3-28 MEDG: Culinary Medicine and the Future of Nutrition Education for Medical Trainees

March 28, 2024

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00:00Anyone
00:03so that'll pop up right now.
00:05My name is Jeanette Tetro.
00:07I currently serve as the Vice Chief
00:09for Education for the section of
00:12General Internal Medicine and our
00:13Section's delighted to come back
00:15together with our friends from
00:17the Center for Medical Education
00:19to Co host one of our medical
00:22education discussion groups.
00:24GIM Co hosted medical
00:25education discussion groups.
00:28Dorothy or I'm sorry, Janet
00:29will formally introduce Doctor
00:31Wood in a moment, but he is a
00:33member of our section we're thrilled about.
00:38And I just wanted to briefly put in a
00:39plug with the next medical education
00:41discussion group will be in April.
00:43Deanna Luzi will be speaking at that session.
00:46And please for everybody on the call,
00:50certainly our GIM folks as well,
00:52Mark your calendars for Medical
00:54Education Day, which will be June 6th.
00:56So I'll turn it over to Janet.
00:58Thank you. Great.
00:59Thanks for those plugs, Jeanette.
01:00That was wonderful.
01:01And I have the great honor of introducing Dr.
01:04Nathan Wood to all of us today.
01:07Many of we, we know him,
01:08He's an instructor in medicine in
01:11the Department of Internal Medicine.
01:12And of course,
01:13when you look back over what he's done,
01:16he received his BS in Linguistics
01:19from University of Michigan,
01:21and then he became a chef.
01:23He went to the professional culinary
01:25arts where he received a diploma from
01:28the Institute of Culinary Education.
01:30And he's really spent time in
01:32thinking about culinary medicine,
01:33which he'll talk with us today.
01:35He then went on and did his
01:37MD at Wayne State,
01:38and he is currently graduating in our
01:42MHS Medical Education Master's program.
01:44And his study was his thesis is
01:48entitled A Randomized Controlled
01:50Trial of a Novel Culinary Medicine
01:53Curriculum for Medical Residents.
01:55But in addition to his work with
01:57residents in a phenomenal thesis,
01:59he's also been this faculty advisor
02:02for the student interest group.
02:04It's entitled Food is Medicine.
02:06The students selected that name,
02:08but he takes them over to the kitchen,
02:11the test kitchen, and works with students.
02:13And they're so interested in this.
02:16He also teaches in our medical student
02:19curriculum and also our PA program.
02:21We have many P as on here today.
02:23And what I think when you think
02:25of the next steps,
02:26it's how do you incorporate all these
02:29silos of pieces and really think
02:31through what is it that our medical
02:33students need as they become doctors
02:36in residency and on and then how are
02:39we preparing our future physicians.
02:41So thank you,
02:42Nate,
02:42for all the work that you do
02:43and I'm really excited to hear
02:45your presentation today.
02:47Great. Thank you so much, Janet,
02:49for that fabulous introduction.
02:50Very generous of you.
02:51So extremely happy to be here today to
02:53talk to you all about my life passion,
02:55which is food and medicine
02:57and the intersection there.
02:57And so today we're gonna be
02:59talking about a new field called
03:00culinary medicine and in general
03:02the future of nutrition education
03:03as Janet mentioned for healthcare
03:05professionals as well As for patients.
03:08So Reagan is putting some information in
03:10the chat about how you can claim your CME.
03:12But just a reminder here to text
03:14that number to that number and what
03:17I'm hoping to accomplish today,
03:18what are our learning objectives?
03:20So we're going to 1st identify this
03:21lack of nutrition education that we
03:23provide our medical trainings which
03:25many of us are familiar with and
03:27actually recognize this as a structural
03:28contributor to diet related disease.
03:31We're going to define culinary
03:33medicine and a plant forward diet to
03:35terms that may be new to a lot of us.
03:37We're going to talk about how culinary
03:39medicine can be used to teach both
03:42healthcare professionals and patients.
03:43We're going to think about kind of
03:45through my recent my thesis research,
03:47what one potential benefit of culinary
03:49medicine might be over just your everyday
03:52lectures that are based on nutrition.
03:54And then think together about an
03:56actionable step that we all can
03:58take to improve the health promoting
04:00potential of our dietary habits.
04:02So, but first,
04:02before we do all that,
04:03I want to get to know you.
04:04So I think Dorothy's going to
04:06launch a poll for us here just
04:08so I can kind of better know what
04:09what folks we're working with here.
04:10Which of the following best describes
04:13your training or certification?
04:15I've already seen that we have a
04:16couple of students in the the room.
04:18So I apologize.
04:19I definitely should have considered
04:20that you're a student,
04:21but if you're in a particular
04:23training program,
04:23maybe you can select that one.
04:42You guys are quick.
04:45OK,
04:54that looks pretty good, I think, OK, we'll
04:58end the poll
05:01and share the results,
05:04OK. So as you can see,
05:05we have a lot of M DS or D OS here.
05:07So a lot of positions, about 10% PAS,
05:09some PhDs and then a lot of kind of
05:11smattering of other medical education
05:13and professional folks as well.
05:15So we always appreciate having
05:17this kind of interdisciplinary
05:18audience because really as you'll
05:20see culinary medicine applies to A
05:22to a whole host of different people.
05:23So hopefully we all have something
05:25that we can take away from
05:26this no matter our profession.
05:27So I'm going to start with just
05:29briefly with the patient case,
05:30something that probably would look
05:31familiar to you. You have a Mr.
05:33Jones coming into your clinic.
05:35He has hypertension and dyslipidemia.
05:37His father died of a heart attack at age 58.
05:40He's recently celebrating his 50th birthday,
05:42which got him thinking about
05:44his own mortality.
05:45And he says like, listen,
05:46I am so confused about this
05:47whole nutrition thing.
05:48Everything I read and I see and
05:50I hear it's so contradictory,
05:52I don't know what to believe.
05:53So hey, doc,
05:54what should I eat to prevent a
05:56heart attack like my dad had?
05:58And for many of us,
06:00this may send shivers down our spine, right?
06:01What are we supposed to say to that?
06:03So one more poll before we really
06:06dig in here.
06:07How confident do you feel in providing
06:09dietary counseling to your patients?
06:10When it comes to this statement,
06:11I feel confident.
06:12How much do you agree or
06:14disagree with that statement?
06:47think we have some experts in the room.
06:56Great. That looks pretty good, I think.
06:59OK, share the results.
07:01All right. So let's take
07:02a look at these here.
07:03So we have a few people who who
07:04really don't feel comfortable.
07:05A lot of folks kind of in the middle like
07:07either somewhat disagree or somewhat agree.
07:09And then if we look specifically at this
07:10metric of agree and strongly agreed together,
07:12it looks like about 41% of people
07:15agree or strongly agree that they
07:17would feel confident doing this.
07:18So let me just delve into like
07:20how standard is that, right.
07:22So that is that's pretty high.
07:24You know, as we'll look here at some local
07:26results and then results more nationally,
07:28really very few people agree or strongly
07:30agree that they feel comfortable providing
07:33nutrition education to patients.
07:35And so when we did a local needs
07:36assessment and asked the same question
07:38to our primary care residents,
07:39about 17% felt that their training
07:41to date had been sufficient.
07:43About a third felt that they had
07:45the necessary nutrition knowledge
07:46and skills and then 94% agreed or
07:49strongly agreed that if they were
07:51to obtain additional training and
07:53nutrition that this would allow them
07:55to provide better clinical care.
07:57And this 17% of feeling that they're
07:59trained to date had been sufficient.
08:01That's pretty reflective nationally as well.
08:03There's a couple of surveys again
08:04from 2005 and then more recently in
08:062014 showing really only about 14% of
08:09physicians agree or strongly agree that
08:11they've been adequately trained to do this.
08:13And this is is also demonstrated outside
08:16of just physicians and and medical
08:18trainees as as well in in medical
08:20school about 29% of nurse practitioners,
08:22so a little bit higher feel that they've
08:24received adequate training in nutrition,
08:25but of course still very far from where
08:28a target would be and we've known that
08:30this is an issue for a long time.
08:32So kind of.
08:32This landmark paper that came out
08:34in 1985 by the National Academy of
08:36Sciences recommended that all medical
08:38students receive at least 25 hours
08:40of nutrition education in their
08:42pre clinical years.
08:43And that was based on their finding that
08:45the average at the time was 21 hours.
08:47But as you can see,
08:48studies have demonstrated at various
08:49time points since then that that
08:51number has dwindled very dramatically
08:53from that 21 hours,
08:54not towards the 25 that are recommended,
08:56but in the exact opposite direction with.
08:58Now the average number of hours that medical
09:01students receive in nutrition is 11.
