent. Major updates were released in 2018 for residency and fellowship training requirements, and there were zero requirements for nutrition. So you could have an internal medicine graduate who comes out of some prestigious program who has learned nothing, literally nothing, about nutrition. Why isn't diet routinely addressed already in both medical education and practice, and what should be done about it? One of the reasons for the medical silence in nutrition, sadly, is that nutrition takes a back seat because there are a few financial incentives to support it. What can we do about that? The Food Law and Policy Clinic at the Harvard Law School identified a dozen different policy levers at all stages of medical education, and the kinds of policy recommendations there could be for the decision makers. For instance, the government could require doctors working at the VA at least to get some courses in nutrition, or we could put questions about nutrition on board exams so schools would be pressured to teach it. But as we are now, even patients who just had a heart attack aren't changing their diet. Doctors may not be telling them, and hospitals may be actively undermining their future with the food they serve the patients. The good news is the American Medical Association has passed a resolution, encouraging healthy food options be available in hospitals. What a concept! The AMA hereby calls on U.S. hospitals to improve the health of patients, staff, and visitors by providing a variety of healthy food, including plant-based meals and meals that are low in fat, sodium, and added sugars, eliminating processed meats from menus, and providing and promoting healthy beverages. Nice! Similarly, in 2018, the state of California mandated the availability of plant-based meals for patients, and there are hospitals in Gainesville, Florida, the Bronx, Manhattan, Denver, and Tampa all offering 100% plant-based meals to their patients on a separate menu and distributing materials to in-patient to improve their education on the role of diet, especially plant-based diets in chronic disease. Let's check out some menus. Hmm, a little lentil bolognese? Here's Montefiori's. A little cauliflower scramble with baked hash browns for breakfast, mushroom ragu for lunch, and a white bean stew for supper, soup, salad, and fruit for dessert. This is the first time a hospital menu ever made me hungry. Makes me want to get appendicitis and stay for a few days. The key to these transformations has been having a physician advocate in increasing education of staff and patients on the benefits of eating more plant-based foods. A single clinician can spark change in a whole system, because science is on their side. Doctors have a unique position in society to influence policy at all levels. It's about time we used it.