Food As Medicine: Good Health Starts in the Kitchen
Do you feel like we’re just being bombarded with directions to eat healthy, or else?
The issue can be very confusing. Constantly changing nutritional information, conflicting research and the latest diet trends promising big results can make your head spin.
A healthy diet should include whole grains, fresh fruits and veggies, but which ones and how much? Steam, bake or sauté? Chia or flax seeds? Stevia or agave? And what is a flavonoid anyway?
Of course we want to eat well to live better and longer. Lucky for us, living in this area of innovation, there are really smart people trying to come up with intelligent and workable solutions about teaching nutrition in ways that get our attention and make sense. Similarly bright people are developing practical ways to help us learn to prepare good food that don’t take all day or break the bank.
If you’ve ever bought fresh produce at a Kaiser Permanente facility, you have Dr. Preston Maring to thank. He’s a passionate trailblazer in the field of “culinary medicine,” or what he calls “food as life.” In 2003, he made the Kaiser administration see all the benefits of establishing an on-site farmers market and now there are 52 around the country, five in our region alone: Redwood City, South San Francisco, Santa Clara and two in San Jose, which all partner with the Pacific Coast Farmers Market Association.
Most of the markets feature a large percentage of organic produce (or are totally organic) and, according to Maring, 50% of shoppers are hospital staff, the rest made up of patients and visitors.
That’s music to his ears. A retired OB/GYN surgeon, he writes a regular blog (Recipe.Kaiser-Permanente.org) about how to cook what’s in season with a treasure trove of archived easy recipes. He also writes about issues around food in his Food for Thought column and stars in some great YouTube cooking demos that offer simple tips and kitchen wisdom on preparing great-tasting healthy food at home.
“I’m no chef,” he insists. “I’m just an aging gynecologist. If I can cook, anybody can.”
Watching him it’s obvious how much he loves preparing food. “A sharp chef’s knife, two cutting boards and a salad spinner can change your life,” he suggests.
But not everyone shares his enthusiasm. “Fewer than 15% of the doctors and healthcare professionals I’ve talked to feel comfortable with a chef’s knife in the kitchen.” He aims to change that.
Apparently doctors don’t get much nutrition training in medical school. He believes they should be as knowledgeable about food and food systems as they are about drugs, for their patients’ benefit as well as for themselves.
So he’s made it part of his mission to enhance their educations. When he lectures now, Maring injects a little levity by ending with a cooking demonstration. “I take the leader of the group and we dice an onion, roll a basil leaf, mince garlic and make a simple vinaigrette for a salad.” It makes an impression.
Getting more fresh local food into Kaiser hospitals, cafeterias and vending machines has been another campaign of Maring’s and he’s been building relationships with organizations like Community Alliance with Family Farmers (CAFF), where he serves on the board.
“I love and appreciate the chance to work with farmers,” he says. “I have so much respect for the human hands that grow our food.” His aim is to build a model around collective purchasing power, which would be a win/win for farmers and institutions like Kaiser.
Though retired from his practice after 41 years, Maring is clearly hitting his stride with this new career as a vocal and passionate advocate for fresh, local food. He’s been bringing people together to address food system challenges and started the Kaiser Permanente Food for Health Forum in 2010 to get doctors, caregivers, chefs, farmers and healthcare professionals to explore solutions for better health through better food choices. And he’s constantly looking at new ideas.
“What I don’t know yet is how to really help a busy family learn to cook more fresh, simple food,” he says. But you can bet he’s working on it.
Palo Alto Medical Foundation
When it comes to being an effective physician, “doctors can’t just talk the talk, we need to walk the walk,” says Palo Alto Medical Foundation internist Linda Shiue, MD. She believes it is part of her responsibility to her patients to be a knowledgeable coach and role model; to find better ways to assist them in improving their food, beverage and lifestyle choices; and to promote wellness.
Over the past few years, Shiue developed a side career as a food writer, recipe creator and blogger (www.SpiceBoxTravels.com), which took her to the annual Healthy Kitchens, Healthy Lives conference presented by Harvard School of Public Health and the Culinary Institute of America in Napa. It was there last winter she had an epiphany about the value of combining her passion for healthy food and educating her patients about how cooking can make a huge difference in disease prevention and longevity.
