An Apple a Day Keeps the Doctor Away:

How Culinary Medicine Encourages the Return of Food as Medicine and Promotes Health

By

Julia Logan

Senior Honors Thesis

Interdisciplinary Studies: Food Studies

University of North Carolina at Chapel Hill

28 November 2021

Approved:

Dr. James Ferguson, Thesis Advisor

Samantha Buckner Terhune, Reader

1
Acknowledgements

To my wonderful advisors Samantha and Jim. I could not have gone through this process without

you! All of your support throughout the past year has only increased my love of food and has

encouraged me to delve thoughtfully into many aspects I had previously never considered. I plan

to continue my quest to eat and cook knowledgeably and to share all I can about this great field:

food studies.

To my twin sister Emily and my mom Judy. Thank you for helping me keep my sanity as you

stayed up with me countless nights helping me to proofread all versions of this paper. Emily

especially, even with your demanding engineering major, you never abandoned me and always

made the time to read my papers (since middle school!), often staying up later than me to make

sure you got them finished for me to review in the morning.

To all of my roommates and friends. I applaud you for bearing with me as I talked nonstop,

cried, complained, and was ultimately psyched about my thesis nonstop for the past months.

Hopefully I repaid you enough in dinners and baked goods.

Finally, to my deep roster of cafes in the triangle area. Keep it up with your early opening times

and delicious vanilla lattes!

2
Table of Contents

Preface…………………………………………………………………………………………….5

Chapter 1: Food as Medicine Across Cultures and History: Traditional Chinese Medicine and

Medieval Medicine

Introduction……………………………………………………………………………….7

Traditional Chinese Medicine: A Summary……………………………………………..10

Origins of Traditional Chinese Medicine…………………………….………………….12

Medieval Medicine: A Summary…………………………………………………...…...14

Medieval Treatments………………………………………………………………….…15

Chapter 2: Too Many Cooks in the Kitchen? Let’s Add Doctors: Current Dietary Advice from

Clinicians and How Culinary Medicine Offers a Remedy

Introduction……………………………………………………………………………...18

A Short History of Medical Dietary Advice…………………………………………….19

Culinary Medicine……………………………………………………………………….26

In the Medical Classroom………………………………………………………..27

In the Community Classroom……………………………………………………30

Research on Culinary Medicine’s Efficacy……………………………………………...31

Is Culinary Medicine Worth it?………………………………………………………….34

Is Culinary Medicine Ethical? …………………………………………………………..38

Circling Back Through History: Culinary Medicine Was Mint to Be…………………...41

Historical Similarities of Traditional Chinese Medicine and Medieval Medicine to

Culinary Medicine……………………………………………………………………….43

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Chapter 3: Culinary Medicine Around the World: China and the United Kingdom

Culinary Medicine in Modern Day China

Health Context in China…………………………………………………………47

Obesity: A Case Study…………………………………………………………..48

Traditional Chinese Medicine Today……………………………………………52

Culinary Medicine in the Modern Day United Kingdom

Health Context in the United Kingdom………………………………………….54

Case Study: Culinary Medicine at University College London………………….55

Medieval Medicine Practices Today? ……………………………………………57

Conclusion………………………………………………………………………………………60

References…………………………………………………………………………………….…62

Appendices………………………………………………………………………………………70

4
Preface:

From when I was about five to twelve years old, whenever I was asked what I wanted to

be when I grew up, I answered “a chef” with no hesitation. All throughout elementary and

middle school, I remember always requesting that my mom wait to go grocery shopping until I

was done with all of my homework so that I could join her. This definitely wasn’t a phase—even

now, when I come home from college, she still makes sure to wait until we can go to our favorite

farm-stand-esque markets together. What I love about cooking is the process: how a pile of raw

ingredients can be completely transformed into the final product. Not only that, but chopping

vegetables is the best stress relief strategy I have found thus far. With a recipe or without, seeing

the way that ingredients combine and undergo chemical changes never fails to enthrall me. Even

though somewhere along the way I decided that becoming a doctor would be a profession more

suited to my goals in life, my love and appreciation for food and cooking have only grown.

I think cooking is where my interest in science stemmed from. I always wondered what

was actually happening to the foods when I whipped, baked, pickled, or even charred them.

When I entered high school, I started to enjoy my science classes more and more. I got my first

lab position during my junior year and realized that chemistry is a lot like cooking. Pipetting

small amounts, mixing them all together, and even microwaving certain components all

solidified this connection. Thus, when I started college, I immediately gravitated toward

chemistry, declaring it as my major and starting to work in a chemistry lab. Of course I loved it,

and still do, but around my sophomore year, I felt like something was missing from my

education. I missed that sense of community and belonging—the kind that comes with a home-

cooked meal. Luckily, I turned to food studies, which has not only taught me valuable

information about the subject I love, but also helped to fill that void I was feeling.

5
 One of my favorite parts about learning about food in an academic setting is that we all

have connections to what we are learning. Sure, we can look at a physics equation on the board

that describes force and yes, we all experience these forces in our daily lives. But, there is no

comparison to the unique connection to food that we all have. It is this value and diversity of

experiences that makes the field of food studies so great. I have had amazing opportunities to

study so many aspects of food including its politics, nutrition, environment, animal ethics, and

cultural differences. Despite declaring this major at the beginning of the COVID-19 pandemic,

my amazing professors still found creative ways to expose me to the much-needed experiential

aspects of food. Not only have I gained knowledge and connections to individuals in the food

world, but I now also have a multitude of mouthwatering recipes.

When faced with the decision to write a senior honors thesis, it could have been as simple

as continuing my project in the chemistry lab where I have worked in for years. Nope. I wanted

to take on a challenge and take advantage of the interdisciplinarity nature of my food studies

major by exploring a topic that not only interests me immensely, but also ties into my future

career goals as a doctor. Never did I think, when I was younger, that I could have the best of both

worlds being able to cook as part of a health professions career. (I mean, there’s the whole

cutting things with knives aspect as both a surgeon and a chef, but I can’t say that’s really the

connection I was looking for).

The process of researching and writing this thesis has been incredibly valuable and

inspired me to advocate for and pursue education in the furtherment of and return to food as a

medical treatment. I can only hope that I attend a medical school where I can be engrossed in the

culinary medicine world. With all of that said, I hope you get as much value from reading this

paper as I got from writing it. Bon Appétit!

6
Chapter 1: Food as Medicine Across Cultures and History: Traditional Chinese Medicine

and Medieval Medicine

Introduction

“The strict diet consists of six large bananas and 1,000 cc.

of skimmed milk, to be eaten in three or more meals,

spaced according to the personal food habits of the

individual” 1

It might seem hard to believe, but this dietary advice was published by Johns Hopkins-

educated Dr. George A. Harrop in the Journal of American Medicine Association in 1934. Eating

six bananas and skimmed milk sounds like a horrible diet idea when compared to our nutritional

standards today, but how different is it from modern dietary advice, really? These days, primary

care physicians too often give their patients the advice to “diet and exercise,” eat leafy greens, or

try and consume less salt. 2 While all of these suggestions may potentially result in the desired

outcome (yes, even bananas and skimmed milk for treating obesity), long-term positive health

results often do not occur with advice like this. Without specific advice tailored to a patient’s

lifestyle, a diet is difficult to stick to and thus unlikely to lead to permanent positive health

outcomes. 3
1
Harrop, George. A. (1934). A Milk And Banana Diet For The Treatment Of Obesity.
JAMA: The Journal of the American Medical Association, 102(24), 2003.
https://doi.org/10.1001/jama.1934.02750240009004
2
Ammerman, Alice. “What is a Healthy Diet?.” Class lecture, HNRS 352, UNC Chapel
Hill, Chapel Hill, January 26, 2021
3
Nargi, L. (2018, February 1). Can Cooking Classes Keep Chronic Heart Failure Patients
Out Of The Hospital? NPR.
https://www.npr.org/sections/thesalt/2018/02/01/581891870/can-cooking-classes-keep-
chronic-heart-failure-patients-out-of-the-hospital.
7
 However, we are not here to judge the (albeit disastrous-sounding) nutritional advice

given by Dr. Harrop in 1934 or the vague advice that is more commonplace, but rather to

recognize a very important aspect of medically-suggested diets. As Dr. Harrop described, even

his milk and banana diet needed to be “spaced according to the personal food habits of the

individual.” 1 It is not only common knowledge but also a common experience these days that

people have to make their diet fit their lifestyle, rather than making their lifestyle fit their diet.

The latter is nearly impossible to achieve and rarely leads to the desired result in the long-term.

A diet needs to be tailored to both address the realities of an individual’s lifestyle—such as their

traditions, socioeconomic status, and time constraints—and to aid the individual’s medical issues

in a nutritional sense, which may even be due in part to genetics.

Chronic illness is currently the leading cause of death in the United States, and many of

these disorders can be prevented or controlled through an individual’s food-related actions. Yes,

nutritionists exist, and there are doctors who give dietary advice. However, given growing rates

of heart disease, obesity, and diabetes, for example, it is clear that more needs to be done. 4

Doctors need another tool they can reach for when treating chronic illness. In America, we are

engrossed in a pill-popping culture where everyone wants a miracle solution to cure their

illness.5,6 We value pharmaceuticals as treatments more than taking care of our own bodies by

considering what we put into them and how we treat them. Why is dietary change not valued

4
Centers for Disease Control and Prevention. (2021, March 1). FastStats - Leading Causes
of Death. Centers for Disease Control and Prevention.
https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm.
5
Carr, T. (2017, August 3). Too Many Meds? America's Love Affair With Prescription
Medication. Consumer Reports. https://www.consumerreports.org/prescription-drugs/too-
many-meds-americas-love-affair-with-prescription-medication/.
6
Assael, L. A. (2006). The Pill Culture, the Pill Society. Journal of Oral and Maxillofacial
Surgery, 64(9), 1331–1332. https://doi.org/10.1016/j.joms.2006.07.002

8
compared to drugs? If we modify how we approach food in the medical field, could dietary shifts

be as effective as medication?

This should seem fairly intuitive; searching for a different type of approach makes sense.

Doctors should be providing dietary advice that is achievable within the scope of their patient’s

abilities. The problem is in determining how to make these practices a reality. Interest in culinary

medicine as we know it is a fairly new, as it is a quickly-growing field that I will argue can be

used in relatively simple and subtle ways in order to improve patient health outcomes.

It must be appreciated that using food as medicine is not a novel concept. One of the

main advantages of culinary medicine is how accessible and intuitive it is. The use of food and

cooking as a way to not only maintain but also improve health is an idea that has been around for

centuries. In the twenty-first century, people have been losing sight of these methods that

governed their lives for years. Many patients often favor an “easy fix” in the form of a

pharmaceutical instead of a lifestyle change. As the culinary medicine movement aims to help

food make a comeback in the medical field, it is crucial to explore the importance and rich

history of food as medicine to understand the origins of what has evolved into the current-day

field of culinary medicine.

The first chapter will investigate some of the earliest recordings of food as medicine in

both medieval Europe and Asia as early as the fifteenth century BC and into the first few

centuries. The focus in Asia will be on Ancient China, where food treatments gained traction

during the Shang dynasty and continued to evolve into the modern day. After this exploration of

traditional Chinese medicine (TCM), the focus will shift to medieval Europe, a time period that

extends centuries later. The medieval era was a unique time where science was strongly

9
influenced by valuable insight from Greek and Roman scholars.7 The second chapter will

introduce culinary medicine and explore its ethics and practicality, which will be followed by an

in-depth analysis of the connections between TCM and medieval medicine in order to show why

culinary medicine is so important to our society as a health tool. Finally, the last chapter will

look at modern day examples of culinary medicine internationally in China and the UK, and

compare them to historical medical techniques previously discussed.

