The Science Behind Culinary Medicine with Melinda Ring, MD

Erin Spain, MS [00:00:10] This is Breakthroughs, a podcast from Northwestern University Feinberg School of Medicine. I'm Erin Spain, host of the show. Proper nutrition is essential for warding off many chronic diseases. Yet many graduating physicians report not feeling competent to counsel patients on their diet. Here at Northwestern Medicine, a course called Cooking Up Health is giving medical students, trainees and health professionals the opportunity to learn culinary medicine and food-as-medicine science concepts. Here with details about this effort is the creator of the course Melinda Ring, MD. Dr. Ring is the director of the Osher Center for Integrative Health and clinical associate professor of medicine and medical social sciences here at Feinberg. Welcome to the show, Dr. Ring.  

Melinda Ring, MD [00:00:58] Thank you. Thanks for having me.  

Erin Spain, MS [00:01:02] We sometimes hear about food as medicine in popular media. But how do you describe the concept, and the concept of culinary medicine?  

Melinda Ring, MD [00:01:11] Yeah, food as medicine has become really popular. I think now, every influencer is talking about what they use as their diet, as food as medicine. And I think in the medical field, we think about it a little bit differently. And we think about it as, how can we both individually, as families, as communities, choose food that helps us prevent disease and treat and even reverse disease? When we think about culinary medicine, it takes it to a whole different level. Because now we're talking about this concept of combining the art of cooking with the science of food and medicine. I'm sure many people have been in a situation where they've been told, ‘Oh, follow this diet for your blood pressure,’ or ‘Oh, you have irritable bowel syndrome, you should consider doing this special FODMAP diet to see if it helps.’ But if they don't know how to actually implement it in the kitchen, then really, we're not setting our patients up for success. So that's really where culinary medicine comes in. It also just makes it more fun.   

Erin Spain, MS [00:02:18] And we'll get into the details of the culinary medicine course you've created here at Feinberg. But I do want to mention again, you're the director of the Osher Center for Integrative Health. How is nutrition and medical education part of the center's mission? 

Melinda Ring, MD [00:02:32] Our Osher Center for Integrative Medicine—so you know, a lot of people don't know what integrative medicine is. Sometimes they think about it as combining Western conventional medicine with Eastern medicine. That's a part of it. But I would really think of it more as kind of a whole person approach or proactive, preventive approach to health care. And so at the core of that is lifestyle. Every patient we see, lifestyle comes first, it's not just about what dietary supplements should I take or, you know, should I do acupuncture, both of which can be helpful options. Really, we have to start with every person with what's happening with their nutrition, their sleep, their stress management, their relationships, their physical activity. And so nutrition is, to me, pretty much core to every patient that we see. When it comes to medical education and, really, education across all levels, it is one of the main missions that we have, which is to help educate the next generation of doctors and of health professionals. I just have this strong belief, you know, I think it's wonderful when I see a patient and I help that patient and maybe I helped you know some of the people around that patient. But when we help change the view of a future doctor, of nutrition, now we're helping to change the way that they address all of their patients in their future practice. So it's really a big part of what we do.  

Erin Spain, MS [00:04:05] How much training do medical students typically receive when it comes to nutrition? 

Melinda Ring, MD [00:04:10] Northwestern happens to have, in the country, one of the more robust nutrition contents. They have a whole wonderful lifestyle medicine thread throughout medical training, but across the country, it's pretty unpalatable, we can say. On average, less than 20 hours, you know, maybe 20—the goal is 25 hours according to recommendations and very few schools reach that. And even when they reach it, it's not about real world outpatient nutrition. It's, you know, how do you treat a patient who's on intravenous nutrition or has a tube? Not a patient who walks in the door and wants to know what they can do for their health.  

Erin Spain, MS [00:04:54] Why do you think there's such a lack in this type of training at American medical schools?  

Melinda Ring, MD [00:04:56] It's really a challenge. I think part of it is that in the past, there wasn't this appreciation for how significant a role nutrition plays in disease. Now we know that at least 80% of chronic diseases could be prevented with improvements in diet. And the Global Burden of Disease Study looked across the globe and said, like, one in five deaths could be prevented just through helping diet. All of the same, diet being a greater risk factor than smoking for disease. But that hasn't been what's been focused on. You know, I think a lot of medical training focuses on interventions, on investigations, on pharmaceuticals, procedures, and those are all incredibly, incredibly important. But because of that, very little of medical education has focused on nutrition traditionally.  

