Culinary Medicine: Paving the Way to Health Through Our Forks

Abstract

Recent findings reveal that suboptimal diet is responsible for more deaths than any other risk factor nationally and globally. It is estimated that with improving eating behaviors, 1 in 5 deaths can be prevented, underscoring the urgent need for effective dietary interventions.

‘. . . one way to help implement change in dietary habits is through instruction on home cooking.’

Overview

Culinary medicine is an emerging, evidence-based discipline, which aims to positively affect public health by improving eating behaviors through integrating nutritional science with food preparation. Although a consensus definition of culinary medicine is yet to come, the definitions proposed by existing programs include reducing the global burden of nutrition-related disease^1,2 and health care costs through delivery of basic nutrition information combined with instruction in practical food related skills. The intention is to help create positive behavior change by not just providing knowledge, but by teaching specific skills that may aid in creating lasting change. Culinary medicine is not a practice that uses alternative approaches, such as specific foods or ingredients as a panacea to disease; rather, it is an evidence-based approach that includes simple nutrition education and instruction in nutritious cooking skills, including shopping, meal planning and preparation, and food storage.

In the past decade, there have been a growing number of educational initiatives that focus on culinary medicine and are designed for clinicians or directly for patients and communities.³ These range from Continuing Medical Education trainings^4,5 and formal medical school curricula⁶ to outpatient shared visits,⁷ live online courses, and remote video coaching.⁸

The Nutritional Benefits of Home Cooking

According to the Centers for Disease Control and Prevention, 36.6% of adult Americans dine at fast food restaurants on a daily basis.⁹ Given that fast food dining is associated with poor dietary quality and high intake of calories,¹⁰ one way to help implement change in dietary habits is through instruction on home cooking. Data have shown that home cooking is associated with higher-quality nutrient intake and reduced calorie intake overall.⁸ An analysis of the National Health and Nutrition Examination Survey data showed that individuals who cook 6 to 7 dinners at home per week consumed an average of 137 calories less per day than those who ate 0 to 1 home-cooked dinners/wk (P < .05).¹¹ Interestingly, this difference was kept even among a subgroup of individuals who did not try to lose weight.^6,12 Furthermore, a recent publication looked at the differences between adults who ate 3 meals a day of ultraprocessed food and those who eat minimally processed food. It showed that eating ultraprocessed food until libitum, results in consuming 500 calories/d more, compared to eating unprocessed diet, which was matched for presented calories, sugar, fat, fiber, and macronutrients.¹³

In addition to improved nutrition, home cooking is also linked to health benefits.¹⁴ For example, analysis of the Nurses’ Health Study (121 700 female registered nurses aged 30-55 years)¹⁵ and the Health Professionals Follow-up Study (51 529 male health professionals aged 40-75 years)¹⁶ data found that people who ate 11 to 14 home-cooked lunches and dinners per week had a 14% lower risk of developing type 2 diabetes than those who ate only 6 or fewer home-cooked lunches and dinners per week¹⁷ and that this association was partly attributed to less weight gain linked with this dining behavior. Furthermore, recent articles showed that the opposite behavior, consuming ultraprocessed food, was attributable to cardiometabolic diseases,¹⁸ overall cancer risk, and breast cancer risk.¹⁹

Starting a Nutrition Conversation

Only 38% of physicians discuss diet during routine office visits,²⁰ which is perhaps a reflection of the lack of nutrition medical education²¹ or the lack of self-adherence to healthy practices. Even when patients are counseled about diet, compliance remains a challenge, and sustainable change can be difficult to achieve²² because change in dietary intake requires a change both in attitudes regarding food and personal habits.

There are a number of options to start incorporating culinary medicine into your practice. The conversation about food and health can be integrated into a patient’s annual health maintenance visit or as a separate visit. In our practice, the patient is given a Food Frequency Questionnaire (FFQ), which assesses their Mediterranean Diet Score. FFQs can assess long-term dietary habits and have been shown to predict long-term health risk.²³ The Mediterranean diet score has been validated^24,25 and can assess the dietary risk factors that have been associated with high mortality, which include diets high in sodium, low in whole grains, low in fruit, low in nuts and seeds, low in vegetables, and low in omega-3 fatty acids.²

Once the assessment has been completed, here are a couple of examples of how a provider might begin the conversation about diet and risk: (1) “There is some new information about the impact of food on our health, is it ok if I share some of this?” and (2) “According to recent studies, dietary habits are responsible for more deaths than any other modifiable risk factor, including smoking and obesity. If you would like, we can review your dietary habits and determine if there are things you can do to help improve your risk.” The patient then has an objective measure of their risk from which to build dietary goals. Next, an action plan can be developed, and recipes that support the plan can be shared.

Below is a featured recipe that can help improve whole grain consumption. Please feel free to try it also yourself because providers who adhere to best practices themselves are most likely to impart knowledge to their patients.

Featured Recipe

Avocado and Pearl Barley Salad

Many of our patients are interested to learn more about whole grains. It is important to note that whole grains have significant benefits over refined grains. Once a grain is refined (processed), it can lose more than half of its nutrients, including fiber.

Of the many available whole grains, barley is the highest in fiber. It contains important phytonutrients and is an excellent source of B vitamins and other nutrients. In addition to their health benefits, these whole grains are excellent in cold salads, thanks to their naturally crunchy texture.²⁶ For example, the next time you prepare a pasta salad, try making it with whole-wheat pasta. The result will be of a much higher nutritional and culinary quality. Let the salad sit for a few minutes after all the ingredients have been mixed, so that the grain has a chance to absorb all the flavors.

Borrow ideas for interesting salads with grains and legumes from the ACLM/ACPM culinary medicine resource section,²⁷ peer-reviewed publications,²⁶ and from international cuisines. Think about the legume salads in Central America, the whole-grain salads of the Mediterranean (like the salads below), and the rice and soba noodle salads from Asia.

Ingredients

Serves 8/Serving size: 3/4 cup

1 cup pearl barley, rinsed and drained

2 cups water

Pinch Atlantic sea salt, or to taste

2 medium Persian style or English style cucumbers cut into cubes

1 cup diced button mushrooms

1 medium avocado, ripe but firm, peeled, pitted, and cut into 1/2-inch cubes

3 tablespoons chopped fresh thyme

1/2 cup chopped fresh parsley

4 tablespoons extra-virgin olive oil

4 tablespoons fresh lemon juice

1 clove garlic, chopped

1 teaspoon honey

Pinch ground black pepper

Directions

In a small pot over high heat, bring pearl barley, water, and salt to a boil. Reduce heat to low and cook for 20 minutes or until liquid is absorbed. Rinse with cold water, drain, and transfer to a medium bowl.

Add cucumbers, mushrooms, avocado, thyme, and parsley, and toss together until combined. Add oil, lemon juice, garlic, and honey, and mix until combined. Let sit for 30 minutes for flavors to blend. Season with salt and pepper before serving.

To make vegan, substitute maple syrup for honey. To make gluten free, substitute wild rice or quinoa. Olive oil can be eliminated if desired.