When Your Doctor is Your Chef

Bloomberg News published a piece today that discusses the movement of doctors learning about healthy cooking and adding this skill to their healthcare toolkit. This is important, because as the obesity and metabolic disease epidemics continue, we realize that relying only on pharmaceuticals is not good medicine. We as physicians, and the broader medical community, owe it to our patients to have the best tools in our toolkits to help prevent and treat disease--including cooking and eating delicious, healthy food.

Delicious, Healthy Meals--Courtesy of @ChefInResidency on Instagram

For more on this, go to Bloomberg News and read "When Your Doctor is Your Chef."

Interview with Stanford Medicine's Scope Blog

Many of you know my story from reading the About the Chef-Doctor  section of the blog or reading Hoda Kotb’s book, Where We Belong: Journeys That Show Us the Way. However, if you’re a newbie to the site, or you’re curious about some of the things that I’ve been up to lately, check out my most recent interview with Stanford Medicine’s Scope Blog, “I wasn’t afraid to fail at my dream”: A physician-chef discusses her unusual career.”

Also, be sure to check back for the following upcoming posts (by popular demand) on common GI issues: GERD (acid reflux), lactose intolerance and IBS…and more recipes, of course!

Group Medical Appointments Utilizing Cooking Classes to Teach About Chronic Disease Treatment & Prevention

It's been about six months since the my co-authors and I published the journal article "Shared Medical Appointments: A Portal for Nutrition and Culinary Education in Primary Care-A Pilot Feasibility Project" in Global Advances in Health and Medicine.

This project was spearheaded by former head of the Clinical Nutrition course at Harvard Medical School, and good friend of mine, Dr. Helen Delichatsios. She is a primary care physician based at the world-renowned Massachusetts General Hospital. When I was a third-year medical student, she and I were at a conference learning about shared medical appointments (SMAs, also called group medical visits), when we began talking about how we could create a new type of SMA that utilized cooking classes to teach about healthy lifestyle, treatment and prevention of chronic diseases related to obesity, inactivity and other unhealthy habits.

Class Recipe: Veggie-Packed Fresh Spring Rolls with Peanut Dressing

Definition: Shared Medical Appointments / Group Medical Visits are when a group of people see a doctor together for one long visit rather than individuals seeing a doctor at many, separate short appointments. There are many types and structures of SMAs.

After a lot of hard work on Helen's part to figure out how to introduce a completely new style of visit into her existing clinical practice--including getting buy-in from the clinic, arranging staffing, reserving space, learning how to bill for these types of appointments, and recruiting patients--we worked together to develop content for the visits. 

Class Recipe: Healthy Smoothies

Each 90-minute visit ran like this:

1. Patients arrived, got their vital signs taken, then were escorted to a regular conference room and seated around a long table.
2. They signed a confidentiality agreement and anonymously wrote questions that they had about their condition(s) or how to make healthy changes on an index card.
3. Once everyone had arrived, Dr. Delichatsios and either myself or another assistant did an icebreaker activity with the patients.
4. There was a short (10-15 minute) lesson on a health issue important to everyone in the room.
5. Then, there was a facilitated group discuss/Q&A while I (or another chef) demonstrated how to prepare a simple, inexpensive, healthy dish.
6. Everyone was given the recipe and the opportunity to taste the food.
7. At the end of the visit, patients were given instructions about their follow-up visits or health care maintenance items that were due. If anyone had an urgent medical concern, Dr. Delichatsios had a short visit with them individually after the group class (this rarely occurred).

Class Recipe: Mexican Quinoa (or Brown Rice) Salad with Citrus Vinaigrette

We hadn't intended to write about this project for publication, but when we realized that patients loved the visits, they didn't cost any more than traditional visits, and they didn't require a special space or a lot of special equipment, we knew that we needed to spread the word that this could be done in ANY primary care clinic as it exists TODAY. Since we started the visits nearly 8 years ago, some specialty clinics and direct primary care clinics have begun to install dedicated teaching kitchens. While this is very exciting (!), we published this last year in an effort to help clinics and practitioners realize that they don't need to wait for someone to fund an expensive teaching kitchen for their clinic. If you have a conference room, table and a sink, you can run group visits and demonstrate basic, healthy cooking for patients. You also don't have to be a chef to demonstrate healthy cooking--once I went off to residency and other assistants moved on to other projects, Dr. Delichatsios took over the cooking demonstration piece of the sessions as well!

Sample Curriculum, Nutrition Topics, and Recipes for Culinary Nutrition-based Shared Medical Appointments.

For more details (and a better picture of the table, above), check out the full article.

Finally, I went on to replicate these type of appointments on my own (without the help of an assistant) in my residency primary care safety-net clinic (a clinic that treats patients regardless of income or ability to pay) with similar results. While I recommend that doctors enlist an assistant, rather than go it alone like I did, I believe that this is a great way to spend an extended amount of time providing lifestyle counseling/coaching to patients. This method also allows patients to learn from each other--both things impossible to do in a traditional primary care visit.

Have you dreamed of getting a cooking class at your doctor's office? Are you a physician who has struggled to get patients to change their eating habits? Why not try this today???

Reference: Delichatsios H, Hauser ME, Burgess J, Eisenberg D. Shared Medical Appointments: A Portal for Nutrition and Culinary Education in Primary Care. A Pilot Feasibility Study. Global Advances in Health & Medicine. 2015;4(6):22-26.

Whole Grain, White Bean and Winter Vegetable Dish with Pickled Red Onions

This delicious, hearty recipe is solidly in the winter comfort food category--and just happens to be healthy! You can use any whole grain that is earthy in flavor and a bit chewy. I prefer Kamut or wheat berries, but short grain brown rice or pearled barley also work well.

Kamut: For those of you who haven't heard of Kamut, it is the trademarked name of an ancient type of wheat berry that was originally grown in Egypt. It is high in protein (12-18%) and always organic. The taste is nearly identical to traditional wheat berries.

Many whole grains take 35-60+ minutes to cook--something I cannot wait for when I get home starving after a long day of work. To solve this problem (and avoid getting take-out), I cook a batch of some type of whole grain most weekends, portion into family-sized servings, and freeze in Ziplock baggies or freezer containers. Then, I just empty the frozen grains into a microwave safe container, cover with a plate, and heat for 1-3 minutes. This technique yields whole grains that taste no different than if they'd been freshly made for that meal! This recipe utilized whole grains that were precooked and reheated in this way.

This process is simple and shown in more detail in the Basic Techniques Series: CookingWhole Grains post which includes a cooking time chart for most whole grains.

Whole Grain, White Bean and Winter Vegetable Dish with Pickled Red Onions 

Pickled Red Onions:

1/4 cup extra-virgin olive oil

Juice of one medium or large lemon (zest lemon before juicing)

1/4 teaspoon sea salt

1/2 cup thinly sliced red onions

Ingredients for the rest of the dish:

1 Tablespoon olive oil

2 medium carrots, sliced 1/8-1/4 inch thick

1 large parsnip, sliced 1/8 inch thick

1 medium or large fennel bulb, halved then sliced ¼ inch thick

Salt, to taste

Pepper, to taste

1 can (or 1-1/2 cups cooked) white beans, drained and rinsed

2 cups cooked Kamut or wheat berries

1 Tablespoon brown sugar

Zest of 1 lemon, chopped

1/4 cup roughly chopped fresh dill

1/3 cup chopped, roasted almonds

Combine the ¼ cup olive oil, lemon juice, salt and red onions in a small bowl. Stir and set aside.

In a large skillet over medium high heat, add 1 tablespoon olive oil and swirl to coat the bottom of the pan. Toss in the carrots, parsnips, and fennel slices then season with salt and pepper. Cook, stirring occasionally, until vegetables get somewhat browned (about 10-12 minutes).

Add the beans, Kamut and brown sugar to the skillet and cook for another 3-5 minutes to heat through. Add the lemon zest and dill; stir to combine. Remove from heat and add red onion mixture; stir and season with salt and pepper.

Let rest at least 5-10 minutes before serving.

Serve topped with chopped almonds. Serves 6-8 as a side dish; 4 as a main dish.

Makes a great vegetarian main dish, or side dish for fish or chicken.

Blueberry Apple Oat-Almond Crumble (with gluten-free option)

This time of year, the seasonal pickings are relatively slim. What I wouldn’t give for summer fresh, farmer’s market berries, tomatoes, and peaches! This recipe for blueberry apple crumble is a great way to shrug off winter and take advantage of blueberries frozen at their peak flavor in the summer months. 

Blueberry Apple Oat-Almond Crumble

A Chef in Residency dessert recipe wouldn’t be complete without a recipe rehab. This recipe rehab took a traditional crumble, then amped up the healthy components and decreased the refined carbohydrates and unhealthy fats as much as possible without sacrificing taste.

The finished product was a total success! I made the crumble in the evening and took it to brunch the following day—it was devoured in minutes and several people asked for the recipe. No one could believe that it was a healthy dessert! (I don't recommend that you tell people...they'll never know.)

For the skeptics out there, I have listed both the healthy ingredients and the refined flours/sugars options so that you can make as many or as few of the alterations as you feel comfortable with. However, I urge you to try the recipe with all of the healthier ingredients since it is at least as delicious as the original.

This recipe is/has:

Tart

Sweet

Fruity

Fresh

Crunchy

Nutty

Notes of cinnamon

Blueberry Apple Oat-Almond Crumble (can be gluten-free)

Ingredients

Filling:

2 pounds fresh or frozen blueberries

1 large Granny Smith apple, cored and chopped into ¼ to ½-inch cubes

¼ cup all-purpose flour, white whole-wheat flour or oat flour (sub with 1 Tablespoon+1 teaspoon of arrowroot powder for gluten-free)

1 teaspoon ground cinnamon

¼ cup finely chopped dates (or ¼ cup granulated sugar)

Juice of 1 lemon (or bitter orange)

Zest of 1 lemon, chopped (or bitter orange)

Crumble Topping:

1 cup almonds             

1 cup of old-fashioned oats (or 1 cup all-purpose flour)

½ cup dates, packed (or sub ¼ cup granulated sugar PLUS 1/3 cup packed brown sugar)

¼ tsp salt

3 Tbsp canola oil (originally, 1 stick or 8 Tablespoons of butter)

½ cup old-fashioned oats, left whole

             

Directions:

1. Preheat oven to 350 F.

2. Mix together filling ingredients: stir together blueberries, apples, flour (or arrowroot), sugar (or dates), cinnamon, lemon juice and zest and set aside.

3. Process almonds and 1 cup oats (or all-purpose flour) in the food processor until they look like flour. Add sugars (or dates), salt and oil; process until well combined. Stir in ½ cup oats, leaving unprocessed.

4. Spray a 13x9-inch cake pan with non-stick spray (or grease with butter or oil), then pour in blueberry mixture making sure that it is relatively level. Sprinkle with crumble topping (use all of the topping). 

5. Bake for 50-70 minutes on the middle shelf in the oven until blueberry juice is bubbling up through in places and the crumble is just starting to brown. Note: if baking in 12 individual dishes (as pictured) cut baking time to 45 minutes.

6. Cool for 15 minutes before eating. Cool completely before covering with a lid or plastic.

Serve as is or with vanilla ice cream. This is delicious reheated.

Makes 12 servings