Erin Spain, MS [00:05:52] Well, nearly seven years ago, you first offered the Cooking Up Health course as an elective for medical students at Feinberg. So describe this course, to me. How does it work? 

Melinda Ring, MD [00:06:04] It's changed as relates to the pandemic. Our course underwent a transition in the pandemic. I’m going to share two different models for it. The first one happened over the course of a semester, and first and second year medical students would come in for six evenings after their other classes. And we would spend time in the kitchen at Northwestern Memorial Hospital, talking about nutrition, learning about nutrition, and actually going into the kitchen to cook an anti-inflammatory diet, to cook a diet that somebody who has a certain condition might be able to follow. And then along with that, there are lectures for them to watch, there's quizzes to take, articles to read. And they go into one of the local Chicago area schools to teach kids in underserved areas about nutrition, which is just a wonderful aspect of it. Now in the pandemic, we, like many, shifted, because we could no longer go into the kitchen to all cook a meal together. And so for the past couple of years, we've now been teaching cooking up health virtually. It’s been really interesting. We, you know, we cook together with the medical students over Zoom and we've seen that it has just as significant an impact on their confidence and being able to counsel patients, and many of them are saying they're more likely to cook in their own kitchen now that they've actually done it. We've seen success both ways. And it just shows how flexible the curriculum can be.  

Erin Spain, MS [00:07:35] And you mentioned how you partnered with local schools, you also partnered with a nonprofit Common Threads, just told me a little bit about that relationship as well.  

Melinda Ring, MD [00:07:46] So Common Threads is a national nonprofit. They're in multiple cities across the country. And they have this mission of helping to bring nutrition education to kids and families. And they have a well-established curriculum, it goes—it's at grade level, it aligns it with National Science guidelines. And they have been a wonderful partner in the whole development of the course and in the delivery. So we have worked with them on delivering it both at Northwestern, but then even in sharing it with other places like Miami and in other cities in partnering. So they're really just a wonderful partner and organization.  

Erin Spain, MS [00:08:29] So you say the students' reaction: They're more likely to cook at home, they feel more confident, you've actually studied this as well, the impact of these classes and published a paper about that. Tell me about the results of the study.  

Melinda Ring, MD [00:08:40] We, as well as others who have done culinary medicine trainings, are really seeing that it's an effective way, and a fun way, for people to learn about nutrition and really get hands on. So we've seen dramatic improvements pre- and post-course in a student's confidence in being able to counsel a patient about nutrition, counsel them about obesity, talk to them about plant-based diets, which is a big focus of the curriculum that we teach and the meals that we cook. And, you know, you brought up the other thing, which is their own confidence in cooking in their own kitchen, which we think is incredibly important. There is a huge burden of burnout within the medical field and the health professional field. And being able to cook healthy meals and take care of yourself is just a skill that we think is really valuable for the medical students and trainees.  

Erin Spain, MS [00:09:37] You mentioned that the program, the curriculum, is kind of spreading to other areas. You’ve helped start a ‘train the trainer’ workshop, where other schools and organizations can learn about implementing cooking up health curriculum. Tell me a little more about that initiative. How is it going?  

Melinda Ring, MD [00:09:53] Well, our goal is really to make this as broadly available as possible and we've been fortunate to have grants and philanthropic funding to help support both the creation and the implementation and dissemination of Cooking Up Health. And we hosted two ‘train the trainers’ and train 29 faculty from across the country to bring Cooking Up Health in some variant of whatever works for them to their own institutions. We’re now at a really exciting point where we have created a project within the national, well, international Teaching Kitchen Collaborative, the TKC, to help leverage up Cooking Up Health and make it something that can be freely available to any health professional education program. So we're working on that exciting project now. That has come about in response to some really interesting things that are happening in our nation. There actually was a bipartisan act that was passed that said that medical schools need to increase nutrition education. And so there's going to be an increased need for curricula like Cooking Up Health. And in addition, the ACGME, which is the Accreditation Council for Graduate Medical Education, in 2023 is going to be convening a nutrition in medical education symposia. So really, we're seeing this increased interest, this awareness building that we need to have better tools to teach our future health professionals. And we are hoping that the work that we've done can be part of meeting that mission.  