Traditional Chinese Medicine: A Summary

Traditional Chinese medicine is comprised of many components, including acupuncture,

cupping, massage, concentration exercises, and herbal remedies. There is a strong emphasis on

balance in this type of medicine in order to achieve the optimal bodily state. 8 A crucial tenet of

this outlook is not only that “food shares the same origin as medicine,” but also that it “can be

used, just like medicine, to treat diseases.”9 In particular, there are two named food treatments in

traditional Chinese medicine: food therapy and medical diet therapy.

The goal of food therapy is to balance one’s nutrition through diet. Medical food therapy

builds off food therapy but instead of solely focusing on nutrition, the goal is to “achieve the

balance of Yin and Yang through the combination of nutrition and medicine.” 8 From this point

on, any reference to TCM in relation to food and health will encompass both of these treatment

types. In TCM, there is both an aesthetic aspect to food (color, temperature, texture) as well as a

7
Thorne, S., Stark, H., & Goodyear, L. (2018). Medicine in the Middle Ages, c.1250-1500.
In Medicine through time, C1250-present (pp. 4–13). Pearson.
8
Wu, Q., & Liang, X. (2018). Food therapy and medical diet therapy of traditional Chinese
medicine. Clinical Nutrition Experimental, 18, 1–5.
https://doi.org/10.1016/j.yclnex.2018.01.001
9
锦玉 Jinyu. (2021, October 15). Chinese food therapy 食疗 (Shí Liáo) // A beginner's
guide. LTL Shanghai. Retrieved October 31, 2021, from
https://www.ltl-shanghai.com/chinese-food-therapy/.
10
nutritional one. In particular, there is an emphasis on the balance between “hot” and “cold”

energy in food, which ties back to the balance between Yin and Yang. TCM also considers the

flow of both blood and Qi (a type of energy) throughout the body. Many foods are believed to

have an intrinsic temperature. For example, foods like cucumbers, which have a high water

content, a white/green color, and a low calorie count would be considered a “cold” or Yin food.

On the other hand, fried food, red meat, and alcohol are examples of contrasting “hot” or Yang

food. It has even been said that the weather can be combatted by consuming food of the opposite

temperature to achieve balance.10 While this may seem intuitive—eating “cooling” foods when

hot can cool one down, it also seems as if it would be hard to measure if this is actually true.

Does the cool refreshing nature of a cucumber actually have this effect of offsetting heat in the

body? In a 2019 chemistry study out of Shandong Academy of Medical Sciences and the

University of Toronto, mice were given different “hot” and “cold” foods and then examined for

spontaneous photon emission. Spontaneous photon emission allowed the researchers to

effectively quantify the cooling or warming effect that a food might have on metabolism. Results

showed that yes, hot foods increase the spontaneous photon emission whereas cold ones decrease

it. Thus, it appears that scientifically, the consumption of these foods may deliver the balancing

effects promised by TCM.11

This emphasis on balance is pervasive throughout TCM. When combining this type of

food therapy with modern drugs, an action plan similar to contemporary culinary medicine

arises. Both emphasize being holistic and aiming to affect the body as a whole rather than the
10
Chen, K. (2018, September 18). Medicinal and historical value of Chinese Food therapy.
Hektoen International. Retrieved October 31, 2021, from
https://hekint.org/2018/09/18/medicinal-and-historical-value-of-chinese-food-therapy/.
11
Zhou, B., Li, T., Yang, M., Pang, J., Min, L., & Han, J. (2019). Characterization of the hot
and cold medicinal properties of traditional Chinese herbs by spontaneous photon emission
ratio of Mice. Journal of Ethnopharmacology, 243, 112108.
https://doi.org/10.1016/j.jep.2019.112108
11
often more narrow-minded, purely pharmaceutical, scientific perspective that often emerges

today.12 Culinary medicine is all about doing what is best for someone specifically in the context

of the resources available. Similarly, a looser contemporary application of TCM is to be more

mindful and appreciate the balance when possible, and this includes while eating. 13

Origins of Traditional Chinese Medicine

The beginnings of TCM date back from the fifteenth to eleventh centuries BC, which was

during the Shang dynasty.12 The Shang dynasty today is primarily remembered for being the first

Chinese dynasty to leave behind written artifacts and recoverable archaeological evidence. 14 It is

believed that one dynasty existed before the Shang dynasty, the Xia dynasty, but this is

sometimes debated due to a lack of hard evidence. The Shang dynasty included the first instances

of a hierarchy, writing, and bronze technology in China.14 It can be extrapolated that this social

organization allowed for free time for people to be able to specialize in fields such as medicine.

Medicine was an inevitable discovery as people faced “struggles[s] against natural forces, beasts

of prey and disease.”15 The first realization that ailments could be improved with certain

treatments occurred with the discovery of alcohol in the Xia dynasty and further discovery of

decoction (herbal remedies) during the Shang dynasty. These both led to the furthering of early

12
American College of Traditional Chinese Medicine. (n.d.). Chinese medicine. American
College of Traditional Chinese Medicine. Retrieved October 31, 2021, from
https://www.actcm.edu/chinese-medicine.
13
Traditional Chinese Medicine World Foundation. (n.d.). Eating habits. TCM World.
Retrieved October 31, 2021, from https://www.tcmworld.org/the-dragons-way-program-
components/eating-habits/.
14
Lai, S., & Brown, W. T. (2006, November). The Shang Dynasty, 1600 to 1050 BCE.
SPICE Stanford Program on International and Cross-Cultural Education. Retrieved
October 31, 2021, from
https://spice.fsi.stanford.edu/docs/the_shang_dynasty_1600_to_1050_bce.
15
Wang, Z., Chen, P., & Xie, P. (1999). History and development of traditional Chinese
medicine. Beijing.
12
treatment technology. From there, in the subsequent Zhou dynasty (eleventh to second century

BC), medicine became more refined. By that point, further specialization was seen in the fields

of dietician, physician, doctor of decoctions, and veterinarian.16 The real spread of food therapy,

though, did not occur until a book was published and distributed through China during the Tang

dynasty in 654 AD that translates to Prescriptions Worth a Thousand Gold (Qianjin Yaofang) by

Sun Simiao, a man better known as “Medicine God” or “King of Medicine”.10,17 This book had a

jaw-dropping 4,500 different formulas of “food therapy” made of different herbs and food

mixtures that addressed many different health problems. Out of those, there were 233 medicines

derived from vegetables.15

These traditions continued to develop into the modern day with innovations in technology

until finally, in 2015, a Nobel Prize was awarded to Youyou Tu, who used science rooted in

herbal remedies of TCM to develop a crucial antimalarial drug.18 This helped to spark the

comeback of TCM, just around the same time that culinary medicine was pushed into the

limelight. It would be hard to believe that some inspiration for the modern field of culinary

medicine did not come from the rich history of other people and cultures using food as medicine.

However, while TCM has a more pharmacologic outlook, culinary medicine tries to move away

from that and supports food as something people already consume every day and could optimize

for their health. Either way, the power of food and its connection to health is clear. Even as

16
China's State Council Information Office. (2016, December 6). Traditional Chinese
Medicine in China. Traditional Chinese medicine in China. Retrieved October 31, 2021,
from http://en.nhc.gov.cn/2016-12/06/c_74787_2.htm.
17
Dharmananda, S. (n.d.). SUN SIMIAO Author of the Earliest Chinese Encyclopedia for
Clinical Practice. Institute for Traditional Medicine . Retrieved November 1, 2021, from
http://www.itmonline.org/arts/sunsimiao.htm.
18
Wang, X., Zhang, A., Sun, H., Yan, G., Wang, P., & Han, Y. (2017). Traditional chinese
medicine. Serum Pharmacochemistry of Traditional Chinese Medicine, 1–6.
https://doi.org/10.1016/b978-0-12-811147-5.00001-7
13
culinary medicine diverges from TCM, it continues to grow today and gain respect and traction

as a reputable form of treatment.

Medieval Medicine: A Summary

While the first recorded example of food as medicine occurred in ancient China, similar

developments were occurring in medieval times with strong influence from the Greeks and

Romans.19 In fact, Hippocrates, a famed Greek physician who greatly influenced the course of

medieval medicine, says: “Let food be thy medicine and medicine be thy food.” 20 As early as 129

AD, Galen used food in a medical context.21 During the Middle Ages, which started around the

time of the Tang dynasty in China in 400 AD and continued until 1500 AD, humans had a

unique view of their bodies.

During medieval times (although originated with Galen), bodily understanding was

governed by humorism. Humorism focuses on the four elements: fire, water, air, and earth.

These four elements further correspond to different moisture and heat levels.22 Each body thus

has components that are an embodiment of each of these: blood, phlegm, and yellow, and black

bile. Medieval humorism practitioners believed that their bodies were more “open” and “porous”

than human bodies are accepted to be today. Each element was thought to be in a sort of

19
Bifulco, M., Marasco, M., & Pisanti, S. (2009). Dietary recommendations in the Medieval
Medical School of Salerno. American Journal of Preventive Medicine, 35(6), 602–603.
https://doi.org/10.1016/j.amepre.2008.07.004
20
Witkamp, R. F., & Norren, K. van. (2018, May 26). Let thy food be thy medicine....when
possible. European Journal of Pharmacology.
https://www.sciencedirect.com/science/article/pii/S0014299918303595.
21
Bovey, A. (2015, April 30). Medicine in the Middle Ages. British Library. Retrieved
November 1, 2021, from https://www.bl.uk/the-middle-ages/articles/medicine-diagnosis-
and-treatment-in-the-middle-ages.
22
National Institutes of Health. (n.d.). The World of Shakespeare's Humors. U.S. National
Library of Medicine. Retrieved November 1, 2021, from
https://www.nlm.nih.gov/exhibition/shakespeare/fourhumors.html.
14
“equilibrium” in the body and any disequilibrium could be mended with the corresponding

outside element.23 Various illnesses were thought to be elemental imbalances, thus requiring

treatment to restore that balance. In many of these cases, this required food to be used as

medicine. Most of the professional practitioners of medicine were connected to the monasteries

and it could be difficult for a commoner to access it. However, there were also some locals with

less formal knowledge who performed and advised about treatments.21 In the context of modern-

day knowledge and technology, many of the most common treatments seem dangerous or ill-

advised. However, looking at these actions through the lens of humorism lends context to the

question of why they chose to pursue these treatments. In contrast to TCM, which is upheld by

even our current-day standards, medieval medicine can be difficult to understand.

Medieval Treatments

Medieval medicine is best characterized by examples of treatments. Although many of

their treatments do not adhere to the modern-day concept of “food as medicine,” a lot of them

rely on food products to produce certain outcomes. In medieval medicine, it was believed that

everyone had their own humoral balance that was related to their social statuses. For example,

someone doing physical work outdoors might have a more cool and wet humoral disposition,

thus requiring a diet full of foods such as “fish, cabbage, rosewater, [and] leeks”.24 On the other

side of the spectrum, someone who needs to be warm such as an elderly person or royalty (heat

was correlated with rank), would need to eat dry and hot foods like “nutmeg, cinnamon, venison

and red wine”.24 This emphasis on temperature connects strongly to TCM, where it also served as

the basis for the valuation of certain foods in their society. However, although there is scientific
23
Hartnell, J. (2019). Medieval bodies: Life and death in the Middle Ages. W.W. Norton &
Company, Inc. Page 13.
24
Hartnell. Page 212.
15
evidence that these foods may actually cause physiological change, the connection between

social status and food temperature is more dubious and has yet to be proven.

