By Henry Ehrlich
Not long ago an article popped up in my newsfeed about a movement in medical schools to offer elective courses in culinary medicine taught by teams of doctors, dieticians, and chefs. The classes typically provide hands-on cooking experience that will allow them to help patients learn cooking skills consistent with managing chronic conditions such as diabetes. They sometimes include field trips to “food deserts” neighborhoods where grocery stores are scarce. This is intriguing to me because I read about so much confusion and despair in food allergy families struggling to maintain healthy diets amid many restrictions, and even in cases where desensitization has taken place, or patients have outgrown their allergies, families have a difficult time re-engaging with food on an equal footing of nutrition and pleasure. I asked my daughter-in-law, a nurse midwife who was the most recent recipient of medical training I know, what she learned about food in school, which might be very useful in coaching mothers both pre- and post-natal. She said that they had one or two courses in nutrition but nothing about cooking.
One paragraph in the article intrigued me because it seemed to have particular relevance to food allergy families.”Culinary medicine courses provide students with strategies they can use to help patients who are struggling with new dietary restrictions and wondering what they can eat given these limitations, says Hope Barkoukis, an associate professor and interim chair of the department of nutrition at the Case Western Reserve University School of Medicine.” So I took the opportunity to track Dr. Barkoukis down and ask her a few questions.—Henry Ehrlich
AAC: Thanks, Hope, for taking this time for our readers. First of all, I’d like to know about how you became interested in your field. When I interview doctors, there’s often one patient who made an indelible impression on them. Do you have some personal connection?
Hope: My grandparents were typical Greeks with a little restaurant making all homemade foods. We always focused on our cultural foods, and homemade ones at that. My own grandmother sadly was exposed to her own mother being starved when the Germans invaded Crete during the war. So, there was always a focus on having food in the house- again, always the traditional Greek foods, made in the home.
AAC: Great story! Moving on, could you tell us where culinary medicine curriculum started? It seems long overdue. Certainly we have seen an explosion of interest in better food and better cooking in the society at large. How did it penetrate academic medicine?
Hope: In the past several years it has become quite clear that a proactive approach to health care is needed. That means integrating into the education of all health care professionals an appreciation for the role of physical activity according to established guidelines, focus on strategies aimed at fostering stress reduction and emotional well-being and of course really appreciating how food and nutrition are the cornerstones to good health. I think from this approach, it was a natural evolution to engage future physicians (and currently practicing ones) into opportunities linking core food education with key nutrition concepts, or culinary medicine.
AAC: I can imagine that doctors in training are receptive to it. I went to a lunchtime lecture at SUNY Downstate Medical School recently and it was very well attended in no small part because there was free lasagna and salad–clearly those students were drawn to good food. But what about senior faculty? Is it the Food Network Effect? What does it take to convince senior faculty and administration to embrace such instruction, which surely wasn’t present in their own training?
Hope: Our observation is that practicing physicians and physicians in training welcome these opportunities. Senior faculty and administration do recognize the importance of this and it is a misrepresentation to say they aren’t interested in making this happen. The challenge is finding the time to compete with the enormous amount of content that is required in the curriculum for today’s medical student. And, in the world of practicing physicians, I think a challenge is finding reputable resources that are focused on linking food and nutrition education to core health prevention rather resources that have a specific narrative to promote and products to sell as their hidden primary objectives.
AAC: Given all that we hear about the time pressure in primary care settings, is it realistic to expect that doctors will really practice culinary medicine? If so, what will it look like?
Hope: This is a great question and here’s why: Culinary medicine is one key pillar, but it is only one of the important cornerstone pillars of a healthy lifestyle. It’s not about trying to create chef physicians. The goal is to increase physicians’ confidence in understanding how to actually talk to their patients about food and nutrition. Culinary medicine should be part of a total package of ‘wellness’ education, ideally not the exclusive component.
And, your question hits the key point— we aren’t going to see physicians in mass numbers creating teaching kitchens, but hopefully they will prioritize “ healthy food” first as a therapeutic tool. And, in fact, physicians are trained to work in an interdisciplinary team, including the registered dietitian, who can also help them identify messaging related to food as one tool for better health for patients.
