The Case for Culinary Medicine
ICE's first doctors describe why medical students need nutrition and cooking education.
Culinary medicine is a new evidence-based field that blends the art of food and cooking with the science of medicine. Dr. John La Puma, one of the pioneers, published "ChefMD’s Big Book of Culinary Medicine" in 2009 and started drawing the landscape where culinary arts and medicine are intersecting. Culinary medicine aims to help people reach good personal medical decisions and encourage them to control their dietary intake while enjoying and being inspired by cooking and eating high-quality meals that help prevent and treat disease and restore well-being.
As two practicing medical doctors involved in medical education, we recognize the limitations of conventional teaching methods when it comes to nutrition. Lecturing medical students about nutrition in a large lecture hall would fall short. It is well established that doctors would like to be sources of nutritional information for their patients and often feel inadequately educated to fill that role. The medical community has come to admit that reading, understanding and studying a manual before trying out a new device might not be the most effective way of truly comprehending it, especially not for our curious medical students. Seeking a more interactive way to teach medical students about the importance and the implementation of nutritional concepts, we stumbled onto culinary medicine.
The science of nutrition and how it relates to diet and health has been rapidly evolving. Let's take a closer look at colon cancer: Around 30 years ago we started recommending a high-fiber diet to lower the risk of colon cancer, based on an observation that countries with a low fiber intake had higher rates of colon cancer. When studies followed that put one group on a high-fiber diet, while the other group followed a lower fiber diet, there was no difference in the groups after three to four years. However, fiber does have a positive effect on the management of diabetes, diverticular disease and constipation.
Any amount of processed meat and more than around 18 ounces of fresh meat per week are most strongly linked with a higher risk of cancer. This illustrates that your food choices and food preparation can change your risk of certain diseases. Poor diet continues to be one of the biggest contributors to chronic disease and mortality in the U.S., killing one in five Americans every year. That’s a higher rate than other risk factors — pollution, lack of exercise, alcohol and drug use — combined. Currently, there is strong evidence of the effect of diet on the treatment and/or prevention of high blood pressure, heart disease, strokes, diabetes and certain cancers.
Interestingly, the preparation of our food has also been found to be significant. Home-cooked meals are typically lower in processed foods and can be adjusted to any budget. For decades Americans have been eating out or ordering in more and preparing less food at home, but the pandemic and subsequent quarantine has begun to reverse this trend.
We began implementing the concepts of culinary medicine in an elective at the Weill Cornell Medical College in 2017. The classes consisted of evidence-based didactics, small group cooking activities in a teaching kitchen, eating and discussing the nutritional concepts taught. We used a holistic and patient-centered approach. We also incorporated the cultural diversity of New York City. Students completed final projects designing and developing recipes tailored to the health needs of their patients, taking cultural preferences and socioeconomic factors into account. Not surprisingly, this innovative method of interactive teaching was far more satisfying for the students and educators. The sessions were led by a multidisciplinary group of doctors, registered dietitians and chefs. The feedback we received from the students was overwhelmingly positive: “Especially with medical students, we feel that we don’t have a lot of time and may not eat healthy as a result. This course can show how many healthy recipes can be easy to make.” Others shared: “Learning how diet can manage diseases was eye-opening and I believe should be incorporated into med school curriculum.”
When polled, 100% of our medical students “agreed” or “strongly agreed” that this course has been beneficial to their education and think every medical student would stand to benefit from education in culinary medicine. We saw responses like, "This class should be essential to medical students. This information is crucial for every physician to know," and "I feel like this is a course that should be implemented in every med school curriculum because it is so important to understand that it is the foundation of health – and everything else stems from that."
Historically, nutrition has been denied a prominent place in medical school curriculum. Medical school, referred to formally as “undergraduate medical education” (UME), is the first stage of medical education. United States medical schools offer an average of 19 hours total on nutrition education over four years, much of which is devoted to non-clinical topics like biochemistry. Among physicians, only 14% of doctors feel qualified to offer nutrition advice.
According to Harvard’s Food Law and Policy Clinic, on average, students in medical schools across the country spend less than 1% of lecture time learning about diet, falling short of the National Research Council’s recommendation for baseline nutrition curriculum. Neither the federal government, which provides a significant chunk of funding to medical schools nor accreditation groups, which validate them, enforce any minimum level of diet instruction.
In New York, state legislators recently proposed a bill that would require practicing physicians to receive six hours of nutrition coursework or training every two years (currently “In Assembly Committee”). Our timing is crucial, the burden of diet-related diseases and the gap in nutritional education are pressing. And as health care providers we are being challenged to flatten the curve of mortality and morbidity and improve the knowledge of our students, health care providers and patients. We are looking forward to seeing you soon at ICE.