“You can’t just hand them a brochure or tell them to take a class—you have to be part of the process,” she stresses. Last year, participants in a PAMF study investigating new ways to treat hypertension had three classes with Shiue at Whole Foods, where they learned what foods to buy and then cooked together.
“I showed them how they could lower their blood pressure with foods high in potassium and low in sodium,” she explains. They also learned how to enhance food flavor without salt by substituting herbs, vinegar and lemon juice. “I prepared everything in real time. I have a busy life, so my meals have to be ready in 30 minutes.”
Right now her big dream is to help get a teaching kitchen established at PAMF so she and her colleagues can collaborate on bringing chefs and food experts in to do hands-on health education outreach and training for patients and medical professionals.
Stanford Hospital and Medical Center
There is interesting and useful food research coming out of Stanford, particularly at the Prevention Research Center, which is part of the medical school. Studies conducted by Christopher Gardner, PhD, director of Nutrition Studies, have gained significant attention. A lot of people were surprised when his study of popular weight-loss programs, published in the Journal of the American Medical Association in March 2007, found that “the Atkins low-carb diet produced more weight loss and better health improvements than the low-fat Ornish, moderate-carb Zone or standard American LEARN diet.”
Previously, “many health professionals, including us, had either dismissed the value of very-low-carbohydrate diets for weight loss or been very skeptical of them,” Gardner stated.
He is the founder of the annual Food Summit, which brings together faculty, students, community activists, chefs and community-based food organizations to discuss ways to improve the quality of the local food systems. As a result, all seven Stanford schools are now working on a range of food-related research projects and Gardner has indicated he hopes to eventually start a food systems research center at Stanford.
The Stanford Cancer Institute is part of the medical school and also involved in research around food. Currently it is participating in the national Women’s Healthy Eating and Living (WHEL) six-year trial to determine whether a low-fat, high-fiber, plant-based diet can prevent recurrence of breast cancer.
But even more important than the research is the sensible guidance and hands-on support patients get with strategies for eating well, especially during treatment. Alison Ryan, MS, RD, works with patients in the Cancer Supportive Care program to help them figure out what they can and should eat and how best to cook it. “Phytochemicals are the cancer fighters in food,” she explains. That means unrefined whole grains, legumes, dark leafy greens and dark chocolate. “I suggest they eat a rainbow of colors.” And keeping active is essential for relieving stress and staying positive.
Ryan says their intent is to come up with a plan that is easiest for the patient, helping them manage side effects, and identify simple foods. Their website is loaded with recipes that are easy to prepare and delicious.
As with Kaiser, Stanford Hospital is also actively engaged in providing healthy food to support patient care, employee and community wellness. Part of that effort is through the national Healthy Food in Health Care program part of Health Care Without Harm. Kendra Klein, the California coordinator, works with leadership teams at Bay Area hospitals to locally source produce, pool their purchasing power, develop balanced menus, offer biodegradable serviceware, and says that one of the programs they hope to expand is physician training about the importance of food as medicine.
Stanford Executive Chef Randy Aprill is working closely with Klein and Forest Caro, the retail operations manager, to provide the freshest ingredients for both in-patients and those who eat in the cafeteria. They are engaged in the Buy Fresh Buy Local program through CAFF and leverage their size to purchase as many organic and sustainable products as possible. Whole-grain items like quinoa, barley and wheat berry are featured and they are moving away from salt—enhancing flavor and texture with herbs and spices.
Patients also get more engaged in their food by creating an a la cart menu via the At Your Request program from their beds. It’s set up like a restaurant service, with each meal prepared according to a patient’s specific order. Some food items are pre-made, but most meals are prepared to each patient’s specific requirements and evaluated by a software program that analyzes all ingredients, monitoring carbohydrates, salt, potassium or other dietary restrictions.
A Natural Approach
Increasingly people are seeking complementary and alternative medicine practitioners, which may place a greater emphasis on the relationship between food and health. At Silicon Valley Preventative Medicine in Campbell, Dr. Tracy Chan and her partner Dr. Kevan Huynh “believe in treating the cause of illness rather than masking symptoms with prescriptions.”
