“You must be able to support”: this new diploma trains doctors in vegetarian diets

France is certainly not one of the 5 most vegetarian countries in the world, but the trend to make your plate greener continues on our territory. According to an Ifop survey conducted in 2020, 2.2% of the population declare to have followed a meat-free diet (pescetarian, vegetarian or vegan) and 24% of French men and women, ie a quarter of the population, are focused on flexitarianism. Whatever the motivations, the transition to a more plant-based diet requires support from a health perspective, as it will require a review of all of your nutritional balance performance. Problem: Most doctors have little or no training on these issues. Faced with this observation, the Faculty of Medicine of the Sorbonne launched this year the first university course dedicated to vegetarian diets. We spoke with Prof. Olivier Steichen, the co-founder of this unique training.

From January to May 2022, the Faculty of Medicine of the Sorbonne University welcomes the first-ever promotion of the University Degree (DU) “Vegetarian Foods”. For example, some 40 health professionals are being trained remotely in the care of a patient population that has completely or partially excluded products of animal origin. This training was unprecedented “long awaited”, according to Prof. Olivier Steichen. The latter, head of the department of internal medicine at Tenon Hospital, founded this DU together with his colleague Nathanaël Lapidus, lecturer at Sorbonne University and hospital doctor in public health at Saint-Antoine Hospital. Their goal: to enable doctors to carry out their mission of support and to adequately follow up the growing number of vegetarian or vegan patients. For vege goodProfessor Olivier Steichen discusses the contours of this new diploma.

Photo: Olivier Steichen

Why did you and your colleague decide to create this university course, which is unique in France?

It all started with a general observation: during medical training very few courses are devoted to nutrition in general and even less to specific diets such as vegetarianism or veganism. In recent years we have received a lot of feedback from patients who wanted to start eating more plant-based, but were advised against it by their doctor. Mostly, practitioners told them they were at risk of missing out on protein or iron… Although this isn’t the biggest problem at all!

In fact, most doctors are misinformed about this topic, I think it extends to all medical professions. The risk is that this leads to poor support for the patient or to conflict, or even a break in the relationship of trust between the practitioner and his patient.

We want to avoid this at all costs, especially since very often patients are determined to change their diet regardless of their doctor’s advice. If they are confronted with restraint in consultation, they may not dare to take up the subject for fear of being stigmatized or of hearing arguments they know are false. That’s why we created this training so that doctors can learn and understand their patients’ motivations to fully fulfill their mission of support. The goal: to make the approach of these patients compatible with their health, thanks to effective follow-up.

The vegan diet, like vegetarianism, suffers from many misconceptions, but are they dangerous to your health?

If they are done properly, there are no risks. These two diets offer no advantages over a balanced diet that contains proteins of animal origin, but at least for a balanced diet it should only contain these proteins in small amounts. A vegetarian or vegan diet can also be well-balanced, but you need to know how to put together complete meals.

Especially among vegans, there is still a need to be vigilant about some nutrients such as vitamin B12 or iodine, which require understanding of the subject and giving advice tailored to the patient.

What does the counseling of vegans or vegetarians for a doctor consist of?

First of all, it is necessary to respect the same principles of balance as for the other types of food. In other words, one must ensure that the calorie intake is sufficient but not excessive, that there are enough fruits and vegetables, that the proteins are obtained in sufficient quantities, that there is not too much sugar, etc. For proteins, it is for example, necessary to be vigilant because in an omnivorous diet they are quite easily found in animal meat, eggs or milk, but for vegans or vegetarians it is necessary to learn how to obtain them in other ways. The doctor can then refer the patient to nuts, legumes, whole grains, and other sources of plant proteins.

Then health professionals should also monitor the risk of deficiencies, especially in iodine and vitamin B12 for vegans. Patients should be instructed on how to properly supplement.

Finally, I would say that in order to properly support these patients, you have to listen to them and understand their motivations – without necessarily sticking to them. Empathy is also cognitive and part of medical care. Our training includes all these aspects to give as many keys as possible to practitioners.

Photo: Shutterstock

Who exactly is this new university diploma for?