09:04PA's again are not adequately trained in
09:06nutrition just like medical students,
09:07just like nurse practitioners don't
09:09feel like they've received adequate
09:11training with 75% of PA's reporting
09:13that they received 10 hours or
09:15less than nutrition education.
09:17And this is a big problem because we
09:20know that diet is the third leading
09:22risk factor for morbidity in the
09:24United States and it is the number
09:26one risk factor for mortality.
09:27So this is by the US burden of disease
09:30collaborators in this landmark
09:31paper that came out in 2018.
09:33And so again, we know diet is
09:34a big cause of morbidity and
09:35mortality here in the United States,
09:37the leading cause of mortality.
09:39And yet our physician and
09:40healthcare for workforces is
09:41really not trained to address this.
09:42And we're beginning to realize more and
09:45more that this is a systemic issue, right.
09:47If we don't address the contributions of
09:49food to health in the clinical context,
09:51that should be considered an
09:53ethical lapse or actually in and
09:55of itself a structural contributor
09:58to diet related disease.
09:59But you know, I told you in 1985,
10:02they said we need to change things.
10:04Really nothing changed.
10:04And in fact things got
10:06worse for a lot of decades.
10:07But now very, very recently,
10:08there's a renewed interest
10:09in kind of addressing this.
10:11So in May of 2022,
10:12the US House of Representatives
10:14passed a resolution that said our
10:16healthcare workforce is not trained to
10:18nutrition and we need to change that.
10:20That was really championed by
10:22Jim McGovern in Massachusetts.
10:23In September of 2022,
10:25this White House Conference on Hunger,
10:26Nutrition and Health was held.
10:28This was the first of its kind
10:29in only 50 in over 50 years.
10:31The first one was with Lyndon B Johnson
10:33and LED to programs like SNAP and WIC.
10:35So really important conference
10:37that took place in September of
10:392022 and really ignited this work.
10:42The first ever Summit on Nutrition
10:44and Medical Education took place
10:45in court ancient with the A/C,
10:47G,
10:47MB and the AAMC in March of 2023
10:49where they brought together thought
10:51leaders from across the nation
10:52and said how do we fix this.
10:53And so their the reports just
10:55came out a couple of months ago.
10:57In April of 2023,
10:58the NIH released its request for
10:59information on food is medicine research.
11:02Food is medicine being this new field
11:03that kind of focuses on 4 pillars
11:05of addressing diet and disease.
11:07And one of those pillars is actually
11:10healthcare provider education,
11:11of which culinary medicine is a part.
11:14And then most exciting perhaps for
11:15me is just last month we founded the
11:18American College of Culinary Medicine.
11:19And so this is really igniting quickly.
11:22Change is very much happening in this area.
11:25So it's an exciting time to
11:26be working on this.
11:27But I keep using this term culinary
11:28medicine and for some of us
11:29that might be a brand new term.
11:31So let me just mention what culinary
11:33medicine is and how we think of it as
11:35providing nutrition education for our
11:37healthcare providers and trainees.
11:39So culinary medicine is evidence based.
11:41It's necessarily into professional
11:42relying on chefs, dietitians,
11:44physicians and it combines together
11:46several fields of medicine,
11:48culinary arts, nutrition,
11:49science and medical education.
11:51And the goal is to prevent and
11:53treat diet related disease.
11:55So how do we do that?
11:55We take folks into a teaching
11:57kitchen and we teach them nutrition
11:59and then we teach them to put into
12:01practice using hands on cooking
12:02theory and technique and practice.
12:04And then like I said, the goal is to
12:06prevent and treat diet related disease.
12:08Now it doesn't have to be a
12:09physical teaching kitchen,
12:10which is interesting.
12:10That's how the field began of course.
12:12And as you can see,
12:12we have a beautiful physical teaching
12:14kitchen here at Yale that opened last year.
12:16But during the pandemic,
12:17everyone in culinary medicine was forced
12:19to pivot to virtual teaching kitchens,
12:21which is where you have everyone
12:22cooked together from their
12:23own home kitchens on Zoom.
12:24And so you can see a class that we taught
12:26during the pandemic to our residents
12:28here at Yale in a virtual teaching kitchen.
12:31So it's a very flexible
12:32field that has those goals.
12:33And then for healthcare
12:34providers specifically,
12:35when we teach them culinary medicine,
12:36we think about this as being the lab.
12:39So you have your biology lecture,
12:40you have your biology lab for this.
12:42We have our nutrition lecture
12:43and this is the nutrition lab.
12:45We put it into practice.
12:47So what are the goals and aims of the field?
12:49So all of these aims and outcomes
12:51I'm about to tell you about have
12:52been demonstrated in the literature.
12:54So we've shown that culinary medicine
12:56can increase participants nutrition
12:58knowledge and cooking skills,
13:00their confidence and competence
13:01in providing nutrition counseling,
13:03their interprofessional collaboration,
13:05and then really,
13:06it can change perhaps their eating behaviors.
13:08So maybe they're more motivated
13:10to eat more healthfully.
13:11In the first culinary medicine
13:12study I ran in medical school,
13:14we found that participants reported
13:16cooking a greater proportion of
13:18their meals at home after the
13:20intervention as compared to before.
13:21And other research studies have
13:23demonstrated that participants have
13:25greater adherence to a Mediterranean diet
13:27after participating in culinary medicine.
13:29But what's the point of all this?
13:30Well,
13:30we hope that if we have,
13:32we were able to increase participants
13:34knowledge and competence that they
13:36will provide nutrition counseling
13:38to patients more frequently and
13:40in in that nutrition counseling
13:41will be better quality that will
13:44increase referrals to registered
13:45dietitian nutritionists.
13:46And really that we can walk the
13:48talk that we can serve as examples
13:50for our patients because there's a
13:51lot of literature to suggest that
13:53clinicians who practice healthy
13:55lifestyles themselves are more likely
13:57to talk to their patients about
13:59practicing a healthy lifestyle as well.
14:02So we have this beautiful teaching kitchen
14:03here that I want to tell you about.
14:05So these are some photos from
14:06where it opened.
14:06Like I said just last year,
14:08it's run by an All Star team.
14:10So Joe Mendes is the Executive
14:11Director of Digestive Health and
14:12has really been pushing forward
14:13to this kitchen for many,
14:15many years and brought it to fruition.
14:16So we're so thankful to him.
14:18Amy Ralph and Max Goldstein are our
14:20dietitians who work together and
14:22really understanding that culinary
14:24medicine and nutrition education,
14:25this is a field that should be really
14:27led by dietitians because they are
14:29the experts in nutrition and that
14:30we as physicians and other clinicians
14:32can come alongside them as partners
14:34in order to advance the field.
14:36And Max, I just have to give a plug for,
14:37I think he's on the call here.
14:38He's a chef and a registered dietitian.
14:40What an amazing combo.
14:41There's not many Max's in the
14:42world and he does a fabulous,
14:43fabulous job with patients.
14:45So they really enjoy the
14:46classes that he teaches.
14:47He really runs more things than you
14:49want to know in the teaching kitchen.
14:50And we teach all of our classes
14:52together with our healthcare,
14:54with our healthcare trainees so that
14:56they have this interdisciplinary
14:58instructor team of a physician, a chef,
15:00physician, 2 chefs and a dietitian.
15:02So big shout out to them.
15:05So we've had physician associate
15:06students in the teaching kitchen.
15:07We've had medical students
15:08in the teaching kitchen.
15:09We have our primary care residents
15:11in the teaching kitchen every
15:12year of their residency.
15:13We have the Pediatrics residents
15:15in the teaching kitchen again
15:16every year throughout residency.
15:17And in the future,
15:18we have lots of opportunities to
15:20engage other populations as well.
15:22And so we have a couple of
15:23nursing classes coming up.
15:24We have a faculty group,
15:26the YPC faculty are coming in next Monday,
15:28which of course I'm looking forward to.
15:30But as you can see,
15:30lots of other opportunities to
15:32engage other folks invested in
15:34public health dietetics and the
15:35practice of nutrition and medicine.
15:40But the question kind of quickly becomes,
15:42why culinary medicine?
15:43You know, we know that physicians and other
15:45clinicians are poorly trained in nutrition,
15:47but why not just give them lectures?
15:48That would be easier, right?
15:50It's more standard, it's low resource.
15:52People are trained to give lectures.
15:53Why do we have to build a fancy
15:56teaching kitchen or hire a staff
15:58to teach culinary medicine?
15:59Pots, pans, groceries, laundry. Again,
16:01Max could tell you about all these things,
16:04but why culinary medicine?
16:05And that, to be honest,
16:07is an unanswered question in the field
16:08that's been around for only about 15 years.
