I Prescribe Diet Changes Every Week. Med School Barely Taught Me Anything Relevant

 Nearly every week, I recommend a change in diet as a first-line treatment for type 2 diabetes, high blood pressure, and high cholesterol -- the conditions that fill American clinics and account for more death than any other factors. Yet, nearly everything I know about how to prescribe diet appropriately, I learned after medical school, on my own time. My formal training gave me only a few scattered hours on the single most powerful lever I have for preventing and reversing chronic disease.

I don't say this as a confession of personal negligence. I say it because it is, more or less, the universal experience of American physicians, and it is by design.

Nutrition is a drop in the bucket in U.S. medical school education: less than 1% of total lecture hours cover nutrition, on average. And as of 2024, about three-quarters of U.S. medical schools still did not require any dedicated clinical nutrition courses. Students surveyed in 2021 reported an average of just 1.2 hours of formal nutrition education a year. A 2023 survey found that fewer than 8% had received 20 or more hours across all 4 years. A benchmark of 25 hours, set back in 1985, is still met by only a minority of schools. We produce doctors who can recite the mechanism of every statin, yet they can name almost nothing about the dietary pattern shown to reverse the disease the statin is for.

The mismatch would almost be comical if the stakes were lower. Poor diet now kills more people globally than smoking, and diet-related conditions are the leading drivers of death. Nutrition related disease is also wildly expensive, costing an estimated $400 billion a year in treatment for hypertension, diabetes, and high cholesterol alone, and projected to more than triple within 25 years. We train physicians exhaustively in the pharmacology of managing those diseases and almost not at all in the intervention most likely to prevent or reverse them.

I would argue that medicine needs something like a "Tesla moment" -- a willingness to rethink an infrastructure built for one era in the face of a different problem. Our system was designed around acute illness and single-target treatment: find the broken part, then drug it or cut it out. That model is extraordinary for a heart attack and poorly matched to the slow, multi-system, diet-driven diseases that now dominate. Medical education is where the old infrastructure quietly reproduces itself. Every year we mint thousands of physicians superbly equipped to manage conditions we could often prevent -- because that is what the curriculum was built to do, and what the board exams reward.

Patients and providers feel the gap even when they can't name it. Only about 14% of providers say they feel comfortable talking with patients about food; when nutrition knowledge is actually tested, many physicians and trainees don't pass. So, the patient who asks what she should eat often gets a referral, a prescription, or a shrug -- and then goes looking for answers from influencers, fad diets, and supplement manufacturers, an industry all too happy to fill the vacuum that medicine left open. The absence of trained guidance is not neutral. It cedes the territory to whoever is loudest.

The encouraging news is that this may be changing. In March, HHS announced that 53 medical schools across 31 states had committed to require at least 40 hours of nutrition education beginning this fall. That is real progress, and I welcome it. It is also a quiet indictment: that 40-hour mark -- roughly one week, across 4 years and a career -- highlights how far below the floor we had been operating before. We are congratulating ourselves for giving future doctors 1 week of training pertaining to the largest single contributor to the diseases many of them will spend their lives treating.

But 1 week is a start, not a destination. Real reform means weaving nutrition through the curriculum and into clinical rotations, not quarantining it in a single lecture block; testing it on the exams that determine what students actually bother to learn; and defining competencies, not just hours. Every physician should graduate prepared to have a genuinely useful conversation about food, and to know when and how to hand off a patient to a registered dietitian. That last piece requires a payment system willing to cover the dietitian's time, which today it mostly is not. Training and reimbursement are two halves of the same failure.

None of this means physicians should become dietitians, or that a good diet can replace every medication. It means calibration. When an intervention is genuinely first-line -- recommended in the guidelines, backed by trials, and reached for in clinic every day -- it deserves more than a rounding error of a doctor's education. And the remarkable thing about this particular gap is how concrete the fix is. This is not a mystery of biology. It is a decision about what we choose to teach.

The most useful thing I do for many of my patients is help them change the way they eat, and I have gotten good at it. But I had to go find that skill after my training told me, by omission, that it didn't matter much. The next generation of physicians shouldn't have to learn nutrition on their own time. Give them the week. Then give them the year.

