Let Food be Thy Medicine

Friday, March 10, 2017

Furiously mincing the last of the onion and mushrooms, aggressively churning the lentil marinara to a thick paste, and scrambling to arrange the last of the garnishes before, "Time's up! Deliver your finished product to the demo table." No, it wasn't a rerun of ‘Top Chef’ in which four UCSF medical students were embroiled one evening last month, but rather a pilot of a Culinary Medicine curriculum hosted at Google's teaching kitchen in Mountain View.

The special event featured Dr. Tim Harlan, MD and Kerri Dotson, RD from Tulane Medical School and the Goldring Center for Culinary Medicine, who demonstrated their unique curriculum to UCSF medical students and faculty alongside other Bay Area educators and clinicians.

Harlan and Dotson, both trained chefs, framed the evening around a case study: an overweight, middle aged man with hypertension, hyperlipidemia, and diabetes, all of which are only moderately controlled by seven medications.

Participants dissected the case in small teams, emphasizing nutritional calculations and practical solutions within this patient's lifestyle, budget, and values. The evening quickly moved to the kitchen, where Dotson imparted some foundational knife skills and propelled the budding chefs to their stations.

The kitchen ignited as they set to work, making quick work of the raw ingredients before them. Chefs and assistants swooped in with insight and advice, and the meals swiftly took shape amid a hum of excited discussion. Working in groups of two to three, the 20 participants had 45 minutes to hone their new skills in preparing a relatively unassuming dish of pasta with marinara sauce. However it wasn't until the final plating that they discovered all the meals were variations on each other — together they spanned a spectrum of caloric, meat, fat, salt, and fiber content. Harlan made a final point before mealtime in comparing the similar-appearing dishes: small changes in ingredients and preparation can yield healthier plates while also providing a range of choices for each individual patient.

In the post-meal discussion, Harlan tied the meal prep back to both his patient and to medical literature. In true reverse-classroom format, the evening was preceded by an online module that reviewed some of evidence supporting the Mediterranean Diet, which was chosen for the robustness of quality medical literature supporting it.

The data doesn't fail to impress: One prospective cohort study found that among 22,000 adults in Greece over almost four years of follow-up, a two-point increase in adherence to their Mediterranean Diet Score (one point for increasing each of vegetables, legumes, fruits and nuts, cereal, and fish, and one point for decreasing meat, poultry, and dairy) led to a 25% reduction in all-cause mortality.

Furthermore, a randomized control study in France for patients after a first myocardial infarction showed patients given a specific Mediterranean Diet, compared to those advised to follow a prudent diet had only 35% the cardiac deaths and lower than 50% the all-cause mortality after almost four years.

The staggering impact of nutrition on patient health is undeniable, and there is enormous potential for a salubrious diet to complement and even outpace the outcomes modern pharmaceuticals achieve alone, a theme Harlan reiterated the following day when he gave Medical Education Grand Rounds.

Through both Grand Rounds and the evening's discussion, a practical message emerged that in counseling patients, small changes with real follow-through are a simple and effective recipe for successful lifestyle transformation.

Once patients can commit to a small change and feel the positive results in their own life, a firm foundation for sustainably healthy eating can take root. But the devil is in the details, and in a clinical encounter, merely counseling a patient to 'eat healthy' or 'use less salt' may be as futile as silence.

If the typical UCSF medical student remembers one piece of nutrition advice, it probably is "Follow the Mediterranean Diet", but in an average 15-minute encounter, how many students, or even residents or attending physicians actually take the time or have the confidence to counsel on diet in a specific and meaningful way?

The elements of Tulane's Culinary Medicine curriculum address that gap where the rubber meets the road. In just one evening, it imparted a practical, hands-on appreciation of many of the barriers to helping patients improve their health through nutrition. For students in the pilot program, a message stuck — the time and money barriers to a nutritious lifestyle are often artificial; the real obstacle is effective patient education and communication.

Harlan's well-studied curriculum, licensed at dozens of medical schools throughout the U.S., indicates that students are four times as likely to offer diet advice to patients after participating. Moreover, long-term community follow-up has suggested that the patients influenced are over five times more likely to eat the fruits, vegetables, legumes and healthy oils sufficient to boost their Mediterranean Diet score.

There is no substitute for learning by doing, and whether the benefits of a culinary medicine program ultimately translate to a sustainable clinical model of direct patient counseling or consistent referral to well-qualified nutritional counselors, such a program would likely be a boon to a large contingent of the Bay Area patient population. The UCSF School of Medicine administration is currently discussing the option of incorporating this program as an elective in the Bridges curriculum.

Photo Title & Credit: Tim Harlan, MD, at UCSF’s Medical Education Grand Rounds, photo credit: Mark Wooding