16:11And so that was what my thesis
16:13work tried to start addressing.
16:15And so we had three scoping reviews come
16:17out in 2022 in the field of culinary
16:19medicine and they all said the same thing.
16:21Hey, the research looks good,
16:22but in order to move this forward,
16:23we really need to start moving
16:25into randomized control trials.
16:26There had never been a randomized control
16:28trial among healthcare professionals or
16:30trainees with regard to culinary medicine.
16:32So that's what we did.
16:33We did just you know kind of a pilot proof
16:35of concept study that this could be done.
16:37So our, our,
16:38our results are we took the
16:39the 51 primary care residents,
16:41we randomized them into two groups,
16:43an intervention and a control,
16:46and then we surveyed them at three different
16:48time points before the intervention,
16:49immediately after and eight weeks later.
16:53So let me give you an idea of
16:54what that curriculum looked like.
16:55It was a very short curriculum,
16:56only four hours.
16:56This was not 4 hours a week or 8 weeks.
16:59This was come in, you know,
17:00one time and received 4 hours
17:02of culinary medicine education.
17:03And I felt bad,
17:04you know,
17:04because I had to give this control
17:06curriculum to half of the residents.
17:08And so I still tried very hard
17:09to make it worth their time.
17:11And so you see a lot of the
17:12curricular components were the same,
17:13but there was one important difference.
17:16So for the 1st 45 minutes,
17:17we discussed this Yale office based
17:19medicine chapter Yobum and many
17:20of you are familiar with this.
17:22There's a chapter on dietary counseling
17:24in provide in primary care which
17:26focuses on this USPSTF recommendation
17:28that we should be providing behavioral
17:30counseling to folks who are at
17:32risk for cardiovascular disease.
17:33That's a grade B recommendation.
17:35I then gave a one hour lecture
17:37on the connection between diet
17:38and cardiovascular disease,
17:40specifically the prevention of and
17:41this is where I started to feel bad.
17:44The control group,
17:44half of the residents had to participate
17:46in this video based curriculum.
17:47So this is kind of an off the shelf
17:49curriculum and we pulled out the parts
17:51that were pertinent for cardiovascular
17:52disease and we sat together and
17:54watched these videos for an hour.
17:56That was chosen because for a long time
17:58in nutrition education in medical school,
18:00it's been the standard to
18:01receive a video based off
18:03the shelf curriculum like this.
18:04And then for the other half
18:06of residents we did a culinary
18:07medicine intervention where we
18:08gave them a bag of groceries.
18:10We said go home, you have 15 minutes.
18:11And then we hopped together on
18:13Zoom and cooked together in a
18:14virtual teaching kitchen where we
18:15made this plant based bolognese.
18:18All the residents participated in a group
18:20discussion regarding the application
18:22of this knowledge to patients.
18:23And then there was AQ and A
18:25with a registered dietitian.
18:26So that was our curricular interventions.
18:29As far as outcomes,
18:30we looked at knowledge with a nutrition quiz,
18:32just five questions focusing on
18:34five different learning objectives.
18:35The questions themselves changed
18:37at each time point,
18:38but the learning objectives were the same.
18:41We asked them to kind of self report via
18:43liquid scales their confidence in providing
18:45various aspects of dietary counselling
18:47to patients and then this is my favorite.
18:49I've been wanting to do this for years,
18:51so I was excited we got to do it.
18:52We did this recipe modification
18:54activity where we said you saw a
18:56patient in clinic today.
18:57They told you last night that
18:58they ate a Taco casserole,
18:59they ate chicken pad Thai.
19:01You look up the list of ingredients online.
19:03This is,
19:03this is what it is named three
19:05ways that they can improve the
19:07heart healthiness of the recipe.
19:08And then we tested on them on that.
19:09Before and after the intervention,
19:13they participated in a subscale of
19:15the Nutrition and patient Care survey,
19:16which is a validated survey that measures
19:19how important it the participants think
19:21it is to address nutrition in primary care.
19:24And then we asked them,
19:25how did your behavior change
19:27after the intervention?
19:28It's been 8 weeks.
19:29Did you incorporate anything you learned
19:30into your practice caring for patients?
19:34So as you can see survey
19:35completion rates were pretty good
19:36at baseline and immediate post.
19:38And then as is unfortunately common,
19:40especially when working with residents,
19:41that survey completion
19:42rate dropped 8 weeks post.
19:44They have a lot of things on their plate.
19:47So looking first at these
19:48nutrition quiz outcomes.
19:49So as far as knowledge,
19:50you can see that pre intervention
19:52compared to post in both groups there
19:54were large increases in their in
19:55their scores on this nutrition quiz.
19:57So their knowledge didn't increase.
19:59And then eight weeks later those
20:00scores were still high right?
20:01So they retained the student
20:02nutrition knowledge.
20:05When we asked them to rate their
20:07confidence in various various
20:09aspects of nutrition counselling,
20:10you can see kind of the results here.
20:11But we said how confident do you
20:14feel counselling patients on
20:15accessible heart healthy meals,
20:17providing educational resources to patients,
20:19providing dietary counselling
20:21for dyslipidemia.
20:22As you can see on the right hand
20:23side here in the control group,
20:24only two out of those five outcomes
20:27had statistically significant
20:28increases pre versus post.
20:30And in the intervention,
20:31the culinary medicine group,
20:32those increases were statistically
20:34significant across all 5 domains.
20:37So this is one example of that.
20:38You know we said how confident do
20:40you feel providing plant forward
20:41dietary counseling to patients.
20:43And you can see that increase in
20:44the intervention group here on the
20:46left was statistically significant,
20:47whereas it was not in the control group.
20:51This recipe modification activity,
20:52which I told you I was so excited about,
20:54and again improvements in their ability
20:56to to suggest specific recommendations
20:58for a patient's diet that would
21:00improve its heart healthiness.
21:01The intervention group noted
21:03statistically significant increases
21:04in their ability to do that.
21:06Their score on that activity increased
21:07and that increase was not statistically
21:09significant in the control group.
21:14This nutrition and patient care survey,
21:16the validated survey I was mentioning,
21:17it was scored from 8 to 40 because it
21:19was 8 questions and each question was
21:21worth one to five points essentially.
21:23And so higher scores indicate a greater sense
21:26of the importance of providing nutrition,
21:29counselling and patient care.
21:30So you can see those scores increased
21:32again significantly in the intervention
21:33group but not in the control group.
21:38And then eight weeks after the
21:39curriculum ended, we say, listen,
21:40you've been in clinic sometime,
21:42you've experienced this curriculum.
21:43What have you changed, if anything,
21:44about your practice caring for patients?
21:46And 96% of participants in both groups,
21:49the intervention and the control,
21:50said that they had changed something
21:52in the patient care as a result of
21:54the curriculum and some really nice
21:55qualitative quotes here from the residents
21:57that that warm my primary care heart.
22:02So what does this all mean?
22:04You know, it seems that both culinary
22:06medicine and nutrition lectures
22:07seem to be good in a number of ways.
22:09They're feasible and well received.
22:11They're effective in achieving these
22:13knowledge based learning objectives.
22:15And as we saw, they do have potential
22:18to possibly impact patient care.
22:20However, culinary medicine may and
22:21again this is just a pilot study.
22:23We had a small sample size.
22:25You know, we were kind of
22:26analyzing these groups separately.
22:27So there's there's plenty of
22:29of limitations to the study.
22:30But in this preliminary study,
22:32we see that culinary medicine
22:34curricula may further improve
22:35attitudes regarding the importance
22:37of nutrition in patient care,
22:39make participants feel more
22:40confident when it comes to providing
22:42dietary counseling to patients,
22:44and perhaps increases their skill in
22:46modifying recipes for heart healthiness.
22:48With the goal really being
22:49that they'll be able to get the
22:50conversation started with patients
22:52and provide some specific dietary
22:53recommendations and then encourage
22:55them to continue this conversation
22:56with the registered dietitian nutritionist.
23:01So why is this important?
23:02Well, the A/C GME is actually thinking
23:05about instituting mandatory nutrition
23:06education for residents as early as 2026.
23:08This was announced in October of
23:112023 at the founding of the Food
23:13is Medicine Institute at Tufts.
23:14And so for institutions that really don't
23:16have a teaching kitchen or a trained
23:18staff to provide culinary medicine,
23:19that's OK. Didactics only.
23:21Lecture based nutrition curricula
23:22like we mentioned seem to be
23:24effective in a number of ways.
23:26But for institutions that do have
23:27a teaching kitchen or a trained
23:29staff to provide culinary medicine,
23:30it seems that this may be a
23:32more potent intervention.