In medieval medicine, there were also certain foods used to treat specific states that were

thought to alter the humor. One such state is pregnancy. Trotula, a medical practitioner and

gynecologist, suggests a treatment to address pregnancy cravings that relies on food. However,

instead of feeding the woman the food she craves, it is recommended that she “should be given

cooked beans with sugar,” which supposedly stops these cravings.25 Before labor, she

recommended that women should consume light foods that are easy to digest. This was the

standard during the eleventh century. As time went on, in the thirteenth and fourteenth centuries,

treatments for pregnancy slightly changed. Bernard de Gordon addressed a pregnant woman’s

appetite expanding, recommending more “roasted, fried, and fragrant food” because it was

believed that these cooking methods could reduce appetite. 26 Other medical professionals warned

against using salt because it may make the baby have no fingernails. They also cautioned about

potential eating disorders that may arise and how to avoid them. Ortolf von Baierland, another

prominent medical professional of the time, said that wine should be consumed during pregnancy

—something that we strictly eschew in the modern day United States. One of the purported

benefits of wine was as an anti-nausea treatment.26 It is important to emphasize again that even

though these treatments may seem unimaginable based on today’s standards in the United States,

with what was known back in medieval times about the humoral body, these made perfect sense.

Even medieval dentistry valued the use of food as medicine. When a cavity was discovered, they

25
Hartnell. Page 16.
26
Weiss-Amer, M. (1993). Medieval women's guides to food during pregnancy: Origins,
texts, and traditions. Canadian Bulletin of Medical History, 10(1), 5–23.
https://doi.org/10.3138/cbmh.10.1.5
16
often used peppercorns to treat it. However, despite the very different treatment methods, they

had similar ideas about the causes of cavities and cited the overindulgence of sweet foods. 27

Overall, medieval treatments value the balance of the humors and achieve this through

different combinations of food and herbs. Even the action of muddling herbs is an act of cooking.

Thus, while not all of these treatments occur through consumption, they do involve food and

culinary preparation in some way. Although, as we will see, culinary medicine primarily focuses

on consumption, it also extends to other aspects of food as well, such as culinary education.

Chapter 2: Too Many Cooks in the Kitchen? Let’s Add Doctors: Current Dietary Advice

from Clinicians and How Culinary Medicine Offers a Remedy

Introduction

The chapter that follows will introduce and weigh the practicality and ethicality of

including the teaching of culinary medicine as a tool for medical professionals, and will

ultimately argue for culinary medicine’s more frequent implementation. First, I will introduce

medical dietary advice as it is currently taught in medical school, and how it has been used to

treat patients throughout history. Then I will delve into the current state of culinary medicine,
27
Hartnell. Page 77.
17
and examine whether the cost of the time and resources necessary to implement culinary

medicine is worthwhile. After, I will consider the ethics of culinary medicine implementation, as

dietary changes have the potential to be ethnocentric, especially considering that a majority of

doctors in the United States are white.28 I will include suggestions of feasible ways to provide

this necessary culinary education to doctors, and conclude by discussing connections between

TCM, medieval medicine, and culinary medicine.

As history has shown, food can be a legitimate treatment for many illnesses if it is

utilized in the right way. A culinary education intertwined with medicine and an awareness of

food topics in general, all under the umbrella of culinary medicine, poses a promising solution.

A Short History of Medical Dietary Advice

It is still common practice to weigh patients during their yearly physical and combined

with their height, this information can be used to calculate their body mass index (BMI). BMI

has historically been used as a measure to categorize patients into underweight, healthy (a word

which I will address later), overweight, obese, and extremely obese. Although many medical

professionals recognize that BMI is only “moderately correlated” with measures of body fat, the

CDC continues to claim that it is “strongly correlated with various metabolic and disease

outcome[s].”29 Thus, with the government’s encouragement of continuing this outdated practice,

28
Diversity in Medicine: Facts and Figures 2019. AAMC. (2019).
https://www.aamc.org/data-reports/workforce/interactive-data/figure-18-percentage-all-
active-physicians-race/ethnicity-2018.
29
Centers for Disease Control and Prevention. (2020, September 17). About Adult BMI.
Centers for Disease Control and Prevention.
https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html.
18
many patients each day are told they are obese, which often feels a lot more like an insult rather

than a correlation. Furthermore, BMI is limited by its inability to distinguish between muscle and

fat because it is calculated simply as weight in kilograms divided by height in meters. 29 Weight is

weight whether it is composed of fat or muscle, so even someone who is extremely in-shape and

muscular could be told that they are obese and at risk for certain diseases. The psychiatric effects

of BMI on patients are understandably taxing in many cases. This BMI description should be

used as context for the following history about dietary advice.

It is estimated that 50 to 80 percent of chronic diseases are affected by nutrition. 30 After

identifying an elevated BMI as a risk, many physicians recommend diet and exercise to their

patients as a preventative measure. However, this is not the advice that many patients are

seeking. Many anecdotes from patients seem to result in similar unsolicited advice from

physicians telling them to "just lose some weight. Cut out junk food. Drink more water."31 Thus,

patients often come into an appointment with a completely unrelated issue such as an ear

infection, yet the medical professional cannot see past their weight. This sort of commentary

may even come from a doctor who is obese herself. When asking about ear infection aftercare,

one patient was met with: “Lose some weight.”31 Even doctors who are otherwise unbiased

sometimes slip into these unhelpful practices. Many overweight patients avoid doctor’s offices

due to this weight bias. In one case, a doctor was extremely surprised after taking a patient’s

blood pressure saying, “obese patients don’t usually have low blood pressure.”31 Even if the

30
Cernansky, R. (2018, July 9). Your doctor may not be the best source of nutrition advice.
The Washington Post. https://www.washingtonpost.com/national/health-science/your-
doctor-may-not-be-the-best-source-of-nutrition-advice/2018/07/06/f8b3ecfe-78af-11e8-
93cc-6d3beccdd7a3_story.html.
31
Your Fat Friend. (2018, June 26). Weight Stigma Kept Me Out Of Doctors' Offices for
Almost a Decade. SELF. https://www.self.com/story/weight-stigma-kept-me-out-of-
doctors-offices.
19
doctor herself is unaware of it, a literary review of health care utilization and weight bias

detected common themes of patient-perceived lack of training, ambivalence,

patronization/disrespect, assumptions, and attribution of all health issues to weight.32 Patients are

often met with advice to lose weight without a real plan of attack. Although some of these

problems may be due to implicit bias or plain disrespect, more often the issue is just a lack of

knowledge and comfort with the topic. Knowing how to address these issues more sensitively

with better tools could potentially limit some of these deterrents to optimal healthcare in terms of

patient diets.

How do we treat nutrition-related diseases currently? We are facing alarming rates of

chronic diseases, with nearly half of all adult Americans having at least one. In fact, these

diseases are responsible for over half of the deaths in the United States.32 However, there seems

to be a larger focus on prescribing pharmaceuticals to provide direct relief than looking at the

underlying factors of so many of these diseases: the intertwinement of weight and diet. For

example, the first treatment for type two diabetes should be management of diet, yet doctors

often view dieting as an “adjunct therapy.”33 Nevertheless, many people look to clinicians to tell

them what to do, which is a system that is evidently flawed. Yes, there are great doctors who do

give diet advice that is effective for certain patients, but in terms of “providing sufficiently

detailed nutrition advice that is relevant to a patient's health goals, useful for the patient, and that

32
Raghupathi, W., & Raghupathi, V. (2018). An Empirical Study of Chronic Diseases in the
United States: A Visual Analytics Approach to Public Health. International Journal of
Environmental Research and Public Health, 15(3), 431.
https://doi.org/10.3390/ijerph15030431

33
Adamski, M., Gibson, S., Leech, M., & Truby, H. (2018). Are doctors nutritionists? What
is the role of doctors in providing nutrition advice? Nutrition Bulletin, 43(2), 147–152.
https://doi.org/10.1111/nbu.12320

20
results in measurable changes,”33 this is not as common as it should be. I mean no insult to the

brilliant and hardworking medical professionals of the world (and hope that I am one of them

someday), yet the tools and training that many are equipped with are plainly insufficient in many

cases, leading to an inability to properly advise patients on this topic. Furthermore, big pharma

has a stronghold not only on our industries but also on our culture. Combining this with the

growing contention toward America’s stigmatization of weight, it is clear that something needs

to change.

Although many people immediately think of physical chronic diseases when looking at

the relationship between diet and health, it is imperative to mention the mental health benefits of

a change in diet. The brain-gut connection (also known as the enteric nervous system) is a hot

research topic, and so far, the discoveries have been revolutionary. It is widely accepted that

feelings of anxiety often can cause a stomach ache. New data shows that this may in fact be the

opposite— “irritation to the gastrointestinal system may send signals to the central nervous

system (CNS) that trigger mood changes.”34 Thus, the food put into one’s body might actually

affect one’s mental health. Additionally, eating disorders are unquestionably linked with diets,

and giving medical professionals different tools to use to interact with patients and teach them

about food could potentially make a difference. Sometimes, patients who do not look

“unhealthy” (e.g. abnormally high or low BMI) are overlooked for eating disorhder diagnoses.3

If doctors are equipped with more tools to cater to not only a patient’s diet, but also time, money,

culture, and other factors, it could help so many people. Although medical professionals are

taught about food and nutrition to a certain extent, without possessing the confidence and skills

34
The Brain-Gut Connection. Johns Hopkins Medicine. (n.d.).
https://www.hopkinsmedicine.org/health/wellness-and-prevention/the-brain-gut-
connection.
21
of how to put this knowledge into practice by sharing specific and tangible recommendations that

patients can easily follow, they may not be reaching their full potential as caregivers.

The following is a deeper dive into the education that doctors have historically received

in the field of nutrition. According to Dr. David Eisenberg, adjunct associate professor of

nutrition at Harvard T.H. Chan School of Public Health in 2017, less than one-fifth of medical

schools in the United States require a nutrition course and “most medical schools in the United

States teach less than 25 hours of nutrition over four years”.35 To put it into more relatable terms,

this is the equivalent of taking a three-credit college course for about two months—likely not

memorable or effective. Future doctors need to be adequate in a multitude of fields, and

nutrition is one that is often ignored or neglected more than others. There is no doubt that doctors

are in the perfect position to give dietary advice (despite short appointments, they have a close

long-term relationship with patients who often look to them for advice),33 which is why they also

need sufficient training in this area. Another option, which is severely underutilized, could be

referring patients to a registered nutritionist, who also could use culinary medicine as a tool. 36

However, just knowing the right nutritional science is not necessarily a productive solution, as it

might not be “relevant,” “useful,” and “result in measurable changes.”33 Although some

education is better than none, instead of just focusing on nutrition, food should be recognized as

the interdisciplinary field it is. Doctors should be provided with the most comprehensive and

effective tool possible. In this case, that tool is culinary medicine.

35
Harvard T.H. Chan School of Public Health. (2017, May 9). Doctors need more nutrition
education. News. https://www.hsph.harvard.edu/news/hsph-in-the-news/doctors-nutrition-
education/.
36
Irl B., H., Evert, A., Fleming, A., Gaudiani, L. M., Guggenmos, K. J., Kaufer, D. I.,
McGill, J. B., Verderese, C. A., & Martinez, J. (2019). Culinary medicine: Advancing a
framework for healthier eating to improve chronic disease management and prevention.
Clinical Therapeutics, 41(10), 2184–2198. https://doi.org/10.1016/j.clinthera.2019.08.009
22
 Before introducing culinary medicine and why this field deserves to grow and be better

utilized, the words “healthy” and “unhealthy” need to be examined. As Dr. Alice Ammerman so

wisely questioned: why do the words “healthy” and “unhealthy” somehow equate to good and

bad? How has food become confounded with morals? This system of labeling not only makes

people feel bad about their choices, but it also encourages them to ignore what their bodies

actually need, instead choosing foods that are deemed “healthy.”3 People need certain nutrients

based on their unique situations, and there is no way to prescribe one diet that is “good” or “bad”

for everyone. Thus, this attribution of morality to food habits with the words healthy and

unhealthy is part of the problem.37 For the rest of the paper, the word healthy is distanced from

these moral connotations and is used to refer to an individual’s health in context of their specific

situation.