Our program at Case Western Reserve University, School of Medicine, is teaching medical students and residents about healthy lifestyle medicine principles, including core food/nutrition education, or culinary medicine. That’s a key point because lifestyle medicine recognizes that the foundational pillars of health include physical activity, healthy food/nutrition, as well as emotional and spiritual well-being, as I said previously. It is a holistic health approach for the individual, community and ultimately society. Culinary medicine–or teaching them about how food can indeed proactively promote health–is one component of this healthy lifestyle medicine philosophy.
AAC: When I first reached out to you, you said you couldn’t take part right away because, by coincidence, you were going to meetings specifically about food allergies. This was music to my ears. Could you share some of what you learned?
Hope: Our program here at CWRU, School of Medicine is called the Jack, Joseph, Morton Mandel Wellness & Preventive Care Pathway. We include monthly culinary labs focused on key challenging topics related to their ‘food and nutrition education”. So, when you contacted me originally, we were just in the midst of preparing our culinary lab focused on understanding food allergies and preparing recipes related to the most commonly challenging situations that parents (and patients) will face.
AAC: Do you have any guidance specifically for allergists? And because a good deal of allergic medicine is practiced by primary care physicians these days, do you have any specific guidance for them?
Hope: My specific guidance for them is to check with the national organization, the Academy of Nutrition and Dietetics, via www.eatright.org, to find registered dietitians in their geographical areas who are especially trained in understanding how to work with patients in the challenging landscape of misinformation abounding with respect to allergies.
AAC: Finally, do you have any pointers that all our readers should know, which ever end of the stethoscope they are on?
Hope: Sure. First, your usual dietary pattern– the foods you typically eat repeatedly- matter to your overall health and risk for chronic diseases. It’s not about just that one time you splurged and ate poorly or vice versa. It’s the overall typical pattern of your food intake that matters most.
Second, because of this link between dietary patterns and your health, health care professionals have become very engaged and interested in food and nutrition education– or culinary medicine.
Third, currently the best advice is to focus on a dietary pattern referenced as the Mediterranean diet: high plant focus, use of high quality olive oil–not margarines or highly processed fats, fish, nuts, seeds, limited red meats, yogurt, some cheeses, no processed foods, (whether diet or not). (see oldways website https://oldwayspt.org/traditional-diets/mediterranean-diet
Fourth and finally, dietary fats should be thought of like friends– it’s the quality that matters most. Select dietary fats from sources such as olive oil, fatty fish sources for omega 3 fat sources, and other high quality vegetable oils. Forget what you read about fads such as “butter is fine” and coconut fat is, too. The simple fact is that although there are some differences in how the body responds to these types of saturated fats, it’s very clear that the best health outcomes are associated with eating omega fatty acids, and high quality olive oil, vegetable oils or mono and polyunsaturated fats.
AAC: Thank you for your time.
Hope Barkoukis is a licensed, registered dietitian, Associate Professor in the School of Medicine at Case Western Reserve University, (CWRU), Interim Chair of the Department of Nutrition, a Board member for the largest professional nutrition organization, (The Academy of Nutrition & Dietetics), and the faculty lead for the Jack, Joseph, Morton Mandel Wellness & Preventative Care Pathway. Prior to joining CWRU she developed nutrition and wellness programs for Fortune 500 companies, completed advanced professional culinary training and presented hundreds of nutrition education presentations incorporating culinary demonstrations for television, professional and community audiences. Hope has received many teaching awards for her engaging and energetic teaching style including Top Prof, and the John S. Diekman Graduate Award for teaching excellence. In 2017, she was one of the nominees for the Carl Witte Excellence in undergraduate teaching award. In 2016 she received the Professional Achievement Award from the 7,000 member organization, SCAN: Sports, Cardiovascular and Wellness nutrition practice group, (www.scandpg.org). Additionally, Hope has been appointed by the CWRU Board of Trustees as the inaugural recipient of the Jack, Joseph, Morton Mandel Professorship in Wellness and Preventative Care, 2016-2021. Hope’s research areas include aging, glucose metabolism, the glycemic index, sports nutrition and liver disease. Currently Hope is co-investigator for an NIH study investigating a healthy lifestyle intervention in preparation for pregnancy in obese women.