23:36So that's culinary medicine for healthcare
23:38providers and our medical trainees.
23:39But what about for patients?
23:40What are what are we doing for
23:42patients with culinary medicine?
23:44Well, I want to emphasize that
23:45when we teach culinary medicine
23:46to our healthcare providers,
23:48we're basically saying let's give you
23:50nutrition knowledge and then counseling
23:51skills so that you can talk to your patients.
23:54And then hopefully your patients
23:55will be able to make lifestyle
23:57changes to improve their health.
23:58It's a little more indirect when you're
24:00doing culinary medicine for patients,
24:01it's very direct.
24:02Hello.
24:03Let's talk about nutrition.
24:04Let's learn together how to
24:06cook healthy food.
24:06Hopefully you can go home and do
24:08this and we'll be here to support
24:09you throughout the process.
24:10It's much more direct,
24:11but I want to emphasize that culinary
24:13medicine is only one piece of the puzzle.
24:16Largely here in the United States we
24:18do not follow a heart healthy diet for
24:20a myriad of reasons and as you can see
24:23kind of on the left here at most basic.
24:25You know this is all predicated
24:26our ability to follow a heart
24:28healthy diet on sufficient time
24:29for meal planning and preparation,
24:31which really who feels like they have
24:32enough time to do all that right.
24:34This is a systemic problem and
24:36we really will need solutions
24:37like maternal and paternal leave,
24:39you know, more fair wages,
24:41basically access to work weeks
24:42that are not overwhelming for
24:44folks and workers rights.
24:46Essentially these these systemic
24:47changes will need to take place to
24:49ensure that folks have enough time
24:50to cook and prepare their meals.
24:52And then we know that not everyone
24:54in this country has access to
24:55affordable and nutritious food.
24:56It's about 20% of our patients here in
24:58New Haven are food insecure nationally.
25:01We know that systemic racism and
25:03things like redlining of of grocery
25:05store place placement and food swamps
25:07and deserts are more likely to be
25:09located in minoritized communities,
25:11right.
25:11So there's these bigger systemic
25:13issues that really we have to work on.
25:14And I emphasize that because associates
25:16would say that a systemic problem,
25:18it requires A systemic solution,
25:19which I always tell my trainees.
25:21And so we as clinicians often
25:22have very individual tools.
25:24Culinary medicine is one of them.
25:25But simultaneously really we should
25:27work together to kind of work on
25:29these systemic solutions that that
25:31can work with culinary medicine.
25:33So looking at that second column there
25:35in blue, we have meeting with your PCP,
25:37meeting with a dietitian nutritionist
25:38and then really we think of
25:40culinary medicine as a bridge.
25:41You can know how to eat healthy,
25:43but then not actually do it.
25:45And that culinary medicine is
25:46kind of the bridge that helps
25:47you kind of put it into practice.
25:49The goal of all of this being that
25:50we can help patients to follow
25:52a nutritious diet to prevent
25:53and treat chronic disease.
25:57And so there's been a lot of literature,
25:58more literature in culinary medicine
26:00for patients and healthcare trainees
26:02and it's been shown to improve
26:04some of these biometric outcomes to
26:06improve the quality of their diet.
26:08And then some of these quote UN quote
26:10softer outcomes like personalization,
26:12self efficacy, quality of life,
26:14well-being, these have all been
26:15demonstrated in the literature as a result
26:18of culinary medicine interventions.
26:19So it's a really positive fun, you know,
26:23warming experience for patients.
26:25And so I'm happy to say that
26:26here at our teaching kitchen,
26:27Max, as I mentioned,
26:28teaches a lot of patient classes,
26:30two to three per week and and that's growing.
26:31We've only been doing patient
26:33classes for about 6 months.
26:34These are totally free to patients.
26:36They do not need insurance.
26:37We don't charge insurance.
26:39There's no qualifying diagnosis.
26:40Any patient who has a provider
26:42at Yale can be referred to the
26:43teaching kitchen for free classes.
26:45It's fabulous.
26:46So this is located at North Haven.
26:48Each class is about two hours.
26:49And the way this works is they come to
26:51an introduction to culinary medicine
26:52class and then after that they're
26:54allowed to come to as many or as
26:56few other classes as they'd like.
26:58So I show some offerings of ones we
27:00have here and then some offerings
27:01that we hope to offer in the future.
27:03So really growing quickly and it's been
27:05really a fantastic resource for our patients.
27:10So again, that's how we kind of
27:12teach culinary medicine to patients
27:13and to our medical trainees
27:14and healthcare professionals.
27:15And as I briefly alluded to,
27:17this field's really only been
27:18around for about 15 years.
27:19This is pretty new,
27:20but it's growing quickly.
27:21And So what does the future hold?
27:24So for our patients,
27:25we're going to have many more
27:26physical teaching kitchens.
27:27You know, a lot of people have
27:28never heard of a teaching kitchen
27:30until recently and now they're
27:31becoming extremely commonplace,
27:32right, with more and more
27:34institutions building these.
27:35So you'll have more of
27:36those with group visits.
27:37But then as I mentioned during the pandemic,
27:39we learned how to do this virtually
27:40and it seems that actually patients
27:41self efficacy improves the same
27:43or perhaps even more through
27:44these virtual teaching kitchens
27:46because they're cooking at home
27:47where they're familiar with the
27:48pots and pans and the equipment.
27:50They got the ingredients
27:51themselves and they're like wow,
27:52I really can do this in my home
27:54kitchen because I just did it right.
27:55So these virtual options are
27:57really going to proliferate,
27:58whether it's via asynchronous video
28:00based culinary medicine curricula.
28:02I think we're going to see more of those.
28:04There's already community culinary
28:05medicine classes happening
28:06on Zoom and social media.
28:08This is something we hope to do through
28:10the teaching kitchen here at Yale.
28:11And then I'd like to point out this
28:13kind of cool startup which I think
28:15is going to be a proof of concept
28:17that's that's really going to grow.
28:18It's called Palm Health and they take
28:19advantage of this telehealth model.
28:21It's a private company that contracts
28:24with dietitians and chefs and they
28:26hold group visits via telemedicine.
28:28And then bill,
28:29bill insurance companies,
28:30they partner with insurance companies
28:32and healthcare organizations to provide
28:34group visits surrounding nutrition,
28:36education and culinary medicine actually.
28:38And again you can you can make
28:39this into a profitable platform.
28:41So I think this is something that will
28:43happen more and more in the future.
28:45And then this is my particular passion.
28:46If no one else is going to do it,
28:47I'm going to do it.
28:48Culinary medicine is about to go
28:49mainstream and I think really laypeople
28:51are going to be really interested in this.
28:53You know,
28:53people would like to see an infotainment
28:55series where someone's cooking
28:57healthy food and sharing it with
28:59friends and family with love learning
29:01about nutrition in the process.
29:02And I think this really like
29:04I said culinary medicine term
29:05is about to go mainstream
29:08for healthcare professionals and trainees.
29:09It's a little less sexy,
29:11but essentially we need to
29:12establish some core competencies.
29:14That's what that summit was kind of
29:16focused on last March with validated
29:18curricular assessment tools.
29:19And this will really allow us to
29:21create more standardized culinary
29:22medicine curricula that we can
29:23test in rigorous ways in multi
29:25institutional trials and that'll
29:26really I think push the field forward.
29:30We have a grant here to build an asynchronous
29:32video based culinary medicine curriculum,
29:35which I think will solve a lot of issues.
29:37As I mentioned, folks don't necessarily have
29:39a teaching kitchen or a combination of chefs,
29:41registered dietitians and nutrition experts
29:43on staff that can teach culinary medicine.
29:46But we can create a series of videos
29:48here and then folks can essentially
29:49watch them and cook along at home
29:51asynchronously from their own kitchen.
29:53So I think establishing A curriculum
29:55like that and then making it available
29:57to other institutions and other
29:59programs here at Yale will be huge.
30:01And really, we have all these other
30:03growing fields of medicine that
30:04partners so well with culinary medicine,
30:05for instance, obesity medicine,
30:07lifestyle medicine, Buddhist medicine,
30:09which is a rapidly growing area of medicine
30:11that I'm happy to talk more about later.
30:13And then climate and sustainability
30:15education, This really is,
30:16is taking hold in many areas of our
30:18society and will increasingly be a focus,
30:20I think in the future of medicine as well.
30:22And as it turns out,
30:23the best diet for our body is
30:24the best diet for the planet.
30:26So I think really this is something
30:27we're going to be focusing on
30:28more and more in the future.
30:32So with that, I want to give you
30:33a micro dose of culinary medicine.
30:35So we're not going to cook together.
30:36Don't worry. I know that we're
30:38busy probably writing notes,
30:39listening in, some folks are eating.