In the following sections of this chapter, I will hone in on the cultural aspects of diet and

how these are intertwined in the field of culinary medicine. By culture, I mean anything from

food accessibility to tradition. Too often, diets are solely focused on ditching foods which are

considered to be of low nutritional value in favor of foods considered to be of high nutritional

value, and this type of dieting is nearly impossible to sustain in the long term. People do not tend

to eat what does not fit into their lifestyles. The solution comes from the combination of the

culinary arts and medical fields to help provide accessible solutions to families that include all

aspects of a nutritionally ideal lifestyle, from shopping, to cooking, to storage, and more.38 This

field is called culinary medicine.

37
Euba, R. (2016, September 13). Stop making health and well-being a moral issue. The
Conversation. https://theconversation.com/stop-making-health-and-well-being-a-moral-
issue-64921.
38
Ferreira, S. (2018, July 12). The Art of Cooking for Health: Culinary Medicine. American
Society for Nutrition. https://nutrition.org/the-art-of-cooking-for-health-culinary-
medicine/#:~:text=Culinary%20medicine%20is%20an%20emerging,%2C%20storage%2C
%20and%20meal%20preparation.
23
 While speaking about the type of holistic treatment culinary medicine provides, it is

important to delve into the different types of medical degrees offered. The two most well-known

are a doctor of medicine (MD) and doctor of osteopathic medicine (DO). An MD is allopathic

meaning that it “focuses more on disease treatment” while an DO thinks of the body as in

“integrated whole.”39 I wondered how this might come into play when talking culinary medicine,

so I reached out to two doctors who practice culinary medicine: Dr. Joey Skelton (MD), a

pediatrician and gastroenterologist who works at Wake Health, and Dr. Amir Barzin (DO), a

family practice physician who works at UNC Health. Starting with Dr. Barzin, he emphasized

the importance of a holistic view saying that “it’s always a whole body whole system approach”

and he is always “taking into consideration every factor that could be helping or hurting

someone’s health.” This manifests as “tools to prevent disease versus actually working on

treating disease.”40 One of these tools is culinary medicine. On the other hand, in Dr. Skelton’s

case, he focuses a lot on treating children with obesity. This is an example of how culinary

medicine may be used as a treatment in the MD context versus a preventative tactic in the DO

context. Of course, there is also a lot of overlap in terms of doing the best for each patient. He

says that one of the best things that can be done to help is to “get them in the kitchen. One of the

most important parts about culinary medicine to him is the hands-on aspect: “We could tell them

[patients] how to cook we could give them recipes, but they need to get in there and get

comfortable.”41 When he has time on weeknights and weekends, he enjoys teaching community

cooking classes. At Wake, there is a teaching kitchen and program at the medical school that

allows 32 medical students each cohort to experience this education.41 Both of these medical
39
Piedmont Healthcare. (n.d.). Your doctor: The difference between an M.D. and D.O. |
Piedmont Healthcar. Retrieved November 3, 2021, from https://www.piedmont.org/living-
better/your-doctor-the-difference-between-an-md-and-do.
40
Logan, J., & Barzin, A. (2021, November 2). Amir Barzin Interview. personal.
41
Logan, J., & Skelton, J. (2021, April 30). Joey Skelton Interview. personal.
24
professionals acknowledged that time and resources can be restraining when practicing culinary

medicine, but that there is more and more of a push for it as time goes on. At UNC, they have

been requesting a teaching kitchen on campus.40 There has also been talk of a transformation bill

in North Carolina that would allow medical professionals to bill insurance for a cooking class. 41

Overall, while they have their differences in philosophy and focus, both osteopathic and

allopathic doctors can use culinary medicine to help their patients reach desired health outcomes.

The field is only growing and although time and resources might be tight now, there is a push for

more support from the government.

Culinary Medicine

I am not here to argue that culinary medicine can solve all of our problems, but I think

that it could be a very beneficial addition to the tools that doctors can use when advising patients

about their diets. As noted, culinary medicine is a combination of two familiar fields—culinary

arts and medicine—yet when put together, its meaning is not necessarily intuitive. It may be

easier to start out with and exploration of what culinary medicine is not. One of the biggest

misconceptions is that it is the same as nutrition. Yes, nutrition is definitely an aspect of it but

there is much more to it. Culinary medicine “blends the art of food and cooking with the science

of medicine…[and] is aimed at helping people reach good personal medical decisions about

accessing and eating high-quality meals that help prevent and treat disease and restore well-

being.”42 The general goal is to “teach doctors and health professionals cooking and nutrition

basics, which they then pass on to patients.”43 This is not to necessarily “reject prescription
42
La Puma, J. (2016). What Is Culinary Medicine and What Does It Do? Population Health
Management, 19(1), 1–3. https://doi.org/10.1089/pop.2015.0003
43
Albright, M. B. (2015, January 29). What Exactly Is Culinary Medicine? Culture.
https://www.nationalgeographic.com/culture/article/food-medicine-health-super-bowl-
sunday.
25
medication” or follow “a single dietary philosophy,” but rather to take a more interdisciplinary

approach.42

An example might help clarify the goals of culinary medicine. Say a patient is struggling

with diabetes and healthy eating. Although he might want to cook, his two young sons and

husband demand certain foods high in sugars and other carbohydrates, and it is too hard for him

to make separate meals each night. What if his doctor could talk it through with him and provide

him with some recipes and techniques that both fit into his diet and his daily life in the context of

his culture? If doctors are trained in the kitchen, at least in the context of medicine, they should

be able to use that knowledge to give their patients a very feasible “prescription” for the sorts of

meals to help with their diagnosis or even to help prevent a future diagnosis. To a lesser extent,

culinary medicine handouts (examples in Appendices B, C, and D) could also help patients with

their dietary decisions.

In the Medical Classroom

Currently in 2021, “over 55 medical schools, residency programs, and nursing schools”

include a culinary medicine curriculum.44 The original and most popular curriculum is known as

Health Meets Food and is led by Dr. Timothy S. Harlan, who is also the executive director for

the George Washington School of Medicine’s program as well as the Creative Adviser at

Tulane’s Goldring Center for Culinary Medicine (Appendix E). Many culinary medicine

programs are currently offered as electives that students and professionals have to apply into.

Although considered “extra” coursework in many schools, the draw of food and need for this

education has proven that program is popular and successful. One of Health Meets Food’s most
44
Medical Schools Using the Health meets Food Culinary Medicine Curriculum.
CulinaryMedicine.org. (2021, February 13). https://culinarymedicine.org/culinary-
medicine-partner-schools/partner-medical-schools/.
26
illustrious programs is the Certified Culinary Medicine Specialist (CCMS) for clinicians. This

program is offered to a variety of medical professionals and allows them to gain a certification in

culinary medicine post-medical or other medical professional school.45

An example of this hands-on learning that a medical student might experience could look

like this: First, there would be a lesson on a certain ailment, say, hypertension. After that, the

students could be challenged with a budget, time, and specific means of transportation to buy

ingredients and construct a meal that could benefit a patient with hypertension. Then, all of the

meals could be tasted by other students, professors, or even patients, depending on the scenario.

When students learn how to do tasks like these in real life, it makes it much easier to be able to

recommend something similar yet specific within the realm of each patient’s individual needs. 46

Another well-known culinary medicine curriculum is aptly called The Culinary Medicine

Curriculum and it is “the first, comprehensive, open-source guide created to support the

implementation of CM at health professional training programs (HPTPs) worldwide.”47 This

curriculum originated at Stanford University School of Medicine was authored by Dr. Michelle

Hauser and is now open for anyone to access (Appendix F). It places emphasis on “presenting

healthy food as unapologetically delicious, quick, and inexpensive.”47 These lessons are

applicable to daily life when one may have less time to cook, solidifies skills on “motivational

interviewing” (a way to speak to patients about their diet and exercise and make changes), and

45
The Certified Culinary Medicine Specialist (CCMS) Program. CulinaryMedicine.org.
(n.d.). https://culinarymedicine.org/certified-culinary-medicine-specialist-program/become-
a-certified-culinary-nutrition-specialist/.
46
Doctoring the Menu: Food as Medicine. Johnson & Wales University. (n.d.).
https://www.jwu.edu/news/2016/04/let-food-be-thy-medicine-jwu-food-and-health-
collaborations.html.
47
Hauser, M. E., Nordgren, J. R., Adam, M., Gardner, C. D., Rydel, T., Bever, A. M., &
Steinberg, E. (2020). The first, comprehensive, open-source culinary medicine curriculum
for Health Professional Training Programs: A global reach. American Journal of Lifestyle
Medicine, 14(4), 369–373. https://doi.org/10.1177/1559827620916699
27
gives all the necessary tools to start a culinary medicine course. Currently, many other

universities base their culinary medicine programs on this curriculum. Importantly, all these

teachings are placed in a context of cultural congruence.47

As culinary medicine increasingly asserts itself, it becomes easier to spread as more

materials are available. Medical students absolutely need this as they lack education in how to

interact with and advise their patients about nutrition, in many cases. As a result, not only do

their patients receive care from a more knowledgeable source, but the medical professionals also

feel much more confident in the advice they provide.48

The next logical question is, as this is such a new field, how do older practicing

professionals gain this culinary competency? One way that this is addressed is through

continuing medical education (CME) programs. In order to continue to be certified, some

medical professionals have to take additional classes to refresh their knowledge or get up-to-date

with new knowledge.49 These types of courses span a multitude of different disciplines and

having culinary medicine as a widespread class option could also help disseminate its important

teachings. In fact, courses like these do exist already and at some schools, these classes not only

count for CME credit but also toward the CCMS certification.50

In the Community Classroom

48
Magallanes, E., Sen, A., Siler, M., & Albin, J. (2021). Nutrition from the kitchen: Culinary
medicine impacts students’ counseling confidence. BMC Medical Education, 21(88).
https://doi.org/10.1186/s12909-021-02512-2
49
AMA PRA Credit System requirements. American Medical Association. (n.d.).
https://www.ama-assn.org/education/ama-pra-credit-system/ama-pra-credit-system-
requirements.
50
Upcoming CME Classes. Goldring Center for Culinary Medicine. (n.d.).
https://goldringcenter.tulane.edu/cme-2/upcoming-cme-classes/.
28
 Another way that culinary medicine has been implementing its philosophy is through

group classes. These classes are often taught by people with a lot of cooking experience, and in

certain programs, notably Tulane Medical School’s Goldring Center for Culinary Medicine, they

partner with nearby culinary schools—Johnson and Wales in Tulane’s case. These culinary

professionals teach classes for medical students and medical professionals, as well as for the

surrounding community. They also equip medical students with the skills to teach their own

classes and give patients recipes and advice.51 Many of these classes are attended by both

medical professionals and by their patients. This allows everyone the ability to gain knowledge

of basic cooking skills and also easy substitutions that can be made to pack more nutrients into

their food in a way that is still delicious. Not only that, but it instills confidence in both parties.

In one culinary medicine class led by Michelle Mudge-Riley, DO, the participants requested a

way to make chocolate pudding in a way that would benefit their health more than the sugar-

packed Jell-O brand. Dr. Mudge-Riley tested out recipes and in 2014, before avocados were as

trendy, she settled on an avocado, unsweetened cocoa powder, natural sweetener, and almond

milk combination. The recipe proved to be easy, fast, and delicious.52

It is really quite astonishing to look at just how simple some of the swaps that culinary

medicine teaches its followers are. This includes tips such as using fresh herbs to add flavor

without nutrients that may exacerbate a health issue, using acid such as a “splash of citrus” to

reduce sodium intake (beneficial for heart disease patients, for example), and measuring oil

51
Shaw, G. (2014, March 12). Inside the Culinary Medical Program at Tulane University.
Bon Appetit. https://www.bonappetit.com/entertaining-style/trends-news/article/med-
students-kitchen.
52
Mudge-Riley, M. (2014, November 21). Culinary medicine: The new 'in' thing?
https://www.mgma.com/resources/quality-patient-experience/culinary-medicine-the-new-
%E2%80%98in%E2%80%99-thing.

