I’m a big believer that most “black and white” statements about nutrition are oversimplified, frequently to the point of being inaccurate; and that the longer, grayer story is really the better one.
While I could (and just might) write an entire series based on this introduction, today’s long-overdue post addresses a mostly-inaccurate statement that is frequently made by those offering pet nutrition advice online, and even occasionally by veterinarians. I’m referring to the myth “veterinarians don’t know anything about nutrition.”
First, some truths. All graduates of US veterinary schools, no matter when they graduated, have nutrition integrated into their curriculum, whether it was a required course labeled “Nutrition 407” or whether it was sprinkled into other aspects of medicine, it’s in there. Some nutrition knowledge is also requisite to pass examinations for veterinary graduates to practice in the US. I’ll be the first to agree that some veterinary institutions don’t provide enough nutrition training; however, even those institutions have curriculum that incorporates critical thinking, research, and the importance of continuing education. To maintain licensure to practice, veterinarians are required to complete a certain amount of continuing education each year, and there are many options available for veterinarians to either brush up on nutrition or pick up where vet school left off. It’s just a matter of making an effort to do so. There really isn’t a good excuse for a veterinarian to be ignorant when it comes to nutrition.
All that said, I just revealed my feelings about black-and-white statements about nutrition, so I’ll also say that I absolutely have met a (very) few veterinarians who appear to have completely blocked nutrition from their memory and have no interest in learning something new. They exist, but they’re exceptionally rare. I do, however, stand behind the black-and-white statement that there just isn’t a good excuse for this. What can I say? No profession is perfect.
So, if (nearly) every veterinarian practicing in the US truly has some nutrition knowledge, how can it be that this myth is so prevalent, even to the point that some veterinarians say it about themselves?
While a study on veterinarians’ self-reported level of nutrition knowledge, comparing it to their educational records, and correlating these with how they approach nutrition in practice would be an amazing tool for improving nutrition care within US veterinary practices, and the best way to answer this question, it doesn’t exist, to my knowledge. What I do have to offer, is my assessment of the situation, based on my own veterinary and residency training, my time spent teaching at veterinary universities, and several years of speaking with veterinarians and pet owners about their experiences. This is not a substitute for a more evidence-based approach, but it’s what we have.
The way I view veterinarians’ nutrition deficiencies focuses not on knowledge, but on communication.
First, we have to go back 20-30 years to consider that things have changed relatively recently when it comes to nutrition. There were drastically fewer options for pet owners to choose from when it came to pet food, and pet food marketing was fairly simplistic. The body of knowledge about pet nutrition and diet formulation was much smaller, and internet access wasn’t a factor in people’s decision-making. Because of this, there was a tendency for pet owners to ask veterinarians for nutrition advice when it was needed, and to take that advice at face value. Easy.
Now, all of those factors have changed. Pet owners think about nutrition much more than they did in the past, largely due to the ease with which information is available now. There has been an explosion in the number of pet food options available, and along with this, some very smart marketing that has even managed to look like unbiased information has entered the pet food market. In addition, science has progressed so that we now know much more about pet nutrition, and pet food and the internet has brought the general public a ton of information (some useful, some useless, much confusing). With all of these changes, people’s expectations of their veterinarian, when it comes to nutrition, have changed.
Pet owners are no longer asking for advice (even if they phrase it as such). They’re asking for a dialog. Rather than the basic instruction that would have been acceptable in the past, pet owners now want to know that their veterinarian recognizes their concerns and the energy that they’ve devoted to learning about the subject. They want the vet to be willing and able to engage in a conversation about it and they want to play an active role in determining the course of action.
Like most aspects of both veterinary medicine and life in general, having this conversation takes practice. Incidentally, it’s not something that gets talked about a lot, but one of the most important things that veterinary students in their clinical year, and new graduates, do is refine their explanations of common diseases and medical concepts. It takes time to figure out the most effective and efficient way to convey the most important information; and it’s different for everybody.
So, 20-30 years ago, veterinarians never had to be good at talking with pet owners about nutrition, because no one was asking if a grain-free diet would help their pet with diarrhea. No one was asking if a raw-meat-based diet would improve a skin problem, and no one was trying to balance a home-prepared diet using whole food ingredients. Again, black-and-white statements here- I don’t mean literally anyone, I just mean few enough people to justify not having to learn to have these conversations.