30:41I'm standing at my working desk and I
30:43know a lot of you probably are too.
30:44And so I just want to do a quick
30:46micro dose of culinary medicine to
30:47give you a peek into what types of
30:49concepts we cover with our patients
30:51and with our healthcare trainees.
30:54So many of you may be familiar
30:56with the AH as life's essential 8.
30:58So these are the eight things
30:59they think you should do to
31:01prevent cardiovascular disease.
31:02It used to be the simple 7 but
31:03then I think they realized it's
31:05maybe not so simple after all.
31:06And so as you can see here,
31:085 of the 8 directly tied to diet, right?
31:11This is the foundation of
31:13preventing cardiovascular disease.
31:14And as a side note, #1 here,
31:15eat better, could you give more
31:17vague and unhelpful advice?
31:19Right.
31:19So that's what we're going to
31:21dive into is what does that mean.
31:23So for many of us this,
31:25this,
31:25this word plant forward,
31:26a plant forward dietary pattern might be
31:28a new phrase and this is a growing phase,
31:31a growing phrase in the fields of
31:33nutrition and food is medicine and
31:35what it means is that really for health
31:36we should eat as many plants as possible,
31:39but we don't need to necessarily
31:41exclude animal based products.
31:42So it's not to say let's eat animal based
31:44products plus plants for best health.
31:46It's saying eat as many plants as
31:47you can and it doesn't necessarily,
31:49it allows for some animal based products,
31:51right.
31:51So that's the focus and the reason
31:53we use this term with our healthcare
31:55trainees and with our patients
31:56is that this is we think of it
31:58as kind of an umbrella term.
31:59You know,
32:00many folks have heard of some
32:01of these evidence based diets,
32:02the DASH diet,
32:03the Mediterranean diet of course,
32:05but then some others,
32:06the whole food plant based diet
32:07we all know and love the My Plate,
32:09the Harvard diet et cetera.
32:10There's lots of different types
32:11of diets here that have really
32:12good dietary patterns.
32:13And by saying plant forward,
32:15what we're saying is,
32:16look,
32:16these diets have a lot in common
32:18and we really focus on those commonalities.
32:21And so I think that really helps to reorient
32:24folks to what the evidence is really saying,
32:26which is eat as many plants as possible.
32:29So the way we show that to our our trainees
32:32when we teach these classes is we use this,
32:34this kind of nutrition guideline,
32:37which is to say, OK everyone,
32:38I know nutrition is confusing
32:40and you probably get stuck
32:41in the weeds a lot of time.
32:42I know you see some crazy
32:43things on social media,
32:44right?
32:45But let's just reorient
32:46ourselves to what we know
32:48for sure. And what we know for sure is
32:49that eating plants is healthy, right?
32:51The more plants you can eat, the better,
32:52especially whole and minimally processed
32:54plants which are vegetables and fruits,
32:56whole grains, nuts, seeds and legumes.
32:58But at the same time,
33:00we know that these ultra processed foods,
33:02these junk foods are not heart healthy.
33:05They are health harming, right?
33:06They're high in salt, sugar, saturated fat,
33:08which improves the shelf life,
33:10refined carbohydrates, IE not whole grains,
33:13carcinogens like sodium nitrite,
33:14which we see in processed meats and
33:16plenty of empty calories. Right.
33:18So the reason we we present this like this
33:20is folks really don't argue. You know,
33:22I always say what do people think is this,
33:24is this new information like, you know,
33:26please challenge me, but everyone's like,
33:27no, it makes sense, right?
33:27Junk food, bad plants, good.
33:29I know that, right?
33:30But then to emphasize that these are
33:31two polar opposites and then to leave
33:33room for discussion in the middle,
33:34I think really sets people up for success
33:36with regard to learning about nutrition.
33:38And really the goal is to,
33:39with self love, kind of say,
33:40where do I fall on the spectrum?
33:42And the goal is to just move
33:44more towards the right,
33:45right.
33:46So that's how we kind of describe
33:47things to folks.
33:50But some people of course want more
33:52than just a big broad template and
33:53so some specifics of nutrition.
33:55For cardiovascular disease prevention,
33:56it comes down to just a few basics.
33:58Like we mentioned eating a lot of plants,
34:00there's many reasons for doing that.
34:01Vitamins, minerals, vital nutrients,
34:02but also they have a lot of soluble fiber,
34:05which lowers your LDL, and potassium,
34:07which lowers your blood pressure,
34:09replacing sources of saturated
34:11fat with unsaturated fat.
34:13So saturated fat increases your LDL
34:15from unsaturated fat lowers yoga right?
34:18And so we get our socials of saturated
34:20fat is from animal based foods,
34:22a lot of ultra processed foods
34:23and then tropical oils, so palm,
34:25palm, kernel and coconut oil.
34:27And then unsaturated fat comes from plants
34:32choosing slow carbs.
34:32So this is probably a new term for some
34:34folks that the dietitians like to use.
34:36And what it's emphasizing is you should
34:38think about how quickly the carbohydrates
34:39and sugars that you are eating are
34:41absorbed into the bloodstream, right.
34:43And so the slower the better.
34:44And so added sugar gets
34:46absorbed very quickly, right?
34:47So minimizing added sugar in our diet,
34:49replacing refined grains with whole grains,
34:52the difference there being that a
34:54whole grain has a bran in germ and the
34:56refined grain is just the endosperm.
34:58So the endosperm is quickly
35:00converted into simple sugars and
35:01taken up into the bloodstream.
35:03Whereas these whole grains,
35:04the bran and the germ contains
35:05fiber which slows the absorption
35:07in addition to healthy fats,
35:08vitamins and minerals.
35:11And just as a side note here sugar in
35:12the form of whole fruit is fine because
35:14the sugar is coming with a lot of fiber,
35:16which again slows the absorption
35:18rate into the bloodstream,
35:21avoiding excessive alcohol and caffeine.
35:23Take intake of course,
35:24which probably goes without saying and
35:25we all know and love the DASH diet,
35:27so decreasing salt intake is
35:29helpful for blood pressure.
35:31So these are some very specific tenants of
35:33preventing cardiovascular disease with diet.
35:35But when it comes down to how
35:36do we take recipes and modify
35:38them for heart healthiness,
35:39how do we put this into practice?
35:40So this is something we taught in
35:42this thesis project that led to,
35:44as you saw, a statistically significant
35:46increase in participants ability to
35:49modify recipes for heart healthiness.
35:51So there's three different techniques.
35:52You can either take something out,
35:53you can add something in,
35:54or you can make a swap.
35:55So taking something out is
35:56generally the least fun thing to do,
35:58but it's always an option.
35:59So you can just subtract sugar and salt,
36:01right?
36:01We know those things are not heart
36:02healthy salt for blood pressure.
36:04Sugar impacts your triglycerides,
36:05right?
36:05So subtracting those things out
36:08the replacements are maybe some
36:09more fun things to do, right?
36:10So instead of refined grains
36:12like a white pasta,
36:13replace it with a whole grain
36:15like a whole wheat pasta.
36:16Taking ingredients that
36:17are high in saturated fat,
36:18like these animal based products,
36:20and replacing them that with ingredients
36:21that are lower in saturated fat.
36:23So if you're thinking about
36:24what steak should I get right,
36:25a rib eye is my favorite.
36:27And why is it my favorite?
36:28It is so fatty, right?
36:30That's why it tastes so good.
36:31But instead get a steak that
36:33ends in the suffix loin.
36:34Anything that ends in loin is going to
36:36be more lower, much lower in fat, right?
36:39So instead of the rib eye, get a sirloin.
36:41You'll save a whole bunch
36:42of saturated fat that way.
36:43And then in general,
36:44instead of choosing the steak
36:45in the first place,
36:46maybe like we did with our lentil
36:48bolognese instead of the beef and the
36:50pancetta opt for mushrooms and lentils,
36:51right.
36:52So as many plant based sources of
36:53protein you can get the better because
36:55you save on that saturated fat plus
36:56you get all the benefits of it being a plant,
36:59the fiber, the micronutrients.
37:01And then finally we like I said
37:02we have subtract,
37:03we have replaced and then we have add.
37:04So just add whole or minimally
37:06processed plants,
37:07take whatever you're making,
37:08you know, instant ramen,
37:09add in some frozen vegetables, right.
37:11That's immediately a way to
37:12make it slightly better,
37:13right?
37:13So just thinking about these
37:14specific ways to modify
37:16recipes for metabolic health.
37:20So with that, I'm going to try this challenge
37:22that could be very interesting, right?
37:24So I want you to think of your
37:25favorite dish to prepare or eat.