29
instead of drizzling it in a pan.51 There are roughly 120 calories per tablespoon of oil, so just

measuring it could help to cut down on calories. What is so striking is how these changes seem

like they could be accessible to most people. If a clinician is able to pick and choose from a

whole knowledge base of options like these, many people can alter the nutrients of their diets

without actually altering the food they eat, resulting in more effective dieting. If motivated

enough, patients can even use resources recommended to them by their medical professional to

learn more about certain changes they can make on their own. This can be extremely beneficial

in families, as everyone can continue to share the same meals without the dieter feeling

excluded. Oftentimes, when people diet, their food is labeled as separate, less delicious, and

“unhealthy.” In these diets, the dieter often finds themselves having to make their own separate

meal for himself, and this likely takes up more time and money.

Research on Culinary Medicine’s Efficacy

As culinary medicine is a relatively new field, there is not much concrete scientific

research across multiple sites to support it. (That said, there is an outpouring of support from

both medical professionals and patients who have personally been impacted by culinary

medicine). However, there is one main study called Cooking for Health Optimization with

Patients (CHOP) that spans multiple countries and gathers concrete data as a health trial tracking

the effects of culinary medicine in the preventative cardiology field.53 This study is especially

unique in that it partners with the World Health Organization (WHO) in conjunction with regions

from the Millennium Development Goals in order to address long-standing health issues not only

in America but around the world. The main areas of focus are sub-Saharan Africa, Southeast
53
Monlezun, D. J. (2018, February 23). Cooking for Health Optimization With Patients.
ClinicalTrials.gov. Retrieved November 1, 2021, from
https://clinicaltrials.gov/ct2/show/NCT03443635.
30
Asia, and Latin America and the Caribbean. In particular, this study originates out of Tulane but

partners with physicians in Kenya, Indonesia, and Colombia. These areas have a high prevalence

of both overnutrition (e.g. obesity) and undernutrition (e.g. calorie deficiency, vitamin/mineral

deficiency).54

The question remains: How were these issues addressed? The main methods of this study

were through a CHOP-International database which is an “open source nutrition education tool

and recipe database”.54 The database not only provides medical professionals with more

knowledge about nutrition and cooking, but also includes regional-specific recipes for

distribution and demonstration. The guide for instructors also includes pertinent information on

different substitutions that can be made in the food of people within the realm of their culture.

These suggestions are determined through cultural traditions and what is available in the area

(Appendix G). This can allow patients to make easy and appropriate substitutions in their food

choices that can be tailored to their specific disease.54

The whole goal of this research, besides the obvious one of improving a person’s health,

is to support culinary medicine as a field that is scientifically proven to be effective.

Unfortunately, the results of this study have not yet been released. Research takes a significant

amount of time and a change in diet can take a long time to show efficacy. The estimated date for

results is 2028. The findings likely will come in two phases: the first of which is the effects in

local and partnering hospitals to Tulane’s Goldring Center and the second is from the

international intervention.53

54
Arman, D., Monlezun, D. J., Peters, B., Urday, P., Cutler, H., Pellicore, D., Lim, H. J.,
Sarris, L., & Harlan, T. S. (2015). Chop-international: An open access nutrition education
tool for physicians, resident doctors, and medical and public health students. Journal of
Medicine and the Person, 13(2), 118–124. https://doi.org/10.1007/s12682-014-0202-5
31
 One of the most pressing questions about the efficacy of culinary medicine is how it

impacts both the provider and the patient. Does this sort of education actually reap the results it

promises? On the other hand, while there is no hard evidence that culinary medicine is clinically

effective across the world, there are more results on the way culinary medicine personally

impacts medical professionals and patients who receive that type of care in the United States.

One study out of The University of Texas Southwestern School of Medicine took a cohort of 64

students and surveyed them before and after taking a culinary medicine course. The results were

statistically significant. One of the statistically nonsignificant data points according to the p

values between the two surveys is that “Speaking with…patients about their food choices is an

essential part of any discussion about health”.48 This reinforces the consensus that food is an

undeniable factor of health, and nearly all of these students agreed with this statement both

before and after their culinary medicine education. Post-course, the students changed their

answers significantly. In particular, answers having to do with their comfort and confidence in

speaking to patients about what they eat drastically increased.48 Hence, there is a very strong

correlation between this class and learning culinary medicine principles to the ability of a doctor

to effectively treat a patient in terms of what they eat. As a reminder, these food treatments used

in conjunction with, or even instead of drugs, can help a huge multitude of different diseases.

While the aforementioned study examines confidence levels of medical professionals

after culinary medicine training, a very crucial question still remains. How does this help the

patient in a real-life situation? One University of Washington-based group did a pilot study on

the effects of culinary medicine for type two diabetes. The study members were separated into

two groups: receiving standard nutrition education and participating in a cooking class. Results

showed a greater reduction in diastolic blood pressure levels and cholesterol levels in the group

32
who took the cooking classes. Although this study was small with a total of 27 participants, the

results are promising that this type of culinary medicine approach is effective.36 While there is a

lot of research in progress, the field still needs large studies to prove consistent efficacy and to

help encourage not only the spread but also standardization of the field.

Is Culinary Medicine Worth it?

It is now time to address the elephants in the room, the first being the extremely limited

time and money that many medical students have to seek out a culinary medicine program. With

the intense competition and strenuous requirements, students often end up at the singular medical

school they are accepted to. For many students, there is often no leniency of choice, especially

when looking for certain programs. Those with a choice are known as a “fortunate few.”55 In

most cases, it boils down to this: going to any medical school that offers an acceptance, versus

the hours upon hours of stress and hard work to reapply and boost an application to gain

acceptance to a more desirable one. In both cases, the individual still becomes a doctor, so is all

of the extra work worth it for a specific program? From a student’s perspective, even if they

know about culinary medicine (which has proved to be popular at the schools that offer it)44 and

want to go to a school where they can learn about it, they have to weigh these pros and cons.

Thus, one way to look at the worthiness of a culinary medicine program is to measure it via the

stress it causes students to get into their desired programs. Because not all medical schools have

these programs and the admissions process is already so difficult, constructing additional

programs would allow more students the opportunity to experience culinary medicine and take

55
Murphy, B. (2020, February 20). Accepted by more than 1 medical school? Consider
these factors. American Medical Association. https://www.ama-assn.org/residents-
students/preparing-medical-school/accepted-more-1-medical-school-consider-these-
factors.
33
away some application stress. If culinary medicine became something more widespread, this

admissions situation that many pre-medical students face would not be an issue at all.

Not only can we look at the impact on pre-medical students and the stress of gaining

admission to the desired program, but we can also look at the available time that medical

students have while in medical school. There is so much critical information that medical

students are required to learn, so to accommodate more, would something else have to be cut

out? Well, it turns into a bit of an ethical question here, which we will discuss in depth later.

How can anyone decide which parts of medicine are more worthwhile to learn than others? Each

medical student will move on to different specialties and hence see varying illnesses and need

different knowledge. Food is a commonality between all specialties, and diet and weight can

affect almost all illnesses and injuries, even if it just impacts certain healing processes. For

example, some foods may cause inflammation, so even, perhaps, an orthopedist may need to

consider what their patient eats.56 Thus, the importance of implementing culinary medicine as a

part of the medical school curriculum can easily be asserted. In order to address this issue of

time, at least to start, this curriculum could be offered as an elective to ease medical students into

the additional course load, and later could become something more recommended or required.

Many existing programs use this method.45

Creating a separate program and curriculum at a medical school is bound to cost a lot of

money. Medical students tend to be in enough debt after medical school, so upping the cost does

not pose a viable option. Many of these programs might be a big, yet worthy, investment at the

beginning. One way that existing programs have eased the cost is to partner with nearby culinary

schools and even use certain culinary schools’ facilities in order to implement the curriculum.
56
Reavely, D. (2014, March 23). Nutrition: How diet can affect injury. Athletics Weekly.
https://athleticsweekly.com/performance/nutrition-diet-can-affect-injury-1735/.

34
This is what Tulane did when it paired with Johnson and Wales, for example, and many other

programs do this as well.44 Furthermore, the goal of these programs is to equip doctors with the

ability to best treat their patients. According to a study coming from the Milken Institute, the

United States spends over $1 trillion annually on chronic diseases.57 If more future doctors have

these additional culinary medicine skills to be able to better focus on and address the diet portion

of chronic disease management, this will save money. Another study from Brigham and

Women’s Hospital in collaboration with the Friedman School of Nutrition and Sciences Policy at

Tufts showed that if people with chronic diseases change their diets to be more “optimal” in

these ten categories—“fruits, vegetables, nuts/seeds, whole grains, unprocessed red meats,

processed meats, sugar-sweetened beverages, polyunsaturated fats, seafood omega-3 fats and

sodium”—$50 billion could be saved annually.58 Although no data has been released about how

much it costs specifically to build a culinary medicine program, we can look at one of the largest

costs: constructing the facility itself (which would likely be necessary if the program were to

grow large enough). Recently, the University of Massachusetts Medical School has undertaken

the construction of a new research and education building. This building is estimated to cost

$325 million for 325,000 square feet.59,60 Yes, this is expensive but is also a one-time payment

and ultimately, is only 0.0325% of the total 1 trillion+ that could be saved annually by diet

changes that actually work. Furthermore, having this designated center would also attract more
57
Waters, H., & Graf, M. (2018, August). The Costs of Chronic Disease in the U.S. Milken
Institute. https://milkeninstitute.org/sites/default/files/reports-pdf/ChronicDiseases-
HighRes-FINAL.pdf.
58
Brigham and Women's Hospital. (2019, December 17). Healthy diet could save $50 billion
in health care costs. ScienceDaily. Retrieved April 18, 2021 from
www.sciencedaily.com/releases/2019/12/191217141314.htm
59
New Buildings - GIP. AAMC. (n.d.).
https://www.aamc.org/professional-development/affinity-groups/gip/new-buildings.
60
University of Massachusetts Medical School Plans Biomedical Research and Education
Building. Tradeline, Inc. (2020, November 6). https://www.tradelineinc.com/news/2020-
10/university-massachusetts-medical-school-plans-biomedical-research-and-education.
35
students who could (albeit not necessarily should) pay a bit more for these programs. Ultimately,

investing additional money now may avoid having to use more resources in the future. Overall,

while the initial investment is daunting, it will not only pay off in the health of many in the years

come, but will also pay off in the big picture financially.

Another potential pitfall of culinary medicine is the need to hire people from the culinary

world—existing professors already on salaries would unlikely be able to provide the level of

education necessary. This would seem costly and a very big task to undertake. However, as

mentioned earlier, this can be avoided by partnering with existing culinary schools, their faculty,

and staff. In that way, professors at the medical school can collaborate with the culinary school

instructors, as well as with nutritionists, in order to have a cohesive class with the best of both

worlds.61 Additionally, this type of partnership also allows culinary students to learn more about

the medicine side, in some cases. The collaboration between the two goes both ways, and all of

the students can learn a great deal from each other.