A licensed naturopathic doctor and also trained in Chinese medicine, Chan says “food is a huge modality in chronic diseases.” Traditional Western medicine physicians are not trained to teach patients about the role of nutrition in their health, so patients get left to manage on their own and often come to Chan overwhelmed and confused. She evaluates their condition by having them first keep a food journal and then they work together to create a fully customized plan
“Most of the chronic diseases like high blood pressure are preventable,” she says. “They are caused by poor quality of diet, toxins and stress, which are all linked to inflammation. You can decrease inflammation by not eating anything fried, or anything with processed sugar, or containing any hormones—like beef from a feedlot.”
Though a plant-based diet works for many, she says others can develop nutritional deficiencies over time without animal protein. “They can get anemia or fatigue,” she explains, “so I have them incorporate some fish or grass-fed beef or wild-caught sardines that are high in omega-3s. Protein turns up the metabolic process, it reduces the appetite and is a better fuel.”
Ultimately her approach is holistic, addressing mind, body and spirit with a variety of remedies. At the core she stresses, “We fully embrace ‘Let food be thy medicine.’”
After growing up in a California ranching family, Susan Ditz gained hands-on experience in local food systems as an herb farmer. Currently managing editor of Edible Silicon Valley, she was formerly a columnist for the San Jose Mercury News and regular contributor to the Silicon Valley Business Journal.
Chilled Minted Pea Soup with Indian Spices
By Linda Shiue
What says spring more than fresh green peas? This refreshing, flavorful soup has its roots in English mushy peas, made sophisticated with the exotic touch of Indian spices. The tang of buttermilk, brightness of fresh mint leaves and warmth of freshly toasted spices add an abundance of flavor without much added salt.
2 cups low-fat buttermilk
4 cups freshly shelled or frozen green peas, plus more for garnish
1 pinch kosher salt
10 mint leaves
Freshly ground black pepper
Garnishes: Indian Spiced Oil (recipe below), cilantro
In a medium saucepan, bring the buttermilk to a simmer and add peas and a pinch of salt. Simmer for 1 to 2 minutes over medium heat, stirring often so that the buttermilk does not boil over. Cook until peas are al dente.
Transfer the peas and liquid immediately to a blender with the mint leaves and, starting on low speed, carefully blend (holding the lid on firmly with a dishcloth), working up to high speed for 60 seconds.
In order to preserve the vibrant color and flavor of the peas, the soup must be cooled immediately. Pass through a fine-mesh sieve into a bowl, then rest the bowl inside a larger bowl full of ice water. Stir continuously until cool, tasting occasionally; you will notice that the soup becomes sweeter as it cools. Adjust seasoning with salt and black pepper if needed. Refrigerate until cold.
To serve, ladle soup into bowls or shot glasses.
Use a squeeze bottle to swirl a stream of the herb-infused oil on the top, and garnish with fresh peas, a sprig of mint and freshly ground black pepper.
Indian Spiced Oil
1 cup olive oil (not extra-virgin, which is too flavorful for this)
1 tablespoon cumin seeds
3–4 cloves garlic, crushed
2 quarter-sized slices fresh ginger root, slightly crushed
2 tablespoons minced onion
2 fresh Thai green or serrano chiles, sliced
2 tablespoons minced cilantro
Heat a frying pan over medium flame. When warm, add cumin seeds and lightly toast for a few seconds until aromatic, being careful not to burn them. Remove toasted seeds from pan.
Add olive oil to the pan, and heat over medium flame.
Add garlic, ginger, onion, chiles and cilantro, and sauté for a few minutes until the onions are translucent
Take off heat; allow the oil mixture to sit for at least an hour to allow flavors to infuse.
Strain oil. Add the toasted cumin seeds to the strained oil and transfer the oil and cumin mixture to a bottle with a squeeze tip.
Use desired amount to garnish individual servings of chilled soup. Extra oil may be saved in refrigerator for later use.
Mediterranean Lentil Salad
This recipe was provided by the Stanford Cancer Center. Find more of their recipes at www.Cancer.Stanford.edu/patient_care/services/nutrition/recipes/.