37:27And if you have, like a story about why I,
37:28I would be curious to hear that too.
37:30You know, is it something
37:31your mom made growing up?
37:32Is it something that's a comfort for
37:33you and a particular time in your life?
37:35What is your favorite dish to
37:36either to prepare or to eat?
37:38I'll tell you, mine is pizza,
37:39which is why I'm showing you pizza there.
37:40And then if you could just either,
37:42you know, feel free to turn on your
37:43microphone and tell us about it,
37:44throw it into the chat.
37:45And then maybe I'll ask Janet
37:46to kind of monitor those.
37:48And let's, let's tackle a couple,
37:49see if we can come up with ways
37:51to improve the heart healthiness,
37:52the metabolic health of these recipes.
37:54And if you have an idea of
37:55how to do that already,
37:56feel free to share and then I'll,
37:57I can kind of chime in too.
37:58So we'll just put this to practice.
38:01Well, we have spaghettini, tiny pasta
38:05with butter and grated cheese. She does a
38:11for a little bowl. It is.
38:14What was the first word for the Bolognese?
38:17Oh, Papadel. Papadel. Yeah. Well,
38:18I'll tell you what we did with the Bolognese.
38:21But then I want to go back
38:22to the butter and cheese,
38:22pasta juice, the Papadel Bolognese.
38:24You know, there's pancetta, there's beef,
38:26there's whole milk, there's cheese.
38:27Right. So these are things that
38:28are kind of rich in saturated fat.
38:30So what we did for our Bolognese
38:31was we swapped out the beef instead.
38:33We did lentils and mushrooms.
38:35And you could also chop up some walnuts,
38:37believe it or not.
38:37But that combo of three things provides,
38:39like some meatiness actually,
38:41and some nice texture.
38:42But they're all plants, right?
38:43And then my biggest tip for that
38:45one is instead of using whole milk,
38:46we use evaporated fat free milk,
38:48which is shelf stable.
38:49You buy it in pans, there's no sugar added,
38:52it's not sweetened condensed milk.
38:53Sometimes people get that confused,
38:54but it's where they evaporate
38:55off some of the water.
38:56So it's thicker and creamier,
38:58like whole fat milk,
38:59but it's actually fat free.
39:00So those are my tips for
39:01the lentil bolognese.
39:02And then of course we swapped a a
39:04refined pasta for a whole grain pasta,
39:06the one about the pasta with
39:07the butter and cheese.
39:08First of all, that sounds amazing.
39:10You know,
39:11I think of another way possibly you
39:12could do that is you could swap out
39:14maybe half the butter for some olive oil.
39:16You could almost go towards the
39:17route of like a pasta aglio yoyo,
39:19which is a delicious pasta with
39:22garlic and olive oil, right?
39:23So you could add in,
39:24add in some vegetables like garlic,
39:26it would be good.
39:26Of course with broccoli you could use
39:28some nutritional yeast and some parmesan,
39:30right?
39:30So to cut back on the amount of cheese
39:32you could add in some vegetables.
39:34So that could be a fun one to play with.
39:35But I think swapping the butter
39:36with a little bit of olive oil
39:38could be a good first step.
39:39What else we got,
39:39Janet?
39:40Oh my gosh, we have so many interesting
39:42ideas. One is that we we have Rachel
39:45sneaking hummus into her pasta sauces.
39:49Oh, lovely. Oh, I like that.
39:51Right. So some plant based
39:52protein from the chickpeas.
39:53You can do the same thing with vegetables.
39:55You know, if you actually just, like,
39:56boil some vegetables or take some
39:58frozen vegetables and microwave them,
39:59puree them, and then your kids
40:01will never know it's in the pasta.
40:02We've run this by the pediatricians.
40:04Who says this?
40:05Is this wrong to try to sneak in
40:06vegetables in the pasta sauce?
40:08They said no, absolutely do that.
40:09Right.
40:10So that's a great way. If
40:12that's right, gotta do it.
40:14So ants. Oh, this is interesting.
40:16Replacing Parmesan with nutritional yeast.
40:19I've never heard of that. Yeah,
40:21I find, you know, it actually makes a
40:22really good replacement for cheddar.
40:24It has kind of a cheddary flavor.
40:25So it's a little different than
40:27than Parmesan, but it's nice.
40:28And that has a similar texture and you
40:30can put it on top just like Parmesan.
40:32But yeah, it's a it's a really good one,
40:33'cause it's kind of cheesy flavored.
40:35And then to modify Greek moussaka by using
40:38mashed potatoes instead of bechamel sauce.
40:42Oh, that's a fabulous idea, right?
40:44So bechamel sauce, for folks who don't know,
40:46you take butter and flour,
40:47so already a refined grain
40:49and saturated fat, right?
40:50And then you add a whole bunch of whole milk,
40:52so a bunch more saturated fat, right?
40:53You make this delicious creamy sauce.
40:55It's used in pastas, it's used in lasagnas.
40:57And so thinking about how to take this thick,
41:00white creamy sauce and instead use a
41:02vegetable like mashed potatoes is fantastic.
41:05He could probably do the same
41:06with pureed cauliflower.
41:07So I love that idea.
41:08And then maybe one more.
41:10Well, how about Fred is wondering how
41:12would we modify chicken tikka masala?
41:15Oh well, that's great. Well,
41:16you could do paneer tikka masala, right?
41:18So switching from like a an animal
41:20based source of protein to a
41:22plant based source of protein,
41:23I would have to see what
41:25type of dairy is standard.
41:26But you could think about substituting for
41:29like a lower fat dairy or an alt dairy.
41:32So let's say it's common to
41:33use heavy cream instead.
41:34You could use like I said some
41:36of this evaporated milk or they
41:37make a fat free half and half you
41:39could consider switching to that.
41:40You could do a low fat coconut milk
41:42which would add you know arguably a
41:44slightly different flavor because of
41:46the coconut but would still be delicious.
41:47So thinking about how to swap again
41:49from the the animal based sources
41:51of protein to plant based and then
41:53kind of minimizing the saturated
41:54fat while still maintaining that
41:56delicious flavor and texture.
41:57And then the final suggestion I would
41:59have there is of course instead of
42:01white basmati rice you could use brown
42:03basmati rice which is which is delicious.
42:05Great questions
42:07Nate. I don't know if you want to take
42:08any questions now or do you want to
42:11I'm I'm super close to the end so let
42:12me just wrap up and then yeah let's
42:14take as many questions as we can.
42:15I want to leave time for that. OK,
42:17so I want to leave you with just a few tips,
42:19Practical tips for making healthy happen.
42:21So thinking about how you
42:23can construct your default,
42:24healthy environment, Right.
42:25So if the chips are what you see
42:26on the counter when you come home,
42:28you're going to go for the chips.
42:29If it's fruit out there, you're going
42:31to do that when you open the cupboard.
42:32Are the Oreos the first thing that you see?
42:34Or is it the, you know,
42:36whole wheat crackers and and other pantry
42:39staples like like beans and vegetables,
42:41right? Keeping snacks on hand
42:42for when you're healthy.
42:43Making sure they're when you're hungry.
42:45Making sure they're healthy.
42:47Planning ahead, which is hard.
42:49I know it is.
42:49I, I, I, I personally know that, believe me.
42:51But it's worth it, right?
42:53So thinking about what meals
42:54am I going to make this week?
42:55What days of the week will I have time to
42:57cook and when will I not have time to cook?
42:59And really planning ahead for that.
43:00And then one of my favorite tips,
43:02tips,
43:02looking at restaurant menus in advance.
43:04So saying you know I'm going to go out for
43:06a happy hour on Thursday with colleagues.
43:08I'm going to celebrate with my family at
43:09a dinner out on Saturday night looking
43:11in advance when you are hungry and
43:13satiated saying you know at that time
43:15say what am I going to eat in the future.
43:17And then and then try to stick to
43:18that to make some positive choices,
43:20repurpose leftovers as much as you can
43:21and do not be afraid to use frozen,
43:24dried, canned,
43:24pre cut produce and legumes right.
43:26These things are healthy when they're frozen,
43:28they're picked at the peak of
43:29ripeness and then flash frozen right?
43:31They are just as nutritious as fresh and
43:33sometimes more delicious and more healthy,
43:36especially if they're not
43:37currently in season fresh, right?
43:39So thinking about making use of those
43:41and then just some other small tips here.
43:43Don't grocery shop on an empty stomach.
43:45We all know where that leads.
43:46This is one that I started doing in college,
43:48which I highly recommend.
43:48You know, if you have fried chicken,
43:50collard greens,
43:51kind of some macaroni and cheese
43:53and baked beans, right?
43:54Think about starting with the
43:56fiber rich vegetables first.
