Here we were, 80 eager physicians from across North America in a large teaching kitchen in Northern California.
Surgeons have the best knife skills.
That might sound obvious in the operating room, but here we were, 80 eager physicians from across North America in a large teaching kitchen in Northern California in February.
Our white coats had been traded in for white aprons as we learned the first lesson of the day: The best way to dice an onion is to keep the root intact.
The veteran surgeon from Alaska was encouraging as I attempted to chop the onion into even cubes, as he had humbly done in less than 15 seconds flat. No tears were involved.
Next we went on to preparing grains like farro and cooking plant-based proteins like quinoa and lentils.
Much of the day was also spent addressing nutrition myths (for instance, low-fat diets don’t necessarily lead to weight loss), learning motivational interviewing techniques to help patients identify their readiness to make diet and lifestyle changes, reading nutrition labels, and most important, cooking nutritious meals on a budget — all with the aim of teaching doctors so that they can better educate their patients.
This wasn’t exactly cooking school — it was a three-day “culinary medicine” conference, which just completed its 15th year this past spring. Called Healthy Kitchens, Healthy Lives, there are several others that work along similar lines: Nutrition and Health Conference, Food as Medicine Conference, and most recently the Health Meets Food Conference.
Culinary medicine is an emerging field that teaches doctors to cook while also imparting practical nutrition information, and is defined as “a new evidence-based field in medicine that blends the art of food and cooking with the science of medicine.”
A 2008 study found that doctors coming out of medical schools in the United States lacked the knowledge to effectively counsel patients about nutrition. Similar findings have been reported among Canadian medical students and European residents. Even specialties like gastroenterology and cardiology, which often deal with diseases that have a large dietary component, include little training in nutrition.
I can relate: once in clerkship and residency, it struck me that what I thought I knew about nutrition was totally inadequate to address the questions patients would ask, and left me unprepared to understand and decipher the myriad new nutrition research and ever-changing recommendations that patients get bombarded with everyday.
The movement is gaining ground across North America as well as around the world, with researchers looking into how it could improve health outcomes for chronic diseases such as diabetes, obesity and heart disease.
As physicians themselves aren’t typically the best models for nutrition — long hours and on-the-run meals are common — bringing doctors into the kitchen may also be a way to encourage self-care as well, both through the mindfulness inherent in food preparation and the consumption of wholesome foods.
There are at least 10 culinary programs in the United States that are backed by a hospital, medical school or school of public health. As part of the medical education curriculum, they reach more than 2,500 doctors and other health professionals each year.
Each school approaches the field slightly differently. For instance, since 2012, Tulane University School of Medicine has offered a compulsory culinary medicine curriculum for its medical students while also reaching over a thousand medical residents through online courseware it has licensed to seven American residency programs. Dartmouth School of Medicine provides culinary medicine workshops to medical staff members, patients and the community through teaching kitchens. And Baylor College of Medicine’s Choosing Healthy, Eating Fresh (CHEF) program is a medical student led elective course which facilitates nutrition and cooking workshops for medical students and patients at Texas Children’s Hospital.
Stanford is one of the latest medical schools to jump on board. Co-founded by Dr. Julia Nordgren, “The Doctor is In … The Kitchen” program began last spring. The group meets one evening a week to learn about how culinary medicine is implicated in a real clinical story — for instance, a busy mother with a toddler who is a picky eater, or a patient with diabetes who is on a tight food budget. To be effective, culinary medicine cannot ignore the issue of food insecurity, which affects 12.7 percent of Americans.
My alma mater, the University of Toronto, started a mandatory culinary medicine program for medical students last year under the direction of Dr. John Sievenpiper. It involves an interactive cooking class, open-access lectures and a grocery store tour led by registered dietitians and chefs, where students learn to read labels and prepare simple meals. Late last year, more experienced physicians eager to advance their nutrition knowledge were offered a chance to enroll in an “update” on clinical nutrition which, among other things, will help separate fact from fiction with respect to popular diets for chronic diseases.
“Nutrition evidence is protean; it changes as we learn more,” said Dr. David Jenkins, a professor in the department of nutritional sciences at the University of Toronto whose research played a key role in the development of the glycemic index. “We need to allow students to critically think about nutrition, and extending this teaching into the kitchen could be one good way to do that.”
Studies show that physician beliefs about the role of food in preventive medicine, and cooking specifically, can translate to effective nutrition counseling for patients, leading to better dietary choices. In 2013, researchers reported that participants in a culinary medicine program reported a higher comfort level with cooking and were better able to assess patients’ nutritional status and advise them regarding nutrition changes, and in 2015, a culinary program at New York University reported improved culinary skills and budget-appropriate meal preparation.
Some medical educators question the effectiveness of nutrition counseling at a time when doctors are so pressed for time, or whether the 10 to 15 minutes allotted to a patient visit can cover the primary medical concerns and additional information about diet and cooking. But Dr. Nordgren notes, “it doesn’t take any more time to discuss a technique to cook a vegetable than it does to write a prescription.”
Still, she acknowledges it’s an imperfect system. She and others have reported that nutrition science is an emerging and difficult to research field. Programs across the country would do well to standardize objectives and curriculums. Recently, the European Society for clinical Nutrition and Metabolism and the American College of Lifestyle Medicine have called for a standardized nutrition curriculum in medical schools.
If Hippocrates really did say, “let food be thy medicine and medicine be thy food,” the culinary medicine movement takes it one step further with a nontraditional take on the traditional medical education adage: ‘see one, do one, teach one.’ And perhaps bringing more doctors into the kitchen could lead to fewer patients being brought into the hospital. Wouldn’t this be the sweetest of ironies?