It is intended for health professionals who feel insecure about the quality of their knowledge to support vegetarians or vegans. So this can concern both young graduates and older practitioners. In addition, dieticians also pointed out to us that they are insufficiently trained in these matters during dietetics studies, even though they are increasingly confronted with vegan or vegetarian patients. They would like to train to support these patients with the same level of need as the others. That is why we have decided to make this diploma public.

Thus, among the registrants making up the very first promotion are a third of dietitians, a quarter of physicians (GPs, endocrinologists, sports physicians, etc.) and other health professionals such as nurses, pharmacists and a dentist. There are also nutrition coaches, people who work in local governments – including an elected official from a major city responsible for ecological transition – and restaurant owners who want to offer a healthy and balanced vegetarian offer. The training is completely online, which means we have French students, but also Swiss or Belgian students.

How did you organize this training content?

In total, the training lasts 70 hours and we have divided it into three thirds. The first includes an analysis of the literature and established data on the links between a plant-based diet and health. Specifically, it involves integrating the health benefits and risks of greening one’s diet, in terms of cardiovascular health, bone health, etc. There are also courses on nutrition that cover, for example, proteins or certain trace elements or micronutrients such as iron, zinc or calcium. Finally, recommended dietary intakes and ways to meet them with a plant-based diet are discussed.

The second third is more social-scientific oriented. We’ve got sociologists, anthropologists, psychologists, and economists coming to talk to us about the rationale for greening the board. The aim is to contextualize this personal approach in the context of major social issues (ecology, animal welfare, etc.) so that practitioners better understand the choice of their vegetarian or vegan patients.

Finally, the last third applies to implementing the key principles we identified earlier. The idea is to develop concrete support in different situations by taking examples of, for example, a pregnant woman, an athlete or an elderly person.

The training started in January 2022, what is your assessment so far?

That’s right, it started in January and lasts until May. We are very happy with the way things are going, the participants are very diligent, ask a lot of questions and have original memories. Indeed, the preparation of a dissertation is part of their assessment and while some have opted for research work, particularly on the perception of vegetarian or vegan diets, others have chosen to work on practical applications. For example, there are dietitians who want to develop tools to help their colleagues support vegetarian patients in a simple and practical way.

We believe that this first promotion is invested and motivated by the fact that they are finally being offered a much anticipated training.

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Why do you think there was no training on these subjects before?

I think the phenomenon has been quite marginal so far, especially in France where vegans only represent 1 or 2% of the population. But today the power of flexitarianism is increasing, which would affect almost 25% of French men and women. These people want to significantly reduce their consumption of products of animal origin and above all they come for advice from dieticians. There has therefore been a major movement towards health professionals with a request for support that practitioners are unable to meet. But this is still very recent.

We still find such training abroad, especially in Canada, the United States and the United Kingdom. Some of our students have also been trained in English speaking countries, but their diplomas have no value in France. At the time, they simply had no other way of getting scientifically validated information on the subject.

Today, the scientific literature on vegan and vegetarian diets is considerable, but of varying quality. There is still a lot of material to exploit. Nathanaël Lapidus and I are also part of a working group at ANSES, consisting of about fifteen experts, that deals with these questions. Our mission is to dissect and critically analyze the literature and then establish dietary reference values ​​appropriate for vegetarian or vegan diets.

Do you think that this knowledge should eventually be integrated into compulsory medical training?

Maybe not 70 hours of class like in our training, but there are certain principles that must be learned at all costs, yes, that’s for sure. In particular, the hostility that health professionals can have towards these regimes due to lack of knowledge needs to be reduced. It is necessary to make it clear to the practitioners that there is no problem if they behave well, if the iron or protein intake is adequate, etc.

Finally, we keep repeating this warning, but it is time to strengthen the knowledge about vitamin B12 supplementation. This question is still relatively unknown to healthcare providers, which is surprising but especially regrettable because it is essential.

With the launch of the DU “Vegetarian Foods”, caring for vegetarians and vegans is finally entering the medical curriculum. Good news for doctors, dietitians and patients who want to make their plates greener. Visit the Sorbonne website to learn more about this unique training.

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