Often, it can be hard to convince skeptics that this education is worth it. Even with all of

this evidence, they might still think that the food will “taste healthy” or that this education is no

different than nutrition. This might sound simple, but I personally think that one of the best

selling points of culinary medicine is that it provides the opportunity to taste the foods. Whether

taking a culinary medicine class as a medical professional (or future professional) or a

community member, both groups can taste the satisfying the end product. This can convince

more clinicians to utilize these practices for more patients, while it can show community

members that they can still eat delicious food while minding their health. As Proust so eloquently

61
Pang, B., Memel, Z., Diamant, C., Clarke, E., Chou, S., & Harlan, G. (2019). Culinary
medicine and community partnership: hands-on culinary skills training to empower
medical students to provide patient-centered nutrition education. Medical Education
Online, 24(1). https://doi.org/10.1080/10872981.2019.1630238
36
puts it in his famous short story about Madeleines, taste can be transcendental—it can

completely recontextualize a moment and bring back memories.62 If, with the help of culinary

medicine, people can cook food that emulates those same embedded memories, they may have a

greater chance of sticking to their diet, which will ultimately improve their health. This can be

achieved especially through making ingredient and technique swaps based on the patient’s

medical condition.

Is Culinary Medicine Ethical?

One of the biggest issues that medical professionals currently face when giving dietary

advice is that it may not fit into the patient’s time constraints, lifestyle, or budget. Oftentimes,

professionals prescribing diets do not even consider these factors, as nutritionists are only there

to focus on nutrition. This is a significant reason why many diets are so hard to adhere to. It is

definitely cause for concern that culinary medicine is just another way to appeal to the diets of

rich, white palates whose owners can afford the money and time to cook foods that are not

ethnically diverse at all. While perhaps some of the recipes cater to people who have this kind of

time, money, and taste, the main point of culinary medicine is to match the food

recommendations to the patient, depending on their situation.

Say there is a hypothetical patient who is only able to get to the grocery store once every

week to feed her family of four. She has a budget of $70 per week, and her family really enjoys

“American” food, namely burgers, fries, fried chicken, spaghetti and meatballs, and other similar

foods. This patient is type two diabetic and her husband is hypertensive. Given this case, the job

of the medical professional is to not only gather this useful information, but to look at it like a
62
Proust, M. (n.d.). Excerpt from "Remembrance of Things Past". University of South
Florida. http://art.arts.usf.edu/content/articlefiles/2330-Excerpt%20from%20Remembrance
%20of%20Things%20Past%20by%20Marcel%20Proust.pdf.
37
riddle and try to find solutions. One solution could be to cut down on carbohydrates for diabetes

by finding a substitution for pasta which could be zucchini noodles, chickpea, or cauliflower

pasta alternatives. Chicken could be baked, or air fried, and breaded with crushed nuts in the

mixture to add nutrients, and turkey meat could be used in the meatballs. Again, all of these

recommendations would be within the realm of what the patient can afford. Although all of these

options are theoretical, it shows how the patient can still eat what they want to eat while sticking

to their roots. Furthermore, the clinician could help educate the patient on meal planning and

how to cut down on cooking time. Even if a medical professional does not know about a certain

food culture or tradition, with their cooking knowledge and a description from their patient of the

food, they should still be able to make some adaptations. Furthermore, patients could also try to

seek out professionals with similar backgrounds to themselves if they are able.

It is critical to recognize and remember that culinary medicine should just be another tool

and does not need to be imposed on every patient. Everything should be within the scope of the

patient’s culture and lifestyle, and if a patient thinks that it is not realistic for them to achieve, the

plan should be reevaluated. If a clinician deems that someone would probably not benefit from

this practice, then they do not need to use it. Thus, there is also the concern in how a physician

determines who would benefit or not. However, this is an issue inherent within offering any sort

of treatment to a patient and falls under the umbrella of ethics of medicine in general. This

treatment should not be used if the patient is not open to it and willing to participate. A crucial

tenet of culinary medicine is that the changes can be as large or small as what fits into the

patient’s abilities. In New Orleans, for example, there was a patient who added bacon to her

traditional Creole dishes as it added a smoky background note that she liked. A doctor told her

that by cutting down on the bacon and adding smoked paprika, it could emulate the flavor and

38
cut down on fat. Similarly, many patients are taught cooking skills that they saw as

overwhelming before, for example, chopping vegetables.3 This then allows them to be more

likely to cook for themselves more efficiently and control what they put into their bodies. It

should be acknowledged that yes, there are some limitations, but there are still essential skills

that culinary medicine teaches that can apply to many patients.

It is also important to look at culinary medicine when compared to the alternative advice

of medical professionals who lack this education. Is the advice that they give any more culturally

competent than this? Is no dietary advice better than trying anything at all? For both of those

questions, the answer is no in most cases, and the diabetes study mentioned earlier supports this.

Even participants in the nutrition education group experienced a slight lowering in blood

pressure and cholesterol.36 This is the type of case where, even if this solution does not work

perfectly for everyone, it should be an option. If there is the potential to help so many people

with their health and increase the confidence and tools that both doctors and patients have, then

culinary medicine as a solution is definitely worth the initial investment.

Circling Back Through History: Culinary Medicine Was Mint to Be

This section explores the use of mint across TCM, medieval medicine, and culinary

medicine to show an example of how one item’s use might vary across each method. Although

an herb and not necessarily a food, we have seen earlier how important herbs, spices, and

flavorings are to culinary medicine. Not only do they provide certain medicinal properties, but

they also alter the flavor of a dish.

In culinary medicine, mint is used as an additive and sometimes for intrinsic medicinal

properties. Some clinicians, such as culinary medicine’s Dr. John La Puma, claim that mint can

39
be beneficial for a plethora of issues such as memory, stomach aches, and that “studies have

found that it’s also antimicrobial, antiviral, antioxidant, antitumor, and even antiallergenic.” 63

However, despite these properties that mint may have, culinary medicine focuses more on

changes to get people the nutrients they need, not necessarily using a singular food or herb as a

treatment. In many recipes released by the American College of Preventative Medicine, mint

appears as a crucial ingredient (Appendix H). It is often found in dressings that not only go on

salads but also on grilled or roasted meat and vegetables.64 In culinary medicine, herbs like mint

add flavor to a dish and can make a food taste more delicious. One problem with changing one’s

diet is that food with higher nutritional value is often thought to be less enjoyable as something

deep-fried, for example. However, herbs and spices like mint can provide a different depth of

flavor.

TCM has been spreading recently with aspects such as acupuncture entering mainstream

American culture. One way that it has been used very recently is to treat COVID-19. There are

two prescriptions called Yinqiao san and Sangju yin that are used to treat mild infections. Both

are made from what we would now consider to be foods or herbs—all edible. While Yinqiao san

is used for fever, Sangju yin is used for people with a cough. This sort of treatment is said to

have “antibacterial and antiviral functions” and can help with managing COVID-19 symptoms.

Mint is considered to be “Yin” in TCM, meaning that it is colder. 65 When someone has fever

63
La Puma, J. (n.d.). 10 types of medicinal herbs: Healthy Living, Wellness & Nutrition
expert: Dr John La Puma. Dr John La Puma | Wellness and Nutrition Expert. Retrieved
November 2, 2021, from https://www.drjohnlapuma.com/culinary-medicine/10-types-of-
medicinal-herbs/.
64
Culinary Medicine – Resources for Patients and Clinicians. American College of
Preventative Medicine. (n.d.). Retrieved November 2, 2021, from
https://members.acpm.org/page/culinarymedicine.
65
Xu, J., & Zhang, Y. (2020). Traditional Chinese medicine treatment of covid-19.
Complementary Therapies in Clinical Practice, 39, 101165.
https://doi.org/10.1016/j.ctcp.2020.101165
40
and illness as with COVID-19, it makes sense that this cooling property could be beneficial.

Referring back to the TCM study in mice about warming and cooling foods, despite being just a

cocktail or different herbs and foods, these properties may actually make a difference in

metabolism and could cause reduction of symptoms and potentially the virus itself.11

Finally, in medieval medicine mint was used for many different purposes. Reading a

study out of Vietnam’s Ton Duc Thang University, it looks like mint was used for just about a

little bit of everything. Sources record that it was utilized as a treatment for nausea, digestion,

feminine hygiene, parasites, and many more reasons. Notably, it had a role in “protection”

against the black plague. People believed that mixing mint into a vinegar-based solution

protected people who came into contact with victims of the plague. The belief during that time

period in the Middle Ages was that the plague spread via a vapor from a dying victim called a

miasma, a theory started by Hippocrates and Galen. Both that notion and the utility of mint in

that situation have been disproved.66

Due to its efficacy, mint is a great example of how one aspect of our culinary medicine

today has manifested its use throughout history. This reinforces the idea of how many of the

aspects of culinary medicine we use today have been around for centuries with many of the same

medicinal purposes. In the next section, I will explore more general themes and commonalities

between culinary medicine, TCM, and medieval medicine.

Historical Similarities of Traditional Chinese Medicine and Medieval Medicine to Culinary

Medicine

66
Silva, H. (2020). A descriptive overview of the medical uses given to mentha aromatic
herbs throughout history. Biology, 9(12), 1–21. https://doi.org/10.3390/biology9120484
41
 Even though they originated thousands of years ago, both traditional Chinese medicine

and medieval medicine demonstrate similarities to contemporary culinary medicine. First, there

is the obvious: using food as a way to heal. One of the main goals of culinary medicine today is

to shift the focus of treatment back to one that combines and values food. All humans need food

to stay alive, and the type of food consumed drastically influences their health. In these two past

examples, the value of food is clearly seen and appreciated, whether or not the way that was

done makes sense to us today.

When using food as a treatment, one of the most consistent factors is that there needs to

be balance. In the past, this balance manifested itself with color, temperature, and texture in

TCM and humorally in medieval medicine. They both overlap in the field of temperature which

both cultures and time periods saw as an important way to keep a balance. Nowadays, there is

still not as much emphasis on the temperature of food consumed whether as a physical or a more

intrinsic quality. However, the emphasis on balance most definitely remains. In culinary

medicine, this balance manifests itself both in the food but also in the way it impacts the patient’s

life. To start with the food, there are many measurable nutritional characteristics that are

important to control depending on the patient’s needs. This could be something such as the levels

of sodium or sugar, or the amount of vitamins and minerals. Culinary medicine teaches medical

professionals the competency to make these changes approachable and doable for their patients,

and then they can further provide their patients with the tools necessary to make these changes

on their own in the context of their lives. The second sense of balance in culinary medicine is

more of a cultural one. There needs to be a balance between the necessary dietary changes and

the patient’s values and lifestyle. One way that this is addressed is through recipes and food

substitutions that demonstrate cultural competency and value local ingredients and traditional

42
recipes. Another way to achieve this sort of balance is through sensitivity to lifestyle. The

ingredients should be affordable within a patient’s financial situation and the foods should be

able to be prepared within the patient’s time constraints. Another aspect of balance that is

definitely part of TCM and perhaps less so in medieval medicine is a balance of the mind. TCM

values taichi and qigong, which encourage relaxation and meditation.12 Culinary medicine also

aims for balance in the mind, as food and diet can be a mentally tumultuous topic for many.

Thus, there is also an importance for mental balance in modern-day culinary medicine treatments

as well. This can manifest physically through the brain-gut connection and eating foods with

certain microbes to impact that connection. Additional techniques to maintain balance include

receiving counseling alongside these changes, only eating when relaxed, eating with loved ones,

making goals, and realizing that everyone has different needs among many other strategies. 67

Maintaining balance both within the body and the mind has been crucial for humans throughout

their existence.

Another similarity between culinary medicine and these historical forms of medicine is

their recognition that food has power. In both TCM and medieval medicine, before having a

strong foundation of ways to help to heal people, they both turned to food in some capacity.

