The diabetes community has known for decades that food is medicine, but it’s taking some time for the medical establishment to catch up. In an editorial complaining about this situation, Stanford University’s dean of medicine said that “doctors have historically received almost no nutritional training.” Future doctors spend very few hours on the subject of nutrition, which is “completely disproportionate to its health benefits for patients,” and may learn nothing at all about how to speak to patients about healthy eating.
Lourdes Castro, RD, is on the vanguard of the movement to teach doctors how to take nutrition education more seriously. She is the director of New York University’s Food Lab, a teaching kitchen housed within the Department of Nutrition and Food Science. Castro has recently spearheaded the Food Lab’s new culinary medicine program.
What is culinary medicine? Castro says, “We define it here as using culinary arts and food to help inform the healthcare process.”
“I think most people generally understand what is healthy food and what is unhealthy food,” says Castro. “But in our culture, using food as a medicinal item is still considered a little out there. Which is bananas! What we eat matters. It matters when we’re healthy, and it really matters when we’re living with certain health conditions.”
“Understanding that what you put in your body can function in a therapeutic or medicinal manner, it’s a little bit different.
In a sense, the idea of culinary medicine has been around since time immemorial. As a modern medical phenomenon, it began to emerge about a decade ago. The first culinary medicine center at an American medical school opened in 2013 at Tulane University. A 2016 review of the trend identified several major reasons for the rise of the new discipline:
The Food Network effect and the rise of celebrity chefs and foodie culture have led to increased interest in food and nutrition
The seemingly unstoppable spread of obesity, type 2 diabetes, and other metabolic health issues
Increased suspicion over highly processed foods
The ever-spiraling cost of healthcare
Increased interest in organic and plant-based foods
Culinary medicine is a multidisciplinary field that blends the science of medicine and nutrition with the art of food and cooking. Culinary medicine is extremely practical. Its proponents want to get away from dry advice about the chemistry of macronutrients and engage with real people and the real barriers that are preventing them from choosing healthful foods.
The culinary medicine program at NYU brings grad students from the schools of medicine and nutrition into a professional kitchen. There, the future doctors and nutritionists roll up their sleeves and learn how to chop, roast, and sauté. Of course, doctors don’t have to be chefs — the idea is to familiarize future doctors with the reality of preparing wholesome meals, so that they can engage with their patients in a more grounded and realistic way.
“If we can teach them that it’s not difficult or expensive to cook for yourself using whole ingredients, then they’ll not only be able to counsel their patients better, but they’ll be able to advocate for lifestyle changes.”
Meanwhile, Castro and her instructors also get their students thinking about the type of nutritional science that medical schools typically eschew: “We are teaching them the tenets of evidence-based nutrition in the prevention and treatment of non-communicable diseases like type 2 diabetes.”
The best way to get the next generation of doctors to spread the word on healthy eating is probably to convince the doctors to eat healthy themselves. A study of female doctors found that those with healthy personal habits were far more likely to advise their patients to make decisions that could prevent disease.
“The idea is that, like in the seventies when doctors stopped smoking, they were better able to be good advocates for their patients to not smoke. We want to create a healthcare team that can actually focus on food.”
Castro’s program focuses on a plant-based and minimally-processed ingredients approach — almost universally acknowledged as one of the healthiest eating patterns — but doesn’t mandate that the students become advocates for vegan living. In fact, one of the hallmarks of culinary medicine is its acknowledgment that healthy diets need to fit within the preferences and cultural tolerance of patients.
“It has to be delicious. It has to be exciting to eat. It has to be culturally appropriate. At the same time, it has to be nourishing.”
Castro senses some skepticism from established doctors, but she thinks “the younger generation is all in.” However, it will take years for the new concept of culinary medicine to filter throughout the medical establishment. In the meantime, most people who want to apply the principles of culinary medicine in their own lives will have to do it themselves.
The American Diabetes Association, the major authority on diabetes in the United States, agrees that there’s no such thing as a single perfect diabetes diet. Instead, the organization notes that there are three fundamental factors that almost every potentially beneficial diabetes diet has in common:
Eat more non-starchy vegetables.
Eat less sugar and refined grains.
Choose whole foods over highly processed foods.
It’s no surprise that the organization doesn’t get much more specific than that. As Castro acknowledges, it’s not easy to find hard objective truths in the field of nutrition research — it’s simply impossible to run large rigorous randomized experiments to determine the nutritional impact of eggs or kale. But because we all have different health situations and very different tastes, such detailed work may not be terribly helpful. Castro hopes that she can help a new generation of doctors benefit from a personal experience of the power of healthy cooking and eating so that they can go and share the good news with their patients.
“The point of culinary medicine is that your food is as powerful as the medicine you take.”