In 1998 my skin turned as yellow as a school bus, I broke out in a horrific rash, and I was bedridden with back spasms. When I finally went to the emergency room, the doctors asked me a bunch of questions, ordered blood tests, and sent me down the hall for a chest x-ray. A rash like the one I had, they said, could signal chest cancer. That was a very long hall.

Every test came back negative except one. As best they could tell, I had a very strange, severe case of mononucleosis that had compromised my liver. The doctors and students left my side, and a young intern told me I should rest; I’d be back to normal in about a month.

I asked if there was anything I should or shouldn’t eat to help my liver. The intern said, “Um…Don’t eat chocolate?”

The next day, I saw an herbalist who told me to avoid alcohol, sugar, flour, fried foods, fatty foods, and pretty much any processed food. All of those things make the liver work hard, she said. I took her advice, and just a week later I felt well enough to return to work.

Two months later another doctor checked my bilirubin—the stuff that turned me yellow. It was nearly back to normal, so I asked him if I could drink a beer or two; New Year’s Eve was approaching.

He said, “If I were you, I would never drink alcohol again, at least not for a long time.” He added that any time liver function is that compromised, you really don’t want to mess around. And nothing taxes the liver like alcohol. Then he rattled off a list of foods I should avoid.

I didn’t understand why this physician had such a stronger opinion than the ER doctors. But Martin Kohlmeier could’ve told me. His research shows that at most medical schools, teaching nutrition isn’t a priority. Not even teaching how diet relates to common illnesses or conditions. Students and doctors have to seek out such training on their own. In fact, medical students receive less nutrition training today than five years ago, even though, as Kohlmeier says, patients are clamoring for guidance from their physicians. Part of Kohlmeier’s job is to make sure nutrition training is available to all who want it.

The National Academy of Science’s Institute of Medicine recommends that medical students receive a minimum of twenty-five hours of nutrition training. That’s not a lot, Kohlmeier says, but schools rarely meet that threshold. Kohlmeier, who has an MD, and dietitian Kelly Adams surveyed 109 medical schools—86 percent of all U.S. med schools—and found that only 25 percent of the institutions met the institute’s recommendation. That was down from 40 percent in 2004. They found that nutrition education was optional at four schools, and one school offered no training at all.

Since the 1990s, medical instructors have been telling Adams that they’ve switched to an integrated curriculum where courses such as biochemistry and physiology are interspersed with lectures and commentaries on other subjects, including nutrition. Adams’ survey backed that up. It revealed that a majority of schools use integrated curriculums. “When that happens, there are so many competing demands for professors,” she says. “Nutrition seems to get squeezed out.” Just 26 out of 105 schools had whole courses dedicated to nutrition.

Adams says surveys show that some doctors don’t feel comfortable teaching nutrition because they haven’t been trained to teach it. Nutrition doesn’t have a departmental home at most universities, she says, so there’s no budget for teaching the subject.

Students, meanwhile, don’t have time to study everything. But Kohlmeier says they should make time for nutrition. “We doctors keep saying that more than half of our illnesses are directly related to nutrition,” he says. “Not having nutrition as part of the physician’s toolkit is kind of bizarre. It’s like a computer programmer not knowing programming languages.”

Adams and Kohlmeier are taking on this problem. They run UNC’s Nutrition in Medicine program, which has two missions: to figure out what’s happening in nutrition education at medical schools and to provide an online curriculum to help medical students, residents, fellows, and other doctors get the nutrition coursework they need. The Nutrition in Medicine team of physicians, dieticians, and nutrition educators create and update the curriculum content, which is based on established nutrition guidelines and covers everything from nutrition during infancy to dietary management for diabetics.

“We’re trying to give students and doctors tools right down to specific phrases,” Kohlmeier says. For instance, in the curriculum’s sidebar about breastfeeding a newborn, the advice doctors should give to patients is unequivocal: start immediately, sleep in the same room as your baby, don’t give other fluids, don’t use a pacifier, feed often, evaluate progress, see a pediatrician, give vitamin D drops.

“Sometimes it’s just a thirty-second counsel, but you have to learn that somewhere,” Kohlmeier says. “Everyone assumes surgeons master technique. Well, they don’t learn it on their own; they learn it as part of a program.”

On average, students who use the Nutrition in Medicine curriculum wind up with twenty-four hours of nutritional training during their first two years of med school. Students not using the curriculum average less than fourteen hours. “What we count as nutritional training is fairly generous,” Kohlmeier says. “For instance, when a biochemistry professor talks about vitamins, that counts toward nutrition education even though that’s still really biochemistry.”

As of February 2011, between 25 and 30 percent of all U.S. medical students were using UNC’s Nutrition in Medicine curriculum. They can complete each online unit in under an hour. For residents, fellows, and MDs, the units are much shorter. “The idea is that a doctor can do a unit and walk across the hall and treat a patient,” Adams says. “We’re not trying to teach doctors to become registered dietitians.” In fact, the curriculum makes clear which patients should be referred to a dietitian. “Doctors don’t have an hour to counsel patients on nutrition,” she says. “We understand that, but patients are asking doctors questions.”

In certain situations, Adams says, doctors should bring up nutrition before anything else. “If you’re diagnosed with hypertension,” she says, “and the doctor never mentions diet, then what impression does that give you—medication or nothing? Some dietary interventions are as effective as medication.”

