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‘Culinary medicine’ integrates food and medicine in promotion of cardiometabolic health
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NEW ORLEANS — A program designed to teach medical students how to effectively communicate diet and lifestyle recommendations to patients employs hands-on cooking classes in a restaurant-quality kitchen.
“[Our patients] listen to us at a much higher rate than we think ... but the interesting thing is when we walk the walk ourselves ... even sharing those personal experiences about how I cook, how I exercise, how I solved my lunch problems, how I have breakfast, then our patients listen to us at a very much higher rate,” Timothy S. Harlan, MD, executive director of the Goldring Center for Culinary Medicine at Tulane University in New Orleans, said during a presentation.
The 3-year-old program employs an inverted-classroom design with didactics presented online and class time spent discussing cases with medical school faculty members and cooking with the center’s chef, Leah Sarris.
The foundations of culinary medicine are presented in an eight-module course series for first- and second-year medical students that covers the role of nutrition in chronic diseases, elements of a healthy diet and lifestyle, and methods for teaching patient self-management.
“We take all the stuff that medical students were learning in the first and second year —biochemistry, physiology, etc — and we translate that into the conversation they are going to have in the examination room with their patients about food,” Harlan said.
Modules for advanced students include disease-specific topics, such as celiac disease, heart disease and food allergies.
Not about weight loss
Culinary medicine focuses on food quality rather than restriction, according to Harlan, who was a chef before becoming a physician.
“Obesity is a problem. Our patients are obese, and we want them to lose weight,” Harlan told Endocrine Today. “The reality is, in the best case scenario they’re going to lose 7% of their body weight ... some of them may lose more but very few, and most of those will regain it. It’s just a very challenging discussion to have with your patient.”
Instead of using weight loss as the measure of improved health, the program teaches physicians to talk with patients about the quality of the food they eat.
“I would much prefer that a physician’s metric be how many pieces of fruit are you eating per day, how many servings of legumes did you have last week,” Harlan said.
To that end, the culinary medicine program is built around a Mediterranean-style diet. Harlan reviewed studies spanning several decades that support a role for such a diet in reducing heart disease, diabetes, cancer and overall mortality.
A Mediterranean-style diet for most adults, as defined in the literature, consists of nine components — each corresponding to one point in a person’s “diet score” — with amounts adjusted according to overall proportion of calories in an individual’s daily intake: vegetables 9 oz/day; legumes 2 oz/day; fruits and nuts 8 oz/day; cereals and whole grains 9 oz/day; fish 1 oz/day, which is about two servings each week; oils and fats in a ratio of 10 g of saturated to 16 g of unsaturated fats; dairy less than 7 oz/day; meats and eggs less than 4 oz/day and alcohol about two drinks per day for men and one for women.
“A two-point improvement in your Mediterranean diet score confers a 25% reduction in all-cause mortality irrespective of weight,” Harlan said. “Very small incremental changes in the quality of the calories we put in our mouths day-in and day-out, less calorie-dense, more nutrient-rich foods, lead to lower rates of morbidity and mortality.”
And eating better should reduce medication burden.
“When you combine statins or pharmaceutical medications with diet and lifestyle, the effect is synergistic,” Harlan said. “I have no trouble writing for statins, but I would do everything I can to make the statins more effective.”
Not about recipes
In addition to educating physicians, the Goldring Center incorporates principles of healthy eating in free cooking classes for the public. Perhaps despite their initial expectations, attendees are not handed recipes for hummus and Greek salad, Harlan said.
“We’re covering the basics of what is healthy eating, and we use the Mediterranean diet as a touchstone for this ... but we translate the Mediterranean diet for the American palate,” Sarris told Endocrine Today. “We want people to know that it’s not about Mediterranean recipes.”
Patients often resist changing their eating habits because they incorrectly perceive healthy eating to be expensive, time consuming and unappetizing, according to Sarris.
Sarris helps students budget their time and food dollars to create delicious meals that include dishes they already enjoy, only healthier.
“Our first class is actually on spaghetti ... showing how we can make small changes, small adaptations to that spaghetti to not only make it better for them, but to make it lower in calories so they can eat more, higher in fiber but lower in cost and taste better,” Sarris said.
The key, said Sarris, is planning — with a grocery list based on a well-thought out menu. A week’s menu should include 21 meals plus snacks and account for busy days by incorporating leftovers. Meal planners should begin with a few favorite dishes and cook in larger batches to freeze for later. Menus that incorporate ingredients used in more than one dish can allow shoppers to take advantage of cost savings with larger packages and time savings with ingredient preparation for more than one meal at a time. Of course, most of those ingredients should be fresh and whole foods that tend to be located along the perimeter of the grocery store.
Sarris suggests saving time by identifying favorite brands and sticking with them and by using a smartphone grocery app, such as Grocery IQ, Grocery Gadget or Shopping List, that can save lists, menus and recipes.
Use in practice
The culinary medicine program gives physicians the tools they need to make good on their standard diet and lifestyle recommendations, according to Benjamin Leong, MD, a family medicine resident at Long Beach Memorial Medical Center in California and the student founder of the Goldring Center.
“I feel that diet, exercise and lifestyle modification have become lip service for many providers. It almost certainly appears on every patient’s medical record with chronic disease,” Leong told Endocrine Today.
Leong, who works in a busy outpatient setting, reviews laboratory tests and prescribes medications for his patients with chronic conditions. But he also provides concrete dietary information.
“Whether it is giving examples of high fiber foods, emphasizing certain oils, talking about other ways to season food outside of salt, among other tidbits, I have found that connecting with my patients using food leads to a more relaxed and effective patient–doctor relationship,” Leong told Endocrine Today. “It is very rewarding to see patients benefit from a combination of food and pharmacological intervention, and this serves as my continued inspiration to find ways to incorporate food as medicine into my clinical encounters.”
The Goldring Center now licenses its curriculum to more than 10% of U.S. medical schools and offers continuing medical education classes. – by Jill Rollet
- Reference:
- Harlan T. F04. Presented at: The American Association of Diabetes Educators Annual Meeting; Aug. 5-8, 2015; New Orleans.
Disclosure: Harlan, Leong and Sarris report no relevant financial disclosures.