43:57Make your way into the refined carbs
43:58and then end with the fried chicken,
44:00right?
44:00And instead of eating four pieces
44:02of fried chicken and a smattering
44:03of these other things,
44:04you've really kind of filled up first
44:05on vegetables and then supplemented it
44:06with a little bit of the fried chicken,
44:08right?
44:08So some small changes like that can
44:10can really have a positive effect.
44:12And then drinking plenty of water
44:14in unsweetened beverages because
44:15sometimes our brain says you're hungry,
44:17but really, it's, I'm thirsty,
44:19right? So stay hydrated.
44:22So again, we'll just leave you with
44:24kind of this last tip to take action.
44:26So we talked about a lot of things today,
44:28practical applications,
44:28what a plant for diet is,
44:31how to prevent cardiovascular disease,
44:32how to modify recipes for
44:34heart healthiness, right.
44:35So we took a a lot of knowledge
44:37in a short period of time.
44:39And so I'd encourage you to think of one
44:41thing that you could change that would
44:42improve the heart healthiness of your diet.
44:44I'd encourage you to make a smart goal,
44:45which is something you all
44:47I'm sure are familiar with.
44:48And then if you feel comfortable as
44:49kind of a form of accountability,
44:50to put it out there in the chat and
44:52then we can support you in that.
44:56Hopefully now you feel at
44:57least a little more confident.
44:57Actually, this group felt very
44:59confident to begin with, right?
45:00And so for those of you who are
45:01not feeling as confident, hope you.
45:02Hopefully you feel slightly
45:04more confident if Mr.
45:05Jones walks into your office.
45:07And then in conclusion,
45:08chronic diseases,
45:09the leading cause of death in the
45:11United States and diet is the biggest
45:13risk factor for these diseases.
45:15We as healthcare providers do
45:16not receive enough education and
45:18nutrition and neither do our patients.
45:20Culinary medicine seeks to address
45:22that to improve the nutrition
45:23education in both healthcare
45:25providers and patient care.
45:26And thus we hope to improve
45:28outcomes and really in the future,
45:29The next 1020 years,
45:31I think culinary medicine is
45:32going to be increasingly adopted
45:34into medical education and as
45:35an intervention that improves
45:37value based care for patients.
45:39And it's really poised to dramatically
45:40impact I think the future of healthcare.
45:44Nate, that's your reality show.
45:48There we go. That's how I make it happen,
45:49huh, That's how you make it happen. Great.
45:54So everyone can the feedback,
45:56if you wouldn't mind doing the QR code
46:00and then we're going to have questions.
46:02I'll just mention some of the questions
46:04as you're doing the QR code to give us
46:06feedback which is so important to help
46:08us and always provide feedback to our
46:11presenters and and enhance our learning.
46:14I loved all these ideas, Nate,
46:16about what people are doing.
46:18So that was terrific.
46:19Even at the very beginning oughta
46:21mentioned that even just cooking
46:23together is good for our well-being
46:25which I I love that comment.
46:27Laura was asking if you have any
46:29data to indicate that learning
46:31is enhanced for patients and
46:33clinicians in the kitchen setting.
46:36She was thinking that the experiential
46:38part is hugely impactful,
46:39but also the fact that there are smells,
46:41tastes,
46:42noises and all the affective
46:44connections would be hard to keep.
46:48Yeah, yeah, great, exactly.
46:49Great point that this learning
46:51is kinesthetic, right?
46:52And generally they're learning it twice.
46:54So instead of just learning it in a lecture,
46:56they're learning it in a lecture and then
46:57they're learning it in the kitchen. Right.
46:59And so we do believe that this is, you know,
47:02better than just lecture based learning.
47:04And like I said,
47:05really we would need randomized
47:06control trials to say that for sure.
47:08And the one that I did as kind of
47:09a pilot study was the first ever.
47:11So we'll have better data
47:12on that in the future.
47:13There's been some other studies where
47:15they essentially gave some medical
47:17students a culinary medicine curriculum.
47:20And for the other Med students,
47:21they just said like, oh,
47:22keep doing what you're doing,
47:23whatever it is at your school.
47:24And so that's kind of low quality data and
47:26such in that these medical schools were
47:28all doing different types of curricula.
47:30So that wasn't really very standard.
47:32It wasn't randomized or blinded
47:33or any of those things,
47:34right?
47:34But it indicated that those folks were more
47:36likely to adhere to a Mediterranean diet.
47:38They felt more confident in
47:40counseling their patients.
47:41But like you said,
47:41I think a lot of this comes from them
47:43just being so engaged in the learning.
47:45This is just fun.
47:46This is such a fun field and
47:48a way to learn nutrition.
47:49And so I feel lucky to be involved.
47:51But more and better data
47:52to come in the future.
47:54Yeah. And I I think everyone's
47:55probably has the QR code.
47:56So you could take down your slides.
47:58Nate, we have so many more questions.
48:00Anisha's asking if your team has
48:02collaborated with any of the public schools.
48:05Because as we know what our children are
48:07being offered to eat at the public schools.
48:10Yeah, yeah. A lot of issues there.
48:12One being that like we are effectively
48:14teaching our kids how to eat through
48:16school lunch and what school lunch is,
48:18is let's eat ultra processed foods in 15
48:21minutes as quickly as possible, right.
48:23So that's how we're teaching kids to eat.
48:24So that's one problem that you know
48:26obviously I can't address at present,
48:28but as far as education of K
48:29through 12 students that definitely
48:31needs to change as well.
48:32And so we haven't yet partnered
48:33with any of our our schools here,
48:35but we're hoping to really ramp up this
48:38work starting in July as I finish up
48:40my medical education fellowship and
48:42move into more kind of higher level
48:44collaboration with this teaching kitchen.
48:46And we have, like I said,
48:47several connections and we will be
48:49going into the schools very soon.
48:50I'm overseeing a medical student who's
48:52going to start doing that as well in July.
48:53And so that's a fantastic idea and
48:55we're going to start locally and then
48:57hopefully study that and help folks
48:59more nationally do that as well.
49:00It's very important.
49:01And just to add to that hope,
49:02Ricky Audi was head of the OBGYN
49:04residency at the Beth Israel,
49:06and I'm sure Jessica knew her well at
49:08Harvard and her husband was a chef and he
49:10ended up going into the Brookline schools.
49:12I don't think he published on it,
49:14but it could be good to connect with
49:16him because he totally revamped
49:18the public school program just
49:20because what you're saying, Nate,
49:21it's it's full of processed foods.
49:23So we have a number of Julie's saying
49:25she's a physician at Bridgeport
49:27and if you want to start up there,
49:29she has a strong background in this area.
49:30We have so much excitement about that.
49:34And and then Carol asks,
49:37are you going to have a kitchen in New Haven?
49:39Valeria is asking about Greenwich Hospital.
49:42So we really start looking
49:44at all our hospitals.
49:45So lots of excitement here.
49:49One important question was about
49:51EPIC and it so is the referral
49:54to the patient teaching kitchen.
49:57I was very impressed, Nate,
49:58that you know,
50:01you can refer anybody and I think it was,
50:06yeah, yeah, yeah.
50:07So there is an EPIC referral.
50:09There's one referral for dietitians and
50:10there's one referral for teaching kitchens,
50:12but they're both ref.
50:1450, I believe.
50:14And so this if you scan this QR code,
50:17let me know if it doesn't work.
50:18But this should take you to
50:20the form that tells you how
50:22specifically to place the referral.
50:23And again, any Yale provider
50:24can do this for their patients.
50:26And if you have any clue about
50:27that feel free to e-mail me.
50:28Or you can e-mail Max in the teaching
50:31kitchen directly at teachingkitchen@ynhh.org.
50:33So I'll just leave this QR code
50:34up for another couple seconds.
50:36Thanks Nate. Another question
50:38that Ben's asking, do you know if
50:41non-emergency medical transportation
50:42covers rides to the teaching classes?
50:46Yes, we we think it does and we're not.
50:49We I haven't confirmed that yet,
50:51but basically patients get in
50:53their my chart like a scheduled
50:54appointment just like they were
50:56seeing a doctor or anyone else.
50:58And as you mentioned it's in North Haven,
51:00so we need transportation for that.
51:01So Baio which now I know has a new name,
51:03this non emergent medical transport,
51:05I'm 95% sure it'll cover it,
51:07but we haven't confirmed that yet.
51:09So if you're able to confirm that,
51:10please let me know.
51:11But we are telling patients that it that
51:12it works because it definitely should.
51:16That's great.
51:19Let's see.
51:23And while you're kind of reading
51:24through some more there,
51:25I'll just mention that this
51:26teaching kitchen in North Haven is
51:281 of what we hope will be many.