Without the science that exists today, there were countless possibilities of things to turn to for

people to heal, yet they chose food (no matter whether they harnessed food’s power in the right

way or not). Today, people in many areas tend to choose medicine. People do not think of food

as the first line of treatment for most illnesses or diseases. Pharmaceuticals are what people

usually turn to because of the scientific research that support it, and it is also thought to be easier

67
Leslie, K. (2018). Culinary Medicine for Mental Health. Dr. Leslie Korn. Retrieved
November 2, 2021, from
https://drlesliekorn.com/wp-content/uploads/2018/06/06_Culinary_PPT_Retreat_For-
Print.pdf.
43
to take a pill than to change diet. People think it is harder to eat healthier, but they really just lack

the right training. This is where culinary medicine comes in. Culinary medicine now can harness

the full potential of the power that food holds as now we have the science and technology to back

it up that was lacking in the past.

There is a lot that culinary medicine specialists can learn from historical instances of food

as medicine. Having a written record from these ancient times can only help the advancement of

culinary medicine as we better understand the relationship between humans and food and

medicine and how we can use that to our advantage. Despite some of the TCM and many of the

medieval practices being widely discontinued at this point, there is value in examining and

considering these historical practices and the thought processes behind them. Food is so

important to our wellbeing and through culinary medicine, we can once again harness this power

to reestablish balance.

44
Chapter 3: Culinary Medicine Around the World: China and the United Kingdom

While this paper has focused thus far on culinary medicine in the United States and

looking at its origins in TCM and medieval medicine, it would still benefit from the exploration

of culinary medicine programs today outside of the United States. This chapter will be an in-

depth case study of two countries and the culinary medicine (or similar) programs they have

established. As TCM and medieval medicine were explored in the past two sections, it only

makes sense to do a case study from China and Europe (the United Kingdom, in particular). In

this way, not only can direct comparisons to American culinary medicine be drawn, but also

connections to TCM and medieval medicine and how they manifest themselves today. After

describing the current situations of dietary-based care in each of these locations, this chapter will

make a comparison to the culinary medicine curriculum in the United States and, finally, make

suggestions of feasible ways that these systems can be improved.

Culinary Medicine in Modern Day China

45
Health Context in China

The best way to approach this analysis is to outline the healthcare environment in China.

Similar to the United States, the leading causes of death are due to non-communicable diseases,

such as stroke, heart disease, COPD, and various types of cancer.68 The top ten factors that cause

these diseases that subsequently lead to death include high blood pressure, dietary risks, high

fasting plasma glucose (a precursor to diabetes), high BMI, and high LDL (“bad” cholesterol). 69

Thus, the stage is set comparably to the United States—there are similar health problems in both.

I must add the caveat, though, that the United States continues to exceed China in rates of death

from most of these diseases.70 Thus, this health epidemic is on a slightly lower scale in China in

that sense. One of the salient commonalities between all of the causes of death and disease listed

above is that they are all somewhat treatable or preventable through diet, and one way to address

this could be through culinary medicine.

Obesity: A Case Study

68
Vos, T., Lim, S. S., Abbafati, C., Abbas, K. M., Abbasi, M., Abbasifard, M., Abbasi-
Kangevari, M., Abbastabar, H., Abd-Allah, F., Abdelalim, A., Abdollahi, M.,
Abdollahpour, I., Abolhassani, H., Aboyans, V., Abrams, E. M., Abreu, L. G., Abrigo, M.
R., Abu-Raddad, L. J., Abushouk, A. I., … Murray, C. J. (2020). Global burden of 369
diseases and injuries in 204 countries and territories, 1990–2019: A systematic analysis for
the global burden of disease study 2019. The Lancet, 396(10258), 1204–1222.
https://doi.org/10.1016/s0140-6736(20)30925-9
69
Murray, C. J., Aravkin, A. Y., Zheng, P., Abbafati, C., Abbas, K. M., Abbasi-Kangevari,
M., Abd-Allah, F., Abdelalim, A., Abdollahi, M., Abdollahpour, I., Abegaz, K. H.,
Abolhassani, H., Aboyans, V., Abreu, L. G., Abrigo, M. R., Abualhasan, A., Abu-Raddad,
L. J., Abushouk, A. I., Adabi, M., … Lim, S. S. (2020). Global burden of 87 risk factors in
204 countries and territories, 1990–2019: A systematic analysis for the global burden of
disease study 2019. The Lancet, 396(10258), 1223–1249. https://doi.org/10.1016/s0140-
6736(20)30752-2
70
China vs USA: Top 10 causes of death. World Life Expectancy. (n.d.). Retrieved
November 2, 2021, from https://www.worldlifeexpectancy.com/news/united-states-vs-
china-top-10-causes-of-death.
46
 Now that it has been established that China has many of the same problems that the

United States has in terms of health, it is important to address how the treatments differ. In the

United States, culinary medicine exists as a tool for these issues. In China, culinary medicine has

not yet spread to the same extent that it has in the United States. That said, many ideas and

practices of culinary medicine find themselves embedded in Chinese treatments. One of the

common factors between many of the leading causes of death is their link with obesity—patients

with obesity typically have a higher risk for many diseases. Although China’s healthcare system

has a three-step plan to combat obesity, it is not supported with enough clinical evidence to

prove efficacy. The first line of defense in the Chinese system is a lifestyle intervention, which

consists of a very similar prescription as the United States: diet and exercise. While the United

States, at least, has some sort of guideline with a set amount of lifestyle interventions and long-

term maintenance, China lacks a generalizable model. There is also a lack of evidence gathered

from research that tests different weight-loss interventions. There is no real way to know whether

a certain strategy will be effective in China without these scientific explorations. The second line

of defense is pharmacotherapy which is essentially weight loss medications. These are used

conservatively and are much more prevalent in the United States. Having a “one pill fix” seems

to be something more appealing and even potentially abused in the United States than in China.

Furthermore, obesity is not considered a chronic disease in China, which provides a conflict

when prescribing medication—doctors do not want to prescribe drugs for something not

considered a disease. Other strategies used to address obesity include bariatric surgery, TCM,

and pediatric obesity interventions.71 Thus, the need for a tool like culinary medicine in China is

71
Zeng, Q., Li, N., Pan, X.-F., Chen, L., & Pan, A. (2021). Clinical management and
treatment of obesity in China. The Lancet Diabetes & Endocrinology, 9(6), 393–405.
https://doi.org/10.1016/s2213-8587(21)00047-4
47
great. While the problems are recognized and may be harmful to its citizens, there is no clear

way to address the issue. Even though the United States has more guidance on that front, both

countries could still benefit from additional tools to achieve health goals. Pediatric obesity in

China poses an interesting case study when drawing similarities to culinary medicine.

In China, overweight and obese status in pediatric-aged children is culturally seen as a

sign of “wellness.”71 Thus, historically, the weight status of many children was ignored, despite

putting them at risk for other diseases later in life. More recently, however, with increasing

middle-class incomes and the spread of western fast food, these rates have further increased,

leading to more attention. At present, this is a problem that needs to be addressed on a large scale

and currently, no single effective intervention exists. This is where aspects of culinary medicine

come into play. While the word (or translation) of culinary medicine is not apparently found in

Chinese sources, there are many opportunities for it to tie into plans of action already taken

there.

One specific paper out of Fudan University talks about health education in K-12 schools,

where there is a high prevalence of over and undernutrition.72 Part of culinary medicine is being

educated in nutrition and ensuring that both medical professionals and the community have the

knowledge and tools to eat better. While nutrition education has been established as a goal in

China, there are few guidelines on the delivery. This study focuses on understanding current

nutrition education practices and ultimately has the goal of helping with creating policy. First, a

questionnaire was given to health teachers about if and how they taught nutrition, and from there,

72
Li, F., Yuan, Y., Xu, X., Chen, J., Li, J., He, G., & Chen, B. (2019). Nutrition education
practices of health teachers from Shanghai K-12 schools: The current status, barriers and
willingness to teach. International Journal of Environmental Research and Public Health,
17(1), 86–102. https://doi.org/10.3390/ijerph17010086
48
more details were asked about practices. While nearly 70% of these teachers admitted having a

high concern about nutrition, 73.7% taught less than one hour of nutrition each year. Finally,

about 90% of these teachers were willing to teach nutrition, despite only 18.6% actually

receiving a formal nutrition education as a health teacher. The top ways to encourage these

teachings were also examined, and the conclusion was that there needs to be more training,

resources, financial support, and the enactment of nutrition as a teaching requirement. Some

suggestions of ways to implement nutrition teachings are to post knowledge, incorporate it into

existing health courses, spread materials through handouts and broadcasts, integrate nutrition

information into biology courses, and create separate nutrition courses.72 It is not hard to see that

culinary medicine could cover almost all of these bases. Through culinary medicine, training

could be provided to the health professionals (aka health teachers) who could then help spread

their learnings and understanding to the community (the students). One activity done by TABLE,

a non-profit in North Carolina that provides food and nutrition education to kids, is a snack-

making activity. Though not full-on culinary skills, it teaches kids how to make choices about

portion size and balance of nutrients through fun activities. One specific example is a trail mix

workshop. There, the kids learn how different ingredients need different portions, using parts of

their body as a reference (e.g. palm of the hand, the pinky finger, etc.).73 An activity like this

could utilize parts of culinary medicine to help increase nutritional outcomes of students in China

too (the activity would need to be adjusted culturally). This could manifest as the nutrition

workshop mentioned in the paper. Despite not having a direct culinary medicine program, many

of the ideas that China has come up with to face some of their health issues are similar to

culinary medicine. Of course, not only could this apply in schools but also in the community

73
What is table? Table NC. (n.d.). Retrieved November 2, 2021, from https://tablenc.org/.
49
with adults that have other diseases as well. Once the problem is fully recognized by the

government and the community, there will be more of a need for these sorts of resources in more

medical applications. For example, if the need for culinary medicine is deemed urgent enough, it

might become part of the healthcare curriculum like in the United States. This would allow for

the one on one mentoring we see between medical professionals and their patients as well.

Traditional Chinese Medicine Today

In terms of TCM, these tenets are still used in many practices today. To follow through

with the example of obesity, TCM is still used contemporarily with treatment through

“invigorating Qi” and becoming less “damp”. This can be done with a porridge cooked from

Chinese yams and barley.74 Lipid cholesterol, which is also often accompanied by high fat and

high energy diets that lead to obesity, is able to be treated with TCM as well. One study showed

that if patients drank a combination of black fungus, ginger, and dates for three months that it

lowered the lipid levels.74 While these examples were from controlled studies, the entanglement

of medicine and TCM is very strong. In China, there are many TCM hospitals that are staffed

with TCM physicians, pharmacists, and other professionals.75 Up until 2019, TCM doctors at

many medical schools in China were recognized as physicians throughout the world. However,

in 2019, some were removed from the global medical school directory. This means that the

young doctors were no longer eligible to take the United States Licensing Medical Examination

74
Zhao, X., Tan, X., Shi, H., & Xia, D. (2020). Nutrition and traditional chinese medicine
(TCM): A System’s theoretical perspective. European Journal of Clinical Nutrition, 75(2),
267–273. https://doi.org/10.1038/s41430-020-00737-w
75
Shi, X., Zhu, D., Nicholas, S., Hong, B., Man, X., & He, P. (2020). Is traditional Chinese
medicine “mainstream” in China? trends in traditional Chinese medicine health resources
and their utilization in Traditional Chinese Medicine Hospitals from 2004 to 2016.
Evidence-Based Complementary and Alternative Medicine, 2020, 1–8.
https://doi.org/10.1155/2020/9313491
50
(USMLE), for example. In China, these medical professionals are still qualified to practice

medicine and are considered physicians.76 Overall, while there are now more modern diagnoses

and technology, many natural treatments are still utilized and research shows that they can be

quite effective.

