Physicians and Chefs Cook Up Healthy Med School Curriculum

Neil Osterweil

July 17, 2014

Students at Tulane University School of Medicine in New Orleans, Louisiana, are donning their new, crisp white uniforms and learning how to treat hypertension, diabetes, obesity, and cardiovascular disease using nontraditional tools of the trade: spatulas, knives, and saucepans.

It gives a whole new meaning to the term "cookbook medicine."

Tulane's Goldring Center for Culinary Medicine, a collaboration between the medical school and the Johnson & Wales University College of Culinary Arts in Providence, Rhode Island, brings kitchen and classroom together, making nutrition palatable for MDs in training, midcareer clinicians, and patients.

The goal of the program is to teach the next generation of physicians and their patients about healthful food preparation and eating as a pleasurable way of life, rather than an irksome chore.

Timothy S. Harlan, MD, executive director of the Goldring Center, told Medscape Medical News that the term "culinary medicine," although synonymous with "clinical nutrition," conveys a friendlier and more comprehensive message.

"We wanted to make sure that people had an understanding that this was about health and food, not just food, or not just health," he said.

And the fact that the center was established in New Orleans, the land of gumbo, andouille sausage, crawfish etouffé, and beignets, is not lost on him, either.

"I'm a student of irony," Dr. Harlan said.

Eat, Drink, and Be Healthy

Although the science of clinical nutrition has resulted in the virtual elimination in developed nations of once-common nutritional deficiency states such as scurvy, rickets, and pellagra, the flip side of the coin is a rising epidemic of obesity, hyperlipidemia, type 2 diabetes mellitus, and their attendant consequences.

Culinary medicine programs aim to reverse the trend not through stern proscriptive injunctions (Thou shalt not eat fat! Thou shalt stop salting everything in sight! Thou shalt shun sugar!) but through teaching people how to recognize, combine, and cook food that is as appealing to the senses as it is to the nutritionist's heart.

"Part of our goal here is that we as physicians need to take ownership of this problem, not just obesity per se but also the quality of the calories that our patients are consuming," Dr. Harlan said.

He comes by the work honestly, having managed a restaurant at age 18 years and owned a French bistro at age 22 years before considering a degree in hotel and restaurant management and, eventually, in medicine.

Little Taste for Nutrition Education

Until recently, however, medical schools gave given little more than lip service to nutrition and healthy eating, said David Eisenberg, MD, executive vice president for Health Research and Education at the Samueli Institute and adjunct associate professor in the Department of Nutrition at Harvard School of Public Health in Boston, Massachusetts.

"The average number of hours spent on nutrition across US medical schools is something on the order of 19 or 20 hours over 4 years," he told Medscape Medical News.

Results of a survey of medical schools published in Academic Medicine in 2010 showed that although 103 of 109 responding schools required some form of nutrition, only 26% said they required a dedicated nutrition course. As noted by Dr. Eisenberg, medical students received a mean 19.6 contact hours of nutrition education during their entire medical school career.

During his medical training, "there was little about nutrition, and even less about its translations into food choices: how to cook, how to apportion foods, etc," he said.

"I got 4 hours of nutrition education in medical school, and 6 hours in cooking school," said John La Puma, MD, a practicing internist, professionally trained chef, and cofounder of ChefMD.com. Dr. La Puma is also the author of Chef MD's Big Book of Culinary Medicine.

Watch One, Taste One, Cook One

Although Tulane's culinary medicine curriculum is an elective for first- and second-year students, it is a popular course, according to recent graduate Ben Leong, MD, MPH.

"It wasn't really that hard to recruit people. We said, 'Hey, let's just try this new thing where we're going to bring you into the kitchen, we're going to teach you how to cook, and guess what? You get to eat afterwards.' We could have stopped right there and we would have had a bunch of people signing up," he said.

It is empowering for both physicians and their patients to learn that they can still make favorite dishes such as red beans and rice, jambalaya, and po' boys that taste good, are healthy, and can be made affordably and with ingredients readily available at a local market.

"You really start to engage the patient, med student, or doctor with the idea that food as medicine is a very powerful concept," he said.

Dr. Leong, who helped develop the program while a student at Tulane, is currently a resident in family medicine at the Long Beach (California) Memorial Medical Center.

Teaching Kitchens

Tulane boasts the first teaching kitchen affiliated with a medical school, which is helmed by Johnson & Wales graduate and instructor Leah Sarris.

Sarris told Medscape Medical News that although students have a variety of reasons for taking the course, many seem motivated by the desire to incorporate principles of nutrition into their future practice.

"I think this generation realizes the importance of talking to patients about nutrition, and the importance of their being able to understand it on a level that they can relate to patients," she said.

For clinicians already in practice, Dr. Eisenberg hosts an annual, wildly popular continuing medical education course titled "Healthy Kitchens, Healthy Lives" in collaboration with the Culinary Institute of America in Napa Valley, California.

The 4-day course combines cooking demonstrations and hands-on workshops with didactic sessions on subjects such as glycemic load, managing carbohydrates, and advising patients about the science (or lack of it) behind dietary fads.

"The thesis was that if we could change their personal behaviors, they would be more apt to begin to explore ways in which they could advocate for their patients to change," Dr. Eisenberg said.

The idea is catching on. Tulane is not the only institution at which physicians learn how to wield carving knives with the same dexterity as surgeons handle scalpels. The University of Massachusetts Medical School in Worcester, New York University's Langone Medical Center in New York City, and the University of North Carolina in Chapel Hill all offer courses on cooking and eating healthfully.

"Physicians are eager to learn more about this. They realize, as I certainly did years ago, that there is a gap in their education, and I think physicians want to fill that gap with knowledge and skills to help their patients," Dr. Eisenberg said.

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