The other day I was getting my annual checkup with my longtime primary care physician Dr. Michael Flanagan. We always have some excellent discussions on why eating good nutritious food, especially fruits and vegetables, promotes good health. Dr. Mike grows a large garden and has a home orchard and was telling me about his new favorite food (kale) and his robust Brussels sprouts. He is now promoting kale to his patients and medical students.
Dr. Mike thinks like Hippocrates, the ancient Greek physician, with his precept: “Let thy food be thy medicine.” He related to me how he is also involving his medical students in gardening and in learning to grow and prepare their own vegetables. He is teaching them gardening from the ground up at his home garden, and I was really interested in learning that he and others are developing and teaching a new course called Culinary Medicine (others are involved in another similar initiative, Food as Medicine).
The course description states that Culinary Medicine will teach fundamental dietary and nutrition knowledge with basic culinary skills through inter-professional, hands-on community cooking classes. Lessons will be keyed to both the basic science curriculum while linking concepts learned to the practical clinical skills needed for the patient/physician discussion about the importance of dietary and lifestyle change. Since this elective is integrated with community members, students will get an opportunity to develop relationships and practice nutrition and counseling skills. Students will be guided to lead small group discussions covering the daily culinary medicine topics with community members during each class.
Amy Hoffman, a fourth-year medical student, was one of the students who helped with the virtual culinary medicine course. She said that in this course, they talked about a clinical case pertaining to nutrition and then cooked a meal together over Zoom. Amy said it was a lot of fun and they hope to incorporate it more intentionally into their curriculum in the future. Another medical student, Lauren Pomerantz, found Culinary Medicine immensely helpful. In clinic she said they often tell patients to pursue a certain type of diet or to consume certain types of foods, but before the course, she wasn’t sure why they were suggesting the things they were. She said that every week, they would review the evidence (usually a large research study) behind each of these types of diets so that they really understood why they would recommend things like the Mediterranean Diet for folks with risk factors for and/or diagnosed cardiovascular disease.
Dr. Mike explained that only two out of five medical schools meet the National Academy of Science’s recommendation for 25 hours of nutrition instruction. Given that dietary diseases drive many of the world’s health challenges, there is a dire need for medical students to be better equipped with nutritional knowledge that can be used in patient care and counseling. In the U.S., this need for nutritional education is seen in the high prevalence of chronic conditions like diabetes mellitus and ischemic heart disease.
At the Penn State Milton S. Hershey Medical Center, Daniel George, Ph.D., associate professor, College of Medicine, and College of Medicine scientist Wade Edris, MS, director of the Confocal Laboratory, started a hospital farmers market in 2010 and a community garden in 2014, and both have been centrally involved in the food as medicine initiative. Both said that farmers markets serve public health by increasing fruit and vegetable consumption, revitalizing neighborhoods, strengthening local economies and empowering community members to learn more about the items they buy. Produce markets are increasingly being viewed as one part of the solution to national chronic health problems.
At the market and garden, they have produce programs in which at-risk/food insecure patients are given “prescriptions” for fruits and vegetables to be redeemed at market. Students have partnered with participants to mentor them over several visits to market. In addition to the garden, Edris has involved the students in a medicinal plant plot that he organized. He grows 40 species of plants used in modern pharmaceutical development and folk medicine.
Dr. George told me that a growing national trend is creating partnerships that strengthen the abilities of medical centers and clinics to provide complete patient-centered care and serve community health through farmers markets. According to him, of the 7,175 known farmers markets in the U.S. more than 100 are located on medical center campuses. Medical center markets can enable nursing and medical students and residents to develop their health screening and program management skills; researchers and graduate students can evaluate market-based initiatives; and volunteer staff are committed to improving community health. In addition, market vendors can contribute to this sustainability through health-related programming such as healthy food demonstrations, distributing healthy recipes and participating in federal nutrition supplementation programs. Through this commitment, programs have a better chance to support long-term health benefits for customers.
The farmers market in Hershey takes place once a week and aims for at least 80% organic items for. Community wellness programming through medical professional-led activities that promote public health education is a major strategic focus that differentiates the market in Hershey from others. According to Dr. George, the overarching vision for the market was to combine agricultural, medical and community resources so that the farmers market would significantly contribute to the long-term health of the region and model how a partnership between a medical center and a farmers market can provide more comprehensive care for patients and families. The key differentiating point for a market located on a medical center campus is the proximity of experts in areas such as medicine, public health, nutrition, kinesiology and psychology, which enables the market to serve as a credible community venue for powerful public health promotion.
In the U.S., the traditional medical approach has been to focus on treatment rather than prevention of disease and illness, said Dr. Tomi Dreibelbis, Culinary Medicine course co-director and senior director, Educational Affairs, Penn State College of Medicine, and assistant professor, Department of Public Health Sciences. For the past 100 years, the standard medical school curriculum has required spending only a few days in four years discussing how nutrition affects wellness and the risk of progression of disease. The old saying “you are what you eat” is certainly true, and diet and nutrition will take you either on the path to wellness or on the path to disease.
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