Hana Kahleova, MD, PhD, is an endocrinologist and serves as a director of Clinical Research at the Physicians Committee for Responsible Medicine

https://www.medpagetoday.com/opinion/second-opinions/122446

IRGC says efforts to disarm Hamas doomed to fail

 

Iran’s Islamic Revolutionary Guard Corps (IRGC) said on Sunday that efforts to disarm Hamas had already failed, in a statement marking the second anniversary of Israel’s assassination of former Hamas political chief Ismail Haniyeh in Tehran.

“The final victory of Palestine” is closer than “the enemies imagine,” the statement said, describing Haniyeh’s killing while attending President Masoud Pezeshkian’s inauguration as an official guest as “a flagrant violation of the principles and norms of international law” and Iran’s sovereignty and territorial integrity.

https://www.iranintl.com/en/202608025878

Iranian agents use legal routes to enter UK - Sunday Express

 

Iranian spies are bringing surveillance teams and hitmen into the UK on work and study visas, while the Islamic Revolutionary Guard Corps (IRGC) has also smuggled operatives into the country on small boats, the Sunday Express reported.

https://www.iranintl.com/en/202608026154

UAE pressed Trump for tougher Iran action, IRGC weighs preemptive strikes - WSJ

 

The United Arab Emirates has lobbied US President Donald Trump in recent days to take more decisive action against Iran, the Wall Street Journal reported, citing senior officials from Persian Gulf states familiar with the discussion.

The officials suggested that Iran’s Islamic Revolutionary Guard Corps (IRGC) would not compromise until the US escalated, took control over the Strait of Hormuz and perhaps considered ground operations, according to the report.

An Iranian diplomat told the Journal that Iranian officials were aware of Trump’s political vulnerability and were looking to exploit it if necessary. Should diplomacy fail, the diplomat said, the IRGC was considering preemptive strikes even if the US did not attack.

https://www.iranintl.com/en/202608022486

'WaPo: Head of US military Euro Command says not sufficiently equipped to defend Israel'

 Gen. Alexus Grynkewich, head of the US military’s European Command, has sent the Pentagon a written warning that if he doesn’t receive another Navy destroyer, he “will be forced to choose defense of the United States ‘homeland’ over that of Israel, according to unidentified officials cited by the Washington Post.

The European Command coordinates operations in the Mediterranean, where its vessels help shoot down projectiles launched at Israel from both Iran and Yemen’s Iran-backed Houthi rebels, the Post says. Two of the European Command’s five Rota, Spain-based destroyers were stationed in the Mediterranean as of Friday, according to the Post.

On the other hand, the European Command is also responsible for protecting against potential Russian incursions into NATO territory and the threat posed by Russia’s long-range missiles, which can reach the US, the Post notes.

The Pentagon declined to comment on the report, while the European Command did not respond to requests for comment and a spokesperson for the Israeli embassy in Washington could not be reached for comment, the newspaper says.

https://www.timesofisrael.com/liveblog_entry/head-of-us-militarys-european-command-said-to-warn-his-navy-not-enough-to-defend-both-israel-and-us/

Entitled Migrants Complain About Hospitality And Prices After Invading Spanish Territory

 One of the most egregious fantasies promoted by liberals over the past several decades is the worshipful image of the desperate and grateful third world asylum seeker.  We see it constantly in movies television and popular media; the narrative of the "huddled masses, yearning to breathe free..."  This narrative has become so ingrained in western culture that it is absolutely world shattering when people find out how entitled and arrogant most migrants really are.

The flood of over 60,000 Muslim migrants from Morocco to the Spanish enclave of Ceuta has dashed a lot of progressive delusions in the past week, with migrants fresh from the beaches already looting businesses, raiding homes, attacking locals and setting fires.  European officials are reluctantly admitting that the invasion is a problem that must be corrected.   

The video evidence on social media is a crushing blow to the multicultural agenda, so much so that Ursula von der Leyen, head of the European Commission, complained about the optics of the images coming out of Ceuta on social media. 

Spanish officials have attacked the negative response of some European leaders as "selfish" and "prejudiced", stating that the European Union would be harmed by the "polarizing" rhetoric.  

But isn't this migrant horde exactly what European elites have been enabling for the past decade?  Yes, it is, but the Cueta incident is happening too quickly and gaining far too much public attention.  They usually prefer a "frog in a boiling pot" strategy over blatant barbarian pillaging plastered all over international news. 

But it gets much worse for the multicultural cabal, because interviews with these migrants are hitting the mainstream.  What these people have to say about their stay in Ceuta so far is mind blowing.  The entitlement is unprecedented.  Third worlders thought they were marching into a free buffet with easy access to amenities, jobs and westerners bowing at their feet. 

Instead, the illegals were met with closed businesses (for safety), prices they could not afford, no jobs and hostility from other migrants who came to Ceuta legally.  

People being beaten or killed (if the claims are true) is unfortunate, but then again, it seems to have worked.  Large numbers of migrants are reportedly leaving Ceuta on their own because they fear backlash from the locals.  There's an important lesson that could be learned her by populations across the western world:

If governments are not going to do their duty and secure national borders from invaders, then the public still has the power to make those invaders leave simply by making the lives of illegal migrants miserable.  If their experiences in the west are worse than their experiences in their home country, they will go back.

  

Of course, the entitlement of migrants is amplified by progressive leaders in the west.  Foreigners have been regaled with stories from western media about a land of plenty and a life of ease.  All they have to do is make the crossing and the streets will be paved with riches for the taking.  It is clear that the majority of migrants entering Ceuta were under the impression that they would be welcomed with open arms and lavished with subsidies.

Instead, the Spanish military is escorting thousands of them out of the enclave.  Or, at the very least, the military is making a good show of trying to remove the migrants from the area.  Meanwhile, the locals are doing the job that the government should have been doing from the beginning, which is making Ceuta so inhospitable to migrants that they will never want to go back.  

https://www.zerohedge.com/geopolitical/entitled-migrants-complain-about-hospitality-and-prices-after-invading-spanish

The Ceuta Migrant Surge, and the Important SCOTUS Decision Everybody Missed

 By Andrew R. Arthur

On Thursday, many Americans learned for the first time that the European Union (EU) shares a land border with Africa as 49,000 (mainly Moroccan male) migrants poured into Ceuta, a Spanish exclave on the south side of the Strait of Gibraltar that on Wednesday had a population of 83,500. Understanding why they came highlights the importance of Mullin v. Al Otro Lado (Spanish, ironically, for “the other side”), the most important U.S. Supreme Court case this last term that most people missed. 

 

 

A Brief History of Two Spanish Exclaves on the African Coast

Actually, the EU shares two land borders with Africa, both Spanish exclaves (and enclaves): one Ceuta (“Sebtah” to the Moroccans) and the other Melilla (called “Melilah” by Morocco). 

The former was the launchpad for the Islamic invasion of the Iberian peninsula in the 8th century (which began a Muslim occupation that continued in places for nearly 800 years), and ironically, each was subsequently conquered during the Reconquista that ended Muslim rule: Melilla by Spanish captains in 1494 (it was annexed to Spain in 1556); and Ceuta by the Portuguese in 1415, who transferred it to Spain in 1661.

Spain kept the two exclaves even after Morocco gained its independence (from French and Spanish “protectorates”, a complicated story for another day) in 1956, and as the BBC has noted: “For the Muslims, Ceuta and Melilla are a painful reminder of Muslim defeat and humiliation by rising Western, Christian powers.”

Two Triggers for the Latest Surge

While I trust that there are those who will credit “root cause” push factors like “violence, food insecurity, severe poverty, corruption, climate change, the continuing effects of the COVID-19 pandemic, and dire economic conditions” for the Ceuta surge, two “pull factors” – both firmly rooted in Spain and drawing the migrants to the EU – were the more likely triggers. 

The first is an amnesty that Spain’s Socialist prime minister, Pedro Sánchez, finalized in April, which drew 1.17 million applications from migrants who claimed they were in Spain on January 1, 2026, and who had lived there for at least five months prior to that date.

That was “double the government's initial ‌estimate ⁠of 500,000” applications. 

Applicants who meet the amnesty’s requirements (nearly 610,000 were approved by July 2; more are in the queue) will receive one-year residency permits that can be converted into “other work or residency permits” thereafter. 

The window for that amnesty closed on June 30, but: (1) smugglers rarely highlight the fine print when hawking illicit journeys; and (2), would-be “irregular migrants” wouldn’t read it anyway because, as the Center has explained many times in the past, amnesties inevitably trigger fresh waves of illegal entries because they reveal governments don’t take their immigration laws seriously.

The July 8 Decision of the Spanish Supreme Court

The second reason why tens of thousands of migrants are pouring into Ceuta – most by sea – has to do with a decision issued by the Spanish Supreme Court on July 8, barring “hot returns” (“devoluciones en caliente”) of migrants attempting to swim into the two exclaves.

By way of background, in 2015, Spain approved an Organic Law on Public Security, which EJIL: Talk! notes added a Tenth Additional Provision to Spain’s Aliens Law, described as “rechazo en frontera” (rejection at the border). It provides that “foreign nationals detected at the perimeter while attempting to enter Spain irregularly may be rejected in order to prevent their unlawful entry into Spanish territory.”

EJIL Talk! continues, explaining that the case before the Spanish Supreme Court: 

concerned the application of this procedure to migrants intercepted in the water while attempting to swim to Ceuta. At its core, the dispute turned on whether the Tenth Additional Provision of the Aliens Law applies to migrants intercepted in such circumstances.

The court concluded that the law only applied to “containment elements” (“physical obstacles designed to prevent entry”), and that the “maritime boundary cannot be regarded as a containment element”. Consequently, rechazo en frontera didn’t apply to those who swam to Spain – or its exclaves.

Not surprisingly, the Spanish government quickly blamed the disaster on Thursday – in which 19 drowned – on the court’s decision. 

Al Otro Lado

With that in mind, consider the U.S. Supreme Court’s opinion in Al Otro Lado, which was handed down just four days before its Spanish counterpart issued its “rejection at the border” decision. 

On its face, that opinion stands for the proposition that an alien on the perimeter of the United States – just feet from the international boundary – has not “arrived in” this country and thus has no right to be allowed to enter to apply for asylum.

As I explained days after Al Otro Lado was issued, however, the case actually answered a larger and more important question that was hotly debated during the Biden administration: What obligations does the asylum statute, section 208(a)(1) of the Immigration and Nationality Act (INA), impose on DHS when it comes to allowing illegal aliens into the United States, and consequently what force can immigration officers use to keep “asylum seekers” on the perimeter from entering the United States illegally?

Justice Alito, writing for the majority, concluded that section 208(a)(1) imposes no obligation on DHS or the U.S. government as a whole to usher any alien who is not already within our borders into the United States, and thus implicitly the department can use whatever force is reasonable to keep them out. 

CBP under Biden interpreted our law as the justices of the Spanish Supreme Court interpreted theirs, which is why it concluded it was required to tear out temporary concertina wire barriers the state of Texas had erected on the banks of the Rio Grande. 

Arguably, those “c-wire” emplacements were no more “containment elements” than the riverbank itself, which is why Biden’s CBP chased away the Texas state troopers manning them and why Biden’s DOJ later sued Texas to remove “floating buoys” the state placed in the river itself, which were passable, albeit with some difficulty. 

Of course, that opinion is only as impactful as the administration that controls our border: without the willingness to keep migrants from transiting the Rio Grande – with barriers, a show of force, or force itself – nothing keeps them from crossing the watery “perimeter” of the United States into the interior, at which point the asylum laws apply.

D.C. grandees can learn a few lessons from the Ceuta migrant disaster, most notably that amnesty is not a serious response to illegal immigration. That said, the justices of the Spanish Supreme Court can learn a few lessons about maritime borders from their colleagues on “the other side” of the Atlantic, as well.

https://cis.org/Arthur/Ceuta-Migrant-Surge-and-Important-SCOTUS-Decision-Everybody-Missed