Prep time: 10 minutes
Cook time: 25 minutes
1 cup dried lentils
1 clove garlic, peeled and smashed
¼ teaspoon dried oregano
2 bay leaves
1 cinnamon stick or ¼ teaspoon ground cinnamon
¼ cup extra-virgin olive oil
1 tablespoon brown rice vinegar
2 tablespoons freshly squeezed lemon juice
1 teaspoon lemon zest
½ teaspoon ground cumin
¼ teaspoon sea salt
1 red bell pepper, seeded and diced small
1 small cucumber, seeded and diced small
¼ cup pitted Kalamata olive, rinsed and sliced
Large handful baby spinach (torn into smaller pieces, if desired)
3 tablespoons chopped fresh mint
3 tablespoons chopped fresh flat-leaf parsley
2 ounces organic feta cheese, crumbled (optional)
Combine the lentils, garlic, oregano, bay leaf, and cinnamon stick in a saucepan and cover with water or broth by 2 inches. Bring to a boil, then cover, lower the heat, and simmer until the lentils are tender, 20 to 25 minutes. Drain the lentils thoroughly and discard the whole spices. In a separate bowl, whisk the olive oil, vinegar, lemon juice, lemon zest, cumin and salt together. Toss the lentils with the vinaigrette, then refrigerate for 20 minutes.
Stir in the bell pepper, cucumber, olives, spinach, mint and parsley and combine, then do a taste check and season as needed with another pinch of salt, a few grinds of pepper, or lemon juice. Serve with the feta cheese sprinkled over the top.
Nutrition information per serving:
210 calories, 21 grams carbohydrates, 7 grams protein, 11 grams fat, 5 grams fiber.
Adapted from Rebecca Katz.
Spinach, Leek, Garlic and Feta Scramble
By Preston Maring
There must be something about fresh spinach. In close succession, my wife and a longtime patient of mine both suggested I do something with spinach. They buy big bags of it at the market and use it in many different dishes. I thought I would do a frittata for a weekend breakfast the morning after a big rain, but it turned into a scramble.
If you have mature spinach, pull off the toughest stems. Baby spinach needs no preparation. Both can be washed like lettuce and spun dry. The leaves don’t have to get as dry as they do for a salad as the water droplets help steam them while cooking.
4 eggs, lightly beaten (Using 1 egg and 3 egg whites instead would reduce the fat per person.)
2 tablespoons olive oil (If you use a nonstick skillet, maybe a teaspoon of oil will work fine. Even though olive oil is “good fat,” it still has calories.)
2 large handfuls fresh spinach
1 clove garlic, minced
1 leek, white and light green parts, thinly sliced
2 ounces feta, crumbled (Try 1 ounce instead of 2 to “skinny” this recipe even further.)
Salt and freshly ground pepper to taste
Heat the olive oil in a medium skillet. Sauté the leeks until they just start to brown; add the garlic and sauté until fragrant, about 1 minute. Add the spinach. It will cook down to a much smaller volume. Don’t fiddle with it too much as that slows down the cooking time. (You could just do this with extra garlic, no leeks, and some crushed red chilies and call it a side dish for dinner.) (I didn’t add any more oil and I think that’s where this turned into a scramble as I couldn’t turn it over intact.) Add the crumbled feta to the beaten eggs. Season the egg mixture. Add it to the skillet. Let it cook a little then stir it so any uncooked egg gets its turn at the bottom of the pan. Serve with whole-grain toast and “no added sugar” preserves. This is a really good way to start a beautiful day.
Nutrition Information Per Serving (original version—see below for light version):
Calories: 373, Fat: 30 grams, Saturated fat: 9 grams, Trans fat: none, Cholesterol: 448 milligrams, Carbohydrate: 10 grams, Fiber: 1 gram, Sodium: 486 milligrams, Protein: 18 grams
Nutrition Information Per Serving (“light” version made with egg whites and less cheese/olive oil):
Calories: 153, Fat: 8 grams, Saturated fat: 3 grams, Trans fat: none, Cholesterol: 118 milligrams, Carbohydrate: 9 grams, Fiber: 1 gram, Sodium: 306 milligrams, Protein: 12 grams