TCM is not only limited to use in China. In 2018, the World Health Organization (WHO)

recognized TCM in their International Statistical Classification of Diseases and Related Health

Problems (ICD). This was significant because it allowed for the recognition and further spread of

many of these practices. It is said that the “global reach” of information in the handbook is

“unparalleled.”77 There has been a boom in medical tourism and an expansion of many practices

throughout the world. Although TCM can be an effective and novel way to treat illness, when

combined with other westernized treatments there can be some serious side effects. Thus, there is

still caution in many places when considering TCM and many critics who think that it is

“unscientific” and “unsupported by clinical trials.”74 That said, research in this area is only

growing as time goes on and there is more of a demand for these TCM treatments. As these tie

into “food as medicine,” the growth of certain factors of culinary medicine can only grow with

the popularity of TCM.

Overall, although China does not have an established culinary medicine program yet,

there is clearly still a need for this sort of intervention. Current studies have shown that certain

aspects of culinary medicine would be beneficial if used in certain settings to improve health

outcomes. With greater recognition of the need for certain health issues such as obesity to be
76
Feng, J. (2019, November 20). Traditional Chinese medicine schools removed from
Global Medical School Directory: Society News. SupChina. Retrieved November 2, 2021,
from https://supchina.com/2019/11/20/traditional-chinese-medicine-schools-removed-
from-global-medical-school-directory/.
77
Cyranoski, D. (2018, September 26). Why Chinese medicine is heading for clinics around
the world. Nature News. Retrieved November 2, 2021, from
https://www.nature.com/articles/d41586-018-06782-7.
51
addressed, there will be greater demand for policy to address it. Furthermore, as TCM grows in

recognition around the world, the idea of using food as a way to treat medical problems spreads

too. The Chinese already utilize many of the components of what we know as culinary medicine

—they just have yet to combine them all and call it culinary medicine.

Culinary Medicine in the Modern Day United Kingdom

Health Context in the United Kingdom

For context, health in the United Kingdom follows the same trends as the United States

and China. Among the top causes of death are dementia/Alzheimer’s disease, ischemic heart

diseases, lung cancer, and cerebrovascular diseases.78 In the UK, furthermore, more than six in

every ten adults is overweight or obese.79 (Keep in mind, this compares to the US with more than

seven in every ten adults who are overweight or obese).80 Again, there is clearly a need for some

sort of intervention or toolkit of strategies for addressing these issues. Many of these things are

preventable or treatable with lifestyle changes, and culinary medicine provides a method through

which people can effectively make these changes in partnership with medical professionals.

Case Study: Culinary Medicine at University College London

78
Johnson, H. (2021, August 24). Covid makes a comeback as one of top 10 causes of death
in England - what are the others? NationalWorld. Retrieved November 2, 2021, from
https://www.nationalworld.com/health/coronavirus/top-10-causes-of-death-uk-what-are-
the-biggest-killers-in-england-as-covid-re-enters-the-list-3357579.
79
Overweight and obesity statistics. Cancer Research UK. (n.d.). Retrieved November 2,
2021, from https://www.cancerresearchuk.org/health-professional/cancer-statistics/risk/
overweight-and-obesity#heading-Zero.
80
Centers for Disease Control and Prevention. (n.d.). FastStats - overweight prevalence.
Centers for Disease Control and Prevention. Retrieved November 2, 2021, from
https://www.cdc.gov/nchs/fastats/obesity-overweight.htm.
52
 Unlike in China, there are more clear-cut culinary medicine programs. This section will

focus in the UK, on culinary medicine program that takes place at the University College London

Medical School. Like many culinary medicine programs around the world, this one is also quite

new, having been founded in 2020. This program launched fully while the world was dealing

with the impacts of COVID-19, so it was remote to start. Similar to many culinary medicine

programs in the United States, this one partnered with a nearby culinary school at Westminster

Kingsway College.81 Using the culinary expertise and resources at Westminster Kingsway in

conjunction with medical school professors who have medical knowledge, they devised a

culinary medicine course.

This culinary medicine course, which, of course, includes a cooking segment, makes sure

to hit on the other mental, cultural, and financial aspects that a patient may face when changing

their diet. One example of this is learning the motivational interview technique. 82 A motivational

interview is a way of interacting that walks the line between listening to what people have to say,

but also giving them the advice to adjust their actions.83 By using this technique, especially when

talking about diet which can be a sensitive topic, it allows people to feel like they are heard, and

they can work with their medical professionals to come up with a plan of action. As mentioned

earlier, a lot of advice to patients struggling with certain health problems takes the form of “eat
81
Jacobs Media Group. (2020, November 22). Cateys 2020 Health and Nutrition Award...
The Caterer. Retrieved November 2, 2021, from
https://www.thecaterer.com/business/profiles/cateys-2020-health-nutrition.
82
Davies, N. (2020, September 21). UCL Medical School leading the UK culinary medicine
teaching movement. Research Department of Primary Care and Population Health Blog
UCL Medical School Leading the UK Culinary Medicine Teaching Movement Comments.
Retrieved November 2, 2021, from https://blogs.ucl.ac.uk/pcph-blog/2020/09/21/ucl-
medical-school-leading-the-uk-culinary-medicine-teaching-movement/.
83
Motivational Interviewing Network of Trainers 2021. (n.d.). Understanding motivational
interviewing. Understanding Motivational Interviewing | Motivational Interviewing
Network of Trainers (MINT). Retrieved November 2, 2021, from
https://motivationalinterviewing.org/understanding-motivational-interviewing.

53
healthier and exercise” without a strategy given. In conjunction with culinary medicine

knowledge about food identification and preparation along with recipes, doctors can become

equipped to deal with these issues. Another part of this education given in the UK is looking at

“socioeconomic determinants of dietary patterns and access to food.”82 While the same sort of

education is provided in United States culinary medicine programs, this one, in particular, is

adapted to the environment in the UK. This course also explores relevant topics like how the

COVID 19 pandemic disproportionately affects minorities. Thus, students come out of this

course with food preparation skills, patient interaction skills, and plan-making skills. 82

One of the key factors in facilitating this partnership and the eventual course was the help

of Culinary Medicine UK. Culinary Medicine UK is somewhat comparable to Health Meets

Food in the United States. It is the leading provider of culinary medicine resources for in its

area. One way Culinary Medicine UK spreads culinary medicine principles is through an in-

person weekend class for medical professionals. These classes take place in a nearby culinary

school and there are four parts to it. There are presentations, readings, a cooking demonstration,

and finally a discussion.84 These classes are on a much smaller scale than the ones in the United

States as culinary medicine has not caught on as much. There is not yet as much of a community

aspect that the United States' culinary medicine programs have obtained. Another new offering

from Culinary Medicine UK is a completely online course for medical professionals that is

currently open for pre-registration. The goal of this course is to teach “nutrition and culinary

knowledge and how to best motivate patients to lead healthier lives using food.”85 To reiterate,

84
Culinary Medicine UK. (n.d.). What is CM. Culinary Medicine UK. Retrieved November
2, 2021, from https://culinarymedicineuk.org/.
85
Culinary Medicine UK. (n.d.). Our Course. Culinary Medicine UK. Retrieved November
2, 2021, from https://culinarymedicineuk.org/our-course.
54
this program seems less developed than the ones in the United States, lacking the community

aspect. In addition, this program has not yet spread to as many schools as in the United States.

However, on that note though, it is a solid start for culinary medicine in the UK.

The leaders of the Culinary Medicine UK program come from a variety of backgrounds.

The founder is Dr. Rupy Aujla who is a near-constant poster on his website The Doctor’s

Kitchen. He also wrote a book with the same title. Other leaders include director Elaine

Macaninch who works for Brighton and Sussex Medical School, director Dr. Sumi Baruah who

is also a certified health coach, treasurer and director Dr. Abhinav Bhansali who is a clinical

director at St Georges hospital, and other research and chef professionals. The combination of all

of these different minds will only help to spread culinary medicine around the area. A

commonality between all of them is the recognition that culinary medicine can help nutritional

eating become more accessible for all.86

Medieval Medicine Practices Today?

While TCM itself is around today, most associated practices have been disproved.

However, that does not mean that all of the values of medieval medicine have disappeared. As

explored earlier, there is a very strong emphasis on looking at the whole self as well as the

environment to create and maintain balance as part of humorism.87 In fact, although no longer

considered humorism, there has been a boom in alternative medicine around the world, and many

of these treatments rely on this ideology. In London, there is a hospital called The Royal London

Hospital for Integrated Medicine which is part of the University College London Hospital
86
Culinary Medicine UK. (n.d.). Who we are. Culinary Medicine UK. Retrieved November
2, 2021, from https://culinarymedicineuk.org/who-we-are.
87
Breimeier, C. (2018, April 28). The Emergence of Modern Humoralism. Frontiers.
Retrieved November 2, 2021, from https://frontiersmag.wustl.edu/2018/04/28/the-
emergence-of-modern-humoralism/.
55
system. Their mission is “to provide a person-centred, holistic approach, including self-care, in

order to help people with chronic and complex medical conditions live well and feel better” and

their “approach considers the whole person and their environment in the quest for optimal health

and wellbeing.”88 This hospital is outpatient-based and addresses many health issues with a more

unconventional approach. There is an accompanying integrated pharmacy where pharmacists are

able to prescribe medications in conjunction with natural remedies.85 The way both natural

treatment and pharmacological treatment are combined reflects the similarity in how culinary

medicine can also be used in conjunction with drugs.

These centers for holistic integrated medicine are not only limited to Europe where

humorism originated, but they are also all around the world. In the United States, for example,

Duke University has its own center for integrative health. This program only covers primary care

but is more holistic and even incorporates meditation.89 A center for integrative medicine would

be a prime location for contemporary culinary medicine as it encourages close relationships

between doctors and patients and ways to address issues without necessarily turning to

pharmaceuticals immediately.

While medieval medicine itself is long gone, its holistic nature still appears in

contemporary integrative medicine and even in parts of culinary medicine. The growth of

culinary medicine into the UK has not yet been as large of a movement or as successful as in the

88
NHS. (n.d.). Royal London Hospital for Integrated Medicine. University College London
Hospitals. Retrieved November 2, 2021, from https://www.uclh.nhs.uk/our-services/our-
hospitals/royal-london-hospital-integrated-medicine.
89
Duke University Health System. (n.d.). Integrative primary care and consultations. Duke
Health. Retrieved November 2, 2021, from
https://www.dukehealth.org/treatments/integrative-medicine/integrative-primary-care?
utm_source=google&utm_medium=cpc&cr=integrative_primary_care&utm_campaign=W
ELLBEING%2B-%2BIntegrative%2BHealth%2B-
%2BNB&keyword=integrative+medicine&gclid=CjwKCAjwzt6LBhBeEiwAbPGOgbagJ
Rs0wzohm15EMOvceDiZvSkGthV7CtdTjGKFKF2cUJ1Jq9WAqhoCypkQAvD_BwE.
56
United States. However, with programs such as UK Culinary Medicine and partnerships with

culinary schools and universities growing, the culinary medicine movement will only spread. It

is undeniably an effective and important tool that needs to be further utilized around the world.

Conclusion

You do not have to be a future doctor or avid home cook to see that culinary medicine

just makes sense. The concept of food as medicine has existed for centuries, all around the

world. Both TCM and medieval medicine exemplify this practice through treatments that

promote a holistic approach, emphasizing balance. In the United States, currently, medical

professionals are trained to prescribe and patients are conditioned to expect drugs to address

57
many of their medical problems. This is in part due to the source of incentive in big pharma,

namely that the income of these drug firms depends on drug sales. Thus, there is a monetary

motivation to sell as many drugs as possible, even for “unapproved uses.”90 This stronghold has

impacted the entire way that our medical system functions.

One way to fight back against big pharma and provide more complete care to patