The next step in the fight against heart disease: teaching medical students how to cook

Heart disease (cardiovascular disease, or CVD) is responsible for an estimated 20% of the total amount of money spent on health care here in the United States - and nearly 40% of cases of CVD are attributable to behaviors that can be changed, such as poor diet, lack of exercise, and smoking.

With diet such a major contributor to health, you would think that physicians would be the first to talk to you about what you eat, but the fact is that physicians receive little training in nutrition. Despite the Institute of Medicine's recommendation that physicians in training receive at least 25 hours of nutrition curriculum, surveys of practicing physicians indicate that they do not feel adequately prepared to counsel their patients about nutrition.

In 2012 The Goldring Center for Culinary Medicine was founded to change that. (Full disclosure: I am the Executive Director of the Goldring Center for Culinary Medicine and am one of the over 30 authors of this article.)

The Center combines video lectures, readings on health and nutrition, hands-on culinary practice, and team-based learning to not only teach medical students about nutrition, but also to teach them about food, so that they in turn can have effective conversations with their future patients about what to eat.

At the start of the program at Tulane University School of Medicine, the authors of today's article surveyed the entire medical student class at the start of the academic year regarding their personal dietary and health habits, and also explored their perception of the importance of nutrition counseling in primary care. Further, the survey assessed whether the respondents felt themselves to be competent to counsel their patients on 25 different health and nutrition-related subjects, ranging from the Mediterranean Diet and the DASH Diet to glycemic index, antioxidants, and reading food labels (BioMed Res Int 2018;Article ID 5051289). The authors re-surveyed the students at the end of the year and compared the results of those who had taken the Goldring Center programming with those who did not. (While the programming was at first an elective, Goldring Center programming is now a requirement for all medical students at Tulane.)

Over the following 5 years the survey administration expanded from Tulane to the first 20 of the now over 45 medical schools, colleges, and teaching hospitals licensing the curriculum from the Goldring Center. The same surveys were administered each year to all medical students at each medical school at the start and end of the academic year, although the students were not required to respond. Each year the responses of those who participated in the culinary medicine programming were compared with those who did not.

For the over 3,200 medical students who completed the surveys, the results are quite impressive. After the programming had been running for 5 years, the participants were 140% more likely to have a Mediterranean Diet score of 5 (out of 9) or higher, were 122% more likely to consume an adequate amount of fruit, 113% more likely to consume adequate amounts of vegetables, and cut their odds of consuming soft drinks on a daily basis by almost half.

Further, respondents who had taken the culinary medicine curriculum were almost 3 times as likely to agree that "nutrition counseling should be routine" and almost twice as likely to agree that "physicians counseling can improve patient's diets." They further were more likely to feel themselves adequately trained to counsel their patients on Mediterranean Diet (almost 10 times as likely), 5 times as likely to feel competent to discuss DASH diet, three times as likely to understand and counsel on a vegetarian diet, and on and on.

It remains to be seen whether this training will translate into these future physicians' clinical practices. We do know from our experience with smoking that when physicians "walk the walk" (can speak from personal experience on a subject) as well as talking the talk (telling their patients to quit smoking), patients do listen and change their behavior. These future physicians will know what it's like to cook for themselves, and furthermore, will know how - and will know the challenges that their patients face in pursuing a healthier diet. While physicians will not replace registered dietitians, they will be better prepared to help their patients make the behavioral changes that, in the long run, could reverse the tide of heart disease.

What this means for you

The culinary medicine training created at the Goldring Center for Culinary Medicine is not limited to medical students. If you think that it's a good idea for your physician to know about food and health, show them this article so they can visit www.CulinaryMedicine.org for information about CME. Fully accredited Continuing Medical Education (CME) credits are available to physicians and allied health professionals such as pharmacists, nurse practitioners, and physician assistants. Our yearly conference is coming up in June with plenty of opportunities for CME: visit www.CulinaryMedicine.org.

First posted: April 18, 2018