On her recent visit to the doctor, Arlington resident Kitty Thompson learned she had crept from pre-diabetic status into the diabetic category, a more and more common occurrence in physicians’ offices across America. Under the direction of her doctor, she decided to drastically overhaul her diet to improve her health; however, doing so required extensive research on her part.
“I went low-carb to bring down my hemoglobin A1c [Hemoglobin A1c is a blood test predicting average blood glucose levels for the last three months] … That doesn’t mean I don’t still love potatoes and think longingly of them. For snacks, I usually go for olives, cheese, peanut butter, nuts, jerky and, of course, old tried-and-true fruits and veggies,” Thompson says. She also added more lean protein to her diet and doesn’t always skimp on the fats because she says they keep her more satisfied. “After three months of doing this, I brought down my hemoglobin A1c to within normal range. Oh, and I’ve lost 14 pounds,” she says.
It’s this kind of preventative health care that is now at the forefront of the medical field as providers search for an effective solution to the obesity crisis and seemingly uncontrollable rising chronic disease state of the country. The majority of the nutritional content currently taught in medical education is related to biochemistry, not practical, food-related knowledge and skills that may positively impact eating behaviors. However, some integrative health care models, such as the one at University of North Texas Health Science Center (UNTHSC), are incorporating hands-on nutrition education as an effective part of the treatment plan for clients and patients who are plagued with disease.
Students in the Culinary Medicine class.
Dr. Anne VanBeber, professor and chair of the Department of Nutritional Sciences at TCU, along with Dr. Keith Argenbright at the Moncrief Cancer Institute/UT Southwestern, brought the Culinary Medicine program to Fort Worth. She has taught the class since it was launched in 2014 to more than 120 students from the Texas College of Osteopathic Medicine (TCOM) and the UNTHSC. It’s the first of its kind in Texas and one of only about a dozen around the country. It’s so popular that a lottery determines participants.
VanBeber says it is important for any health care professional (doctors, physician assistants, nurses, dietitian/nutritionists, physical therapists, occupational therapists) to not only have a knowledge of healthy eating, but also have the ability to successfully promote it. She says, “The future of nutrition education must include hands-on cooking classes if we are to truly improve the health of the nation. The basic philosophy that we learn from practice is utilized in this program, and the more we practice something, the more we understand it … We need to get people back in the kitchen, and if a health care professional can comfortably discuss this with patients, then the patients are more likely to follow the advice.”
Created by the Goldring Center for Culinary Medicine at Tulane University School of Medicine, the Culinary Medicine program is a collaboration between the TCU Department of Nutritional Sciences, the Moncrief Cancer Center and UNTHSC.
The guiding principles behind the course are based around the Mediterranean diet, which is plant focused and includes a lot of vegetables, fruits, whole grains, nuts/seeds and legumes. VanBeber says, “The ingredients for the recipes we teach can be bought at any grocery store, including Walmart, and the dishes are delicious and have a lot of flavor from the variety of ingredients in the recipes.”
Lessons are taught by faculty from both TCU and UNTHSC, and students benefit from each other’s perspectives on medicine and nutrition. There’s required reading, group discussions and the added bonus not often found in most medical classes … eating delicious food. VanBeber says, “We also focus on knife skills, safety and sanitation in the kitchen throughout the six-week course.”
Taylor Blackwood is a first-year medical student at UNTHSC’s Texas College of Osteopathic Medicine and is currently enrolled in the Culinary Medicine class. “I took a nutrition class while in undergrad, and I can honestly say that it doesn’t even compare to this class. The opportunity to take a hands-on approach to what we are learning through the online modules is second to none. The TCU nutrition students do an amazing job of helping us apply our nutritional knowledge to the dish we make each week in the kitchen and often quiz us on what nutritional benefit each ingredient plays in the overall dish. In my opinion, the kinesthetic approach correlates very well to the way many physicians learn medicine and is probably the reason I’m enjoying it so much,” Blackwood says.
Students prepare a dish as part of UNTHSC’s Culinary Medicine class.
Diet and Disease
According to the Centers for Disease Control and Prevention, nearly half of all Americans routinely take prescription drugs. It’s also reported that 75 percent of all doctor visits involve the prescription of drugs. Pharmaceuticals may not be the best medicine for patients. Doctors’ mindsets are now changing in the way they treat patients by prescribing healthy foods rather than pills to fix the body.
Utilizing online modules in UNTHSC’s Culinary Medicine class, students are learning about food on a scientific level. For instance, they dive deep into the role macronutrients and micronutrients play in the Mediterranean diet. The modules also provide examples of substitutes for commonly eaten foods that aren’t a part of the diet. The substitutes are often both lower in calories and higher in nutrients.
Obesity is present in approximately 36 percent of the U.S. population with another 30-40 percent of adults classified as being overweight. This epic battle with the bulge is accredited nearly entirely to lifestyle factors — inactivity and poor diet choices, including our fast-food frenzy. And this leads directly to health problems among this percentage of the population like an increased risk for hypertension, diabetes and a myriad of other chronic diseases.
The classroom and kitchen portion of the class focuses on some of those medical problems. “This has been beneficial and has given us the knowledge to be able to speak confidently with our patients when discussing diet changes,” Blackwood says.
The skyrocketing increase in diabetes diagnoses is getting worse. There are 29 million people in American with Type 1 or Type 2 diabetes. If things continue along this path, 40-50 percent of adults will have diabetes by 2040, according to dieticians at the Moncrief Cancer Institute. Over time, high blood glucose from diabetes leads to other issues, including damage to blood vessels and the nerves that control your heart and blood vessels. The longer a person has diabetes, the higher the chance for developing heart disease.
Results of recent epidemiological studies indicate that increased sugar in a population’s food supply was linked to higher diabetes rates. Dr. Janet Lieto is an assistant professor of Medical Education at the UNTHSC’s Texas College of Osteopathic Medicine, and she lectures regularly during the Culinary Medicine classes. She stresses the importance of discussing real-life applications and using actual case studies in class.
“There was a case we examined during one of the classes where a guy who lived in Louisiana was drinking something they call ‘Punch’ on a daily basis. He wasn’t aware that by doing this, he was consuming 1,300 calories of sugar every day. That was a regional example, but then we spoke about our obsession with sweet tea in Texas. Just becoming aware of what you are ingesting is a major step. Educating people in baby steps to make small changes will make big differences in the disease process,” Lieto says.
For patients with hypertension, reducing sodium is critical. Most of the salt we consume comes from processed and restaurant food. Just eating at home will help patients naturally lower their risk of hypertension. Lieto says, “My biggest concern is the amount of processed foods we eat. You can’t even pronounce half of what is found in our food anymore. We must get back to real foods. You are seeing a shift into eating locally and organically and going back to our roots before we had so much processed food.”
While there are theoretical factors linking additives, chemicals and food colorings with cancer risk, many doctors say it’s best to focus on the established ways of reducing the risk of cancer, which includes a healthy diet. Plant foods offer protection in many ways. Not only do they provide thousands of phytochemicals, but many are antioxidants that protect and repair our DNA. Certain foods have a more direct effect on a specific type of cancer. For example, some plant foods contain fiber, which can lower the risk of colon cancer.
“When you’re a kid, you always hear, ‘Eat your fruits and vegetables,’ but you are never really told the reason why you should. Studying the Mediterranean diet and the ‘Blue Zones’ [a health initiative in Fort Worth, inspired by different parts of the world where people are living the longest] has taught me that individuals who eat a plant-based diet that is high in micronutrients have increased longevity and decreased potential for disease … This class has shown me that the changes we need to make in our diet to have a significant impact on our health aren’t nearly as drastic as we often imagine,” Blackwood says.
While it might not be realistic to expect physicians to immediately add a dietician’s cap to their already busy wardrobes, UNTHSC’s Culinary Medicine class gets the ball moving in the right direction. VanBeber says, “I do believe that all medical students should participate in a program such as this. Since Tulane started their program in 2012, now more than 30 other institutions have licensed their program. We are promoting that the Culinary Medicine program be included in the curriculum of the new TCU/UNTHSC medical school.”
Overall, the message the local medical community is sending to patients is simple: Fuel your body by eating the right foods and drinking the right fluids in the right amounts at the right times. If you don’t do this, your bodies will eventually break down.
Nutrition by Numbers
2014 is the first year the UNTHSC’s Culinary Medicine course was offered
25 openings for medical students to take this course who are selected by a lottery system
36% of the U.S. population is obese, according to the National Health and Nutrition Examination Survey
70% of the sodium Americans consume comes from processed and restaurant foods, according to the National Center for Chronic Disease Prevention and Health Promotion
30-40% of the U.S. population is considered overweight
$190.2 billion is the estimated annual health care costs of obesity-related illness
1.7 million people are diagnosed with diabetes every year, according to the American Diabetes Association
85.2% of people with Type 2 diabetes are overweight or obese
20% decreased risk of death from cancer in National Institutes of Health Study when patients switched to the Mediterranean diet over a 10-year span
Honey Mustard Pork Tenderloin
*recipe endorsed and provided by UNTHSC
2 teaspoons olive oil
1.25-pound pork tenderloin
1 large shallot, minced
1-2 garlic cloves, minced
1 teaspoon thyme or rosemary, dried
1 teaspoon honey
1 teaspoon apple cider vinegar
¼ teaspoon salt
Freshly ground black pepper, to taste
2 teaspoons Dijon or Creole mustard
Gather all ingredients and equipment.
Preheat the oven to 400 F.
In a medium bowl, mix the shallot, garlic, dried seasonings, honey, vinegar, salt, pepper and mustard. Set aside.
Place a large skillet over medium-high heat. Add the olive oil. Season the pork tenderloin with salt and pepper, then add to pan. Cook until the underside is brown (once it starts browning, it will unstick from the pan; do not force it), then flip and brown. Brown each side of tenderloin.
Remove from pan. Rub the sauce around the entire pork tenderloin.
Place pork on greased foil-lined sheet pan. Bake the pork in the oven until internal temperature reaches 140 F (it will carry over another 5 degrees F as it rests, about 15 minutes). Remove from oven and allow to sit for 5 minutes before slicing.
Slice pork from a bias from end to end and serve warm.