What 20 Years in Medicine Taught Me About Food (That I Didn't Learn in School)

I spent two decades in patient rooms. Some of the things I learned about food came from lectures and journals. Most came from people — sitting across from them, hearing what they ate, watching what worked. These are the ten things I took from clinical practice that I wish someone had told me in my first year.

Not written for a medical audience. Written for the patient I couldn’t give an hour to.

1. What people say they eat and what they actually eat are different

I don’t mean that patients lie. I mean that memory is generous. Someone says “I eat really healthy” and means it. A food journal, kept honestly for one week, almost always reveals a different picture. Not a worse person. Just more accurate.

I stopped asking “what do you eat?” and started asking “what did you eat yesterday, starting at wake-up?” Specific gets honest. General gets optimistic.

2. Most chronic symptoms that don’t show on a blood test still have a pattern

When a patient came to me with “I just don’t feel right” and the labs were normal, I used to reassure and move on. Over years, I noticed these patients almost always had one or two patterns: eating too little protein, eating irregularly, chronic under-sleeping, or a quiet alcohol habit. Not always. Usually.

The blood test is a snapshot. The patterns are the film.

3. Food is the vehicle, structure is the engine

Two patients can eat the exact same food. One eats it standing at a counter, scrolling, over 8 minutes. The other sits, unhurried, over 25. Same calories, same macronutrients. Different outcomes for digestion, satiety, and — sometimes — weight.

Chewing matters. Sitting matters. Time matters. This isn’t romance; it’s mechanics.

4. The stress hormone is louder than the food

A woman comes in with chronic bloating and heartburn. Her diet is clean — we review it three times. What we eventually find is that she eats lunch in 6 minutes between meetings every day. The food isn’t the problem. The state in which she’s eating it is.

Your gut doesn’t care about your calendar. It processes at its own pace. When you rush, it responds.

5. Protein is the most under-eaten nutrient after 45

By far. I watched this pattern in hundreds of women in their 50s and 60s. Protein per meal is often 10-15 grams when it needs to be closer to 25-30. It’s invisible to them because they’re eating “reasonably” — but not enough protein. The consequences (muscle loss, slower metabolism, fatigue) show up slowly and get blamed on age.

Age matters. But the protein does too.

6. Fibre is the actual gut “cleanse”

Every marketed cleanse I’ve ever seen is a distraction from the one thing that actually moves the gut: 25-38 grams of fibre per day, every day. Most Canadians eat half that. If you want your digestion to improve, this is the single highest-leverage change available.

I’m almost tired of saying it. But it remains true.

7. People can tolerate more variation than they think

A lot of patients arrive afraid of food. Gluten is scary. Dairy is scary. Carbs at night are scary. Most of these fears don’t survive a real elimination-and-reintroduction protocol. Of the 100 women I’ve guided through careful reintroduction, about 20 had a real, specific sensitivity. The other 80 were afraid of food that didn’t actually harm them.

Fear limits more lives than the food itself.

8. Sleep beats almost every supplement

If I had to pick one intervention with the most outsized impact on weight, mood, digestion, and blood sugar — it would be consistent sleep. Not eight hours religiously. Consistent hours. Same wake time. Same time to bed ±30 minutes. The body will metabolize in ways supplements can’t match.

I prescribed sleep more than I prescribed anything else in my last few years of practice.

9. Relationships influence what you eat more than willpower does

Who you live with. Who you eat with. Whose kitchen you’re in most of the time. These factors move people’s eating more than any plan I’ve ever written. A husband who buys a box of chocolates every Friday is a variable. A workplace that orders pizza weekly is a variable. A grandmother who offers seconds three times is a variable.

A good plan accounts for them. A bad plan assumes you live alone in a lab.

10. The body rewards slow change

Patients in a hurry to fix everything in 30 days frustrate me, lovingly. Thirty days is enough to see some changes. Ninety is enough to see patterns settle. A year is enough to shift a life. The body doesn’t reward urgency. It rewards consistency.

I repeat this line because it mattered more than I realised at the time: the body rewards slow change.

What I couldn’t do in medicine that I can now

Seven minutes wasn’t enough to say any of this. You can’t teach pattern recognition, food journaling, sleep hygiene, reintroduction protocols, or protein math in seven minutes. You can write a prescription in seven minutes, which is partly why that’s what the system rewarded.

At Vicaria, the default appointment is long enough for this to actually happen.

The Vicaria difference

If you’re in your 40s, 50s, or 60s and you’ve been told your labs are fine but you don’t feel fine — what’s usually missing is the conversation I couldn’t have with you in the clinic. Message us on WhatsApp or book a free 15-minute consultation.

Related: Why I became a health coach after practising medicine for two decades.