Erin Spain, MS [00:11:37] In fact, Northwestern Lake Forest Family Medicine residents are required to take the course right now as part of their training. Tell me how that evolved, and what's reaction been from those residents where this is not an elective—it’s part of the training now.  

Melinda Ring, MD [00:11:52] Yeah. And that's really the goal is that this is not an elective that it just is thought to be so valuable that you need to do it. So with the support of Dr. Deb Clements and Dr. Ana Shanahan, who are both affiliated with the Osher Center for Integrative Health and the family medicine residency programs, last year, we did a pilot where all of the whole family medicine program up in Lake Forest did three sessions of culinary medicine, and then went into a local school in Round Lake to teach children and it was such a success that the program decided that it should happen every year. And so we're in year two and the residents are enjoying it.   

Erin Spain, MS [00:12:34] Give me an example of some of the recipes that the students and residents are cooking.  

Melinda Ring, MD [00:12:40] We try to make the recipes, a few things. One, they're all plant based. And that's for a few different reasons. One is that I think it's pretty clear that eating plants is one of the most important things that we can do to improve our health. The second is that we want the meals to be affordable. So they shouldn't be things that require exotic ingredients or that a family won't be able to do, or even medical students who are oftentimes really on a budget. The third is that we really want to appreciate and be culturally aware and sensitive, and so we rotate the cuisines. We go around the globe to experience different spices and different blends. So we'll do a plant-based Pad Thai recipe, there’s a delicious curry. For the American recipe week, there is a portobello mushroom burger. We just keep playing with the recipes and trying to make a good variety that appeals to everybody.  

Erin Spain, MS [00:13:42] So you're talking about food, I can tell that you love cooking and you love food. Tell me about that. Tell me about what led you personally to this interest in not only diet and nutrition from a medical perspective, but also cooking delicious food.  

Melinda Ring, MD [00:13:55] I grew up not knowing how to cook. I grew up in an era where Wonder Bread and TV dinners was considered healthy. And my mom cooked and she was a great cook. But it really wasn't something that we learned as kids and we did have home-ec, which is one of those things that we need to bring back in schools so that people learn how to cook, but we weren't cooking healthy food and it certainly wasn't something that kept going when I went to college and medical school especially. Everything was just grab and go. I will say that after college, before I went to medical school, I begged my way into being a sous chef at a fancy French-Italian restaurant in Ann Arbor and so I spent the whole summer working, you know, learning how to bone salmons and make sausage from scratch and cook things in papillote and all this stuff. So I kind of had an informal immersion in culinary training. And that plus just again this belief that we are our own best first doctor, and therefore what we choose to do with food and movement and stress and sleep and all of those things. You bring it all together and that equals Integrative health and culinary medicine.  

Erin Spain, MS [00:15:15] Is there anything else that you want to add?  

Melinda Ring, MD [00:15:17] I guess I'll share a few resources. If people are interested in learning more about Cooking Up Health, there was a lovely short documentary done by the Take Care Campaign. And it's about eight to nine minutes long. But it follows the journey of a medical student and a grade schooler, as they go through and learning about food as medicine. And so I'd encourage that. Hopefully, we can drop the link. I did a TEDx last year in Chicago that is called ‘You can be your own best first doctor,’ and it talks about the importance of food as medicine and I give you three takeaway tips that I would suggest, so I'd say that's another and for people who are just interested in hearing more and just getting daily tips and you're a social media person, my Instagram is @drmelindaring. Three times a week I'm sharing my tips on how to live your healthiest and happiest life.  

Erin Spain, MS [00:16:11] Fantastic. Well, thank you so much, Dr. Melinda Ring, for coming on the show and telling us about the program and we will keep following this and see where it ends up.  

Melinda Ring, MD [00:16:22] Yep, hopefully it ends up in your own kitchen.  

Erin Spain, MS [00:16:34] Thanks for listening, and be sure to subscribe to this show on Apple Podcasts or wherever you listen to podcasts, and rate and review us. Also, for medical professionals, this episode of Breakthroughs is available for CME credit. Go to our website feinberg.northwestern.edu and search for CME.