While nutrition is absolutely present in the veterinary curriculum in the US, talking about nutrition: not so much, with the exception of teaching by a few of my very proactive colleagues. It’s been up to vets to learn it on their own. By far, the vast majority of veterinarians that I talk to who’ll say that they “don’t know anything about nutrition” are actually able to make perfectly reasonable nutritional recommendations in most instances, but where they fall down is in answering the pet owner’s question about why they made the recommendation. They haven’t had the practice. It’s not a knowledge issue, it’s a communication issue.
While the pet owner may be asking “is diet x good for my pet?” it’s not a yes-or-no question anymore. Veterinarians don’t usually recognize that exactly what and how a pet is fed can potentially say a lot about the pet owner, and the pet owner may have invested much energy in the subject and determined that diet x is the way to go. Some pet food marketing has given many pet owners some false ideas about what is and is not important in pet food, and when a veterinarian outright disagrees with the results of a pet owner’s research, it’s natural for that pet owner to be offended. As a generally peaceful bunch, most veterinarians don’t enjoy being put in these situations, so it’s easy to see how “I don’t know” may be the easier (though incorrect) answer. Another scenario where “I don’t know” may incorrectly come up is in response to claims such as “feeding abc diet will cure your pet’s medical condition.” Veterinarians are trained in critical evaluation of information, so if there isn’t any valid evidence-based information on which the veterinarian can advise otherwise, “I don’t know” is the alternative to the full explanation of the importance of evidence-based medicine.
While I don’t believe that “I don’t know” is the right answer in either of these scenarios, when veterinarians are managing hospitalized patients and returning phone calls from worried pet owners in between running a hospital, surgeries, appointments that are never long enough, walk-in patients, and emergencies, with a little bit of perspective, it’s easy to understand how saying “I don’t know” and not having a 40-minute conversation about nutrition may be the answer that keeps the day on track.
I’ll try not to sound like a marriage counselor here, but if the problem is communication, then the solution is to understand the other person’s perspective and taking steps to accommodate it.
My calls to action:
Veterinarians: Ask owners of pets requiring nutritional care or clients with concerns about feeding their pet to schedule an appointment to discuss nutrition. Consider that criticism of your client’s current feeding choices is indirectly criticism of your client and their lifestyle. Focus on providing background in evidence-based medicine and the medical basis for your recommendations. Point out the level of evidence that informs each idea being discussed. Find a gentle (but honest) way to suggest making changes, and keep the focus on the fact that you both want to provide the best care possible to the pet. Contact a veterinary nutritionist if needed. Use this opportunity to develop your approach to talking about nutrition. You’ll say “umm” a lot and feel like it’s your first week in practice for a while, but it will become second-nature. Your client will leave with the impression that you care, that you listened, and that you do know something about nutrition.
Pet owners: It’s tricky to navigate pet nutrition advice. There’s a lot of it, and it ranges from excellent to terrible. Often terrible is cleverly disguised as excellent. There are resources for dog and cat owners that can help, but your vet is really the best person to help sort it out. However, understand that while “is diet x good for my pet?” sounds like a simple question, it isn’t. Not if you want an intelligent answer. The answer actually involves your pet’s medical needs (the easy part because your veterinarian already has a handle on this); your pet’s current and possibly previous diets, and his/her response to them; and the logistics of feeding and lifestyle in your home. If you are honestly interested in your veterinarian’s opinion of your pet’s diet (you should be), it’s only fair that you give them an opportunity to give you a good answer. Asking about nutrition as a “by the way” as your vet is leaving for her next appointment isn’t fair. You probably won’t be satisfied with the answer, and your veterinarian won’t get the chance to provide your pet with the best possible care. Just as you’d schedule an appointment with your vet if you had questions about your pet’s itchy skin, go ahead and schedule one for your questions about diet.
It’s not the easy way out (surprise), but between veterinarians’ expanding knowledge base in nutrition, more practice with talking about it, and a bit of perspective, the myth that veterinarians don’t know anything about nutrition can hopefully be put to rest.