In 2005 I had another food-related dilemma. Nearly every day, an hour after breakfast, I’d feel weak, shaky, and tired. My belly would hurt after lunch and dinner. I consulted with a physician, who prescribed an antidepressant.

“But, um,” I stammered, “I’m not depressed.”

“Well,” the doctor said, “antidepressants have been known to help people with digestive problems.”

“So I’d take this drug for how long, exactly?”

The doctor said, “We’d just see how it worked.”

“What about the weakness and lethargy?” I asked.

He said, “Try eating some bacon with your cereal.”

Eating salty strips of greasy pork every day seemed like suspect advice. I crumpled up the prescription and saw a second doctor, who didn’t think diet had anything to do with my digestive problems. Antidepressants could help, he said.

Was this a conspiracy? My gut hurt after I ate food, and I felt weak and tired after I ate breakfast. But diet had nothing to do with either? What I really needed was an antidepressant with a bacon chaser?

Since then, I’ve learned how antidepressants can help people with digestive problems. So might biofeedback and hypnosis. (See More than Meets the Mind.) A third doctor, though, had no doubt that diet was a likely culprit in my case. He had just hired a naturopath—a non-MD practitioner who finds the least invasive measures to relieve symptoms or return the body to its natural state of healthfulness.

The doctor deferred to the naturopath. She asked about my diet, which consisted of heavy doses of bread, chicken, cheese, cereal, assorted baked goods, and probably not enough fruits and vegetables. Obviously, I knew my diet was a bit out of whack, but I didn’t know how far out of whack until she said I should stop eating bread, sugar, and cheese for a while. White bread, she said, essentially turns into sugar during digestion. And sugar feeds the bad bacteria in our intestines. (See The Good, the Bad, and the Unknown.)

To help with my morning weakness, she recommended a homemade cereal of raw oats, almonds, walnuts, sunflower seeds, and pumpkin seeds. She also said I should eat a lot more vegetables and fruit. I bit the bullet and changed my diet, and about a week later I felt like a new man. The naturopath told me her recommendations were based on her training at a school for naturopathy, her own experience with patients, and research studies.

UNC dietitian Suzanne Havala Hobbs, author of Being Vegetarian for Dummies and Living Dairy-Free for Dummies, says there’s overwhelming evidence that limiting sweets and junk food and eating a lot of fruits, vegetables, grains, legumes, seeds, and nuts are the best ways to maintain health, including digestive health. As for specific gastrointestinal symptoms, Hobbs says advice should be individualized. But she does advocate for the elimination diet—cutting out specific foods to see which ones might be causing symptoms. Three other UNC researchers recommend the same thing.

Medical doctor William Heizer and dietitians Susannah Southern and Susan McGovern reviewed 175 research studies about the role of diet in Irritable Bowel Syndrome (IBS)—a group of gastrointestinal symptoms that have no known cause. Clinical studies have shown that changing diet or taking supplements such as soluble fiber, turmeric, and peppermint oil, helps some IBS patients but not others. That makes sense when you consider that IBS symptoms vary widely from person to person.

Southern suggests people keep a food journal and write down symptoms that follow meals or snacks. She says this has helped her patients figure out which foods, if any, are causing problems. Then patients eliminate suspected trouble foods and see if that makes a difference. For me, those foods were bread, cheese, and sugar. “Wheat contains fructans and galactans that are poorly absorbed in most people,” Southern says. “Some people are fructose intolerant, just like some people are lactose intolerant.” Galactan is a carbohydrate also found in legumes, cabbage, and other gas-forming vegetables.

When I told Southern about feeling weak and shaky after breakfast, she said, “Sounds like you needed more protein in the mornings. Eggs, nuts, Greek yogurt, and cottage cheese are all good options. And oats are a good food because of the soluble fiber.”

That sounds like common sense. But many of us, myself included, are trained from a very young age to eat certain foods. It never occured to me that eating nuts and seeds for breakfast would suit me best. Also, I admit I was unaware that humans could even digest raw oats.

Maybe my third doctor shouldn’t have referred me to a naturopath. (Many health professionals are leery of naturopathy.) But the particular MD I saw felt that the naturopath knew more than he did about diet-related digestive problems. To Martin Kohlmeier, a doctor deferring to a naturopath is “a sad testimony” on the state of nutrition in traditional medical practice. “I find it very interesting that you had that experience,” he told me. “It should not be up to patients to seek out nutritional counseling. It should just be part of the package patients get when they visit their physician.”

Kohlmeier says that most patients probably wouldn’t expect their physicians to give them elaborate explanations about nutrition as it relates to certain conditions and diseases. “Probably a few words would’ve helped you,” he told me.

They did. And they still do.

Martin Kohlmeier is a research professor, and Kelly Adams is a research associate, both in the Department of Nutrition in the School of Medicine and the Gillings School of Global Public Health. They receive funding from the National Cancer Institute and the Office of Dietary Supplements in the National Institutes of Health. Susannah Southern is a registered dietitian in the UNC Outpatient Nutrition Clinic, and Suzanne Havala Hobbs is a registered dietitian and clinical associate professor in the Gillings School of Global Public Health.