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From the halls of the United States Congress to the classrooms of medical schools around the world, Martin Kohlmeier, M.D., Ph.D., is championing the cause of nutrition education.
Kohlmeier is a research professor in nutrition with the UNC Chapel Hill Nutrition Research Institute (NRI) at the NC Research Campus in Kannapolis. On April 4, Kohlmeier participated in a Congressional briefing sponsored by the non-profit Physicians Committee for Responsible Medicine in support of two bills, the Expanding Nutrition’s Role in Curricula and Healthcare (ENRICH) Act and the Education and Training (EAT) for Health Act.
ENRICH, sponsored by Rep. Tim Ryan (D-OH), will establish a $15 million grant program through the National Institutes of Health to integrate nutrition education into medical school curricula. EAT, sponsored by Rep. Raul Grijalva (D-AZ), ensures that federallyemployed, health-care professionals receive a specific number of credits in continuing medical education.
“Nutrition education in medical school is a very obvious need, but a very difficult thing because medical curricula are already so crammed,” Kohlmeier commented. “Nutrition is just not something that a lot of physicians think should get the priority. On the other hand, we do the research. We read the literature, and we know how powerful nutrition is.”
Shaping Medical Nutrition
For Kohlmeier, the legislation is a step forward in his quest to improve nutritional education for physicians, a quest that started in 1992 in partnership with Steven Zeisel, MD, PhD, director of the NRI.
Zeisel’s and Kohlmeier’s interest in medical nutrition education was spurred by a 1985 national report that stated nutrition education in medical schools was insufficient, and that a minimum of 25 to 30 hours across the medical school curriculum should be taught. As a result of regular surveys of US medical schools since 2000, Kohlmeier knows that the median number of hours nutrition is taught is now at 17. Still, according to Kohlmeier’s data, 10 percent of all US medical schools do not provide any nutrition education.
Results of the surveys and additional insights into the status of US medical school nutrition education are documented in two journal articles published in May 2014 in the American Journal of Clinical Nutrition titled Residency and specialties training in nutrition: a call for action and Nutrition education in medical school: a time of opportunity.
The goal is simple. “If patients have a question about supplements or diets or food,” Kohlmeier explained, “then we want their physicians to be competent to work with them. We want physicians to know how to counsel patients and talk to them in a time-efficient manner. All of that requires significant training.”
Kohlmeier facilitates that training by producing online nutrition education materials. The materials are used in about half of the medical schools in the United States and in countries like Iceland, Philippines, United Arab Emirates, Sweden, Malawi, Chile and Canada. Most recently, he was invited to visit medical schools in Australia because they are considering his materials as a basis for their nutrition curriculum.
Personalizing Nutrition
Kohlmeier’s passion for nutrition education is fueled by his position at the NRI. “I’m excited about personalized nutrition. At the NRI, our mission is to promote nutrition individuality,” he said.
Individual or personalized nutrition takes into account differences in people’s genes. Scientists like Kohlmeier look specifically at single nucleotide polymorphisms (SNPs) or “alternate spellings” in DNA. Those types of differences in individual genetic codes determine everything from lactose intolerance to whether or not people develop certain cancers, obesity, diabetes and other diseases.
Kohlmeier has published numerous, peer-reviewed papers looking at nutrition and genetics and their effect on health conditions such as bone health, heart disease and cancer. He currently researches the nutrient choline in collaboration with Dr. Zeisel. Choline is an essential nutrient found mostly in meat and eggs. It plays a critical role in cell and brain development, particularly the hippocampus or memory center.
According to Kohlmeier, about half the US population has a genetic variation that makes it harder to produce enough choline, forcing their bodies to rely more on dietary intake. Since choline production is boosted by the female hormone estrogen, men are more susceptible to choline deficiency. A study he is conducting with adult men is specifically looking at choline and muscle health.
“A number of years ago, we found that people who get very little choline sometimes develop signs of muscle damage,” Kohlmeier said. “If you have the genetic disposition that you don’t make enough choline, you may not build as much muscle and that may contribute to muscle loss with aging, which is called sarcopenia. Having enough muscle is a huge issue for older people, preventing a lot of long-term risks. It is related to resistance to infections and resistance to dementia, for example.”
Kohlmeier is combining his experience with nutrition education and genetics and moving it into a new arena. “I’m interested in the translational applications of genetics and nutrigenomics, and bringing them down to the consumer level,” he said. “I have developed a software system that generates meal plans based on who you are, what you do and, not least, your genetic make-up.”
People can use this program at their kitchen counters, in the workplace or in restaurants to create and modify meal plans built on their genetics, food likes and dislikes and lifestyle. Links to recipes are included. Kohlmeier is working on a mobile application complete with restaurant menus.
“When we bring specific genetics into the mix, you see the common thread,” he said. “We can often tell who is likely to need a bit more or should get less of key nutrients to stay healthy and prevent disease.”