51:30And so thinking about teaching
51:31kitchens and other locations,
51:33perhaps a mobile teaching kitchen
51:34which could go into communities and
51:36and provide this kind of education,
51:38I think would be huge.
51:39And as I mentioned,
51:40the NIH is very interested in supporting
51:42this kind of work going forward.
51:44And so we expect some funds to be made
51:46available for projects like that.
51:47So looking forward to that expansion.
51:49And there was a question about
51:52the cultural aspect, Nate.
51:53And do you incorporate any cultural
51:56aspects when you're providing counseling?
52:00Yeah, yeah, absolutely.
52:01Great point. So we like to use.
52:04So there's this organization called Old Ways,
52:07which I would recommend and
52:09it's been around for decades.
52:10And they focus on what are called
52:13traditional heritage diets.
52:14So one traditional heritage diet,
52:15which we all know and love is
52:17called the Mediterranean diet.
52:18And you can see their kind
52:19of pyramid for that here.
52:20But really, we've studied the Mediterranean
52:22diet in the field for a long time,
52:24but we haven't studied all of these
52:27other traditional heritage diets.
52:28But really,
52:29they're all basically the same.
52:30You know,
52:31it's not to say that the specific foods in
52:33this Mediterranean diet are what's healthy,
52:36but as you can see,
52:37it's that they're eating a lot of plants,
52:39mostly plants with a few animal products,
52:41right.
52:42And that same plant forward dietary
52:43formula is present across the
52:45world in the ways that people have
52:47traditionally eaten for a long time.
52:49And so this resource,
52:50old ways we use in our teaching,
52:52which is to say, you know,
52:53there's lots of different
52:54ways of eating culturally.
52:56We don't have to prescribe
52:57a Mediterranean diet.
52:58And really focusing and plants that are,
52:59you know,
53:00specific to your culture and your
53:02heritage is the best thing probably to do,
53:04right,
53:04instead of this ethnocentric recommendation
53:05of you should all eat a Mediterranean diet,
53:07right.
53:08So that's why we use this term plant
53:09forward and we make use of these old ways,
53:11ways of looking at traditional
53:13heritage diets to encourage folks
53:15to kind of need as many whole and
53:17minimally processed plants that are
53:19culturally specific to them as possible.
53:21And so this website allows you
53:22to look at all of those pyramids
53:24that I just showed you.
53:24But they also have a lot of recipes
53:26and you can sort them based on
53:28the traditional heritage diet,
53:29which is kind of fun.
53:31So we we really rely on some of
53:32their resources as well to do
53:33that because it's so important.
53:35And Nate, there's a little bit
53:38of confusion about caffeine.
53:39If you could make any comments about that.
53:42Someone says, well, Gee,
53:43maybe I'm going to take away and not
53:45have caffeine as as my morning routine.
53:47But then someone else says,
53:48well, Gee, maybe doesn't it have
53:51some cardiovascular benefits?
53:53Yeah. Yeah, great.
53:54So we, you know, we have kind of
53:56this U-shaped curved with alcohol.
53:58If we think about, like,
53:59I'm going to talk about alcohol first,
54:00kind of mortality and the
54:02amount that you consume.
54:03Right. So if you consume a
54:05very small amount of alcohol,
54:06your mortality's higher and then
54:07it dips down and seems like, oh,
54:09a small amount of alcohol is good,
54:10and then the more you consume,
54:11the higher your mortality is.
54:13Now that's a little fraught because
54:15we think there's kind of this
54:16subset of folks who are consuming
54:180 glasses or of alcohol a day,
54:19zero drinks a day,
54:20who perhaps have had alcohol
54:22use disorder and then now
54:23are not drinking any right.
54:25So perhaps that data is a little skewed.
54:27But for caffeine specifically,
54:28if you're getting your
54:29caffeine from tea and coffee,
54:31it does seem that a moderate amount,
54:32you know,
54:32a couple cups a day is probably
54:34good but actively beneficial.
54:35But if you go overboard and they're
54:37consuming 6810 cups a day, right.
54:39This is going to keep your from
54:41a cardiovascular system pumping
54:42a little excessively fast.
54:43And it's it's related to
54:44some poorer outcomes.
54:45So I drink 2 cups of coffee day
54:48religiously or sometimes a cup of
54:50coffee and an espresso martini.
54:51Right.
54:51So thinking about a small amount
54:53of caffeine is is not a bad thing
54:54and it's perhaps a good thing,
54:56but the the the point is to
54:57not drink it excessively.
54:59And if there's a cardiologist down
55:00here who knows more than that,
55:01I'm happy to defer also.
55:02But that's my understanding
55:03of the literature.
55:04And
55:05Dana's had her hand up.
55:06Nate. Go ahead, Dana.
55:08Yeah. Dana. Yeah. It was so great.
55:09Nate, do you teach this patient,
55:12Yeah, patients how to read nutrition
55:14labels and maybe you don't 'cause
55:16you want them to eat Whole Foods.
55:18But I always remember reading
55:19Michael Pollan would like,
55:20say, tell them to not have
55:22more than five ingredients or
55:24something on a nutrition label.
55:26His food rules. Yeah, exactly.
55:28So we, I'll say, first of all,
55:30I desperately want to incorporate
55:31that into my teaching with
55:32residents and medical students.
55:34And they ask for it frequently.
55:35So that's something that we're
55:36hoping to do in the next year or so.
55:37And Max, who teaches the patient classes,
55:39does teach them how to read a food label.
55:41We use this curriculum called
55:42the Health meets Food curriculum,
55:43which has been around for about 12 years.
55:44And it's kind of the gold standard for
55:46teaching patients culinary medicine.
55:47So we license with them and
55:49they have a handout teaching
55:50how to read a nutrition label.
55:52And like you said,
55:53that's a very important aspect,
55:54not just the nutrition facts,
55:56but then also the ingredients list where you
55:58said Michael Pollan is sometimes focused.
56:00So that's a huge part of it,
56:01right,
56:01Because we can say until we're
56:02blue in the face,
56:03eat as many plants as possible,
56:04but people are still going to eat
56:06ultra processed foods and thinking
56:07about harm reduction measures to
56:09improve the heart healthiness of
56:10the ultra processed and processed
56:12foods that they're eating.
56:13Reading that nutrition label and the
56:15ingredients list is really important.
56:16So that's a great question.
56:18So, so Fred is asking and this
56:20is interesting about the growing
56:22concerns about microplastics and
56:23we have about one minute left,
56:25Nate, just so you know,
56:27yeah, as you mentioned,
56:28it's a growing concern and the research
56:30we have today is not fantastic, but it's
56:32it's essentially to say microplastics,
56:34this is going to be a big downer.
56:35So don't let this be the last question
56:36we have, but microplastics are it
56:38seemingly in everything, right?
56:40And so we don't fully know the
56:43clinical implications or how
56:44best to avoid them essentially.
56:46And so I I don't really we have a
56:49lot of insightful thoughts about how
56:51to avoid them or what the potential
56:53impacts are from an evidence
56:55based standpoint at at present.
56:56So stay tuned,
56:57but that's a that's a great question.
56:59So I'm going to read for the last comment.
57:01Stephanie is one of our PA faculty
57:03and she's thanking you of course.
57:05And Otta had mentioned early but the
57:07well-being factor of the sessions and
57:09** *** is saying Nate facilitated a
57:12virtual culinary medicine workshop
57:13for the PA online students and it
57:16brought the students together so well
57:18that a group of students continued
57:19to do it on their own virtual shared
57:22meals joining each other on to cook
57:25and eat together throughout the year.
57:28It was excellent.
57:29Excellent. And
57:32yes, I didn't know that I was that
57:34Stephanie Neri, thanks so much, Stephanie,
57:35for saying that. I had no idea. So
57:36we're we're going to end,
57:37we're going to collect all these
57:39comments because there's even Maria
57:40really wants to connect with you.
57:42She has sessions at Hill House
57:43and wants to join with you.
57:45We're going to get all of
57:46these comments to you, Nate.
57:48They're phenomenal comments and ideas.
57:50And I truly just want to thank you.
57:53I was a great session and
57:55I want to make a plug.
57:58Jessica Luziard,
57:58our deputy Dean for education,
58:00is giving our next session our MEDG.
58:04And I hope that you will all
58:05put it in your calendars.
58:07I I know that Sarah put it
58:08in the in the chat before,
58:10but I just so cherished getting
58:12together on these discussion groups.
58:15And so do do come to Jessica's next session,
58:18everybody. And thank you so much,
58:20Nate.
58:21This was an engaging and very exciting talk.
58:24Thank you.
58:25Yes, thank you so much.
58:26Appreciate you. Thank you.