Demand for physician-based dietary treatment of hypercholesterolemia is increasing, but medical care providers feel that they lack the skills and confidence necessary to provide these services. Using a self-administered questionnaire, we studied the relationships among dietary knowledge, attitudes, and behaviors to identify the educational needs of entering medical students. On average, dietary behavior and background knowledge of the diet-coronary heart disease association compared favorably to national dietary recommendations and knowledge of the U.S. public. However, practical knowledge necessary for diet counseling was weak, and attitudes about the "prudent" diet were poor. More favorable attitude scores were associated with healthier eating habits, while greater knowledge was not. Our results suggest that entering medical students already have a basic understanding of the diet-heart disease link, which is covered in the curricula of most medical schools. Medical education should include more emphasis on practical dietary knowledge and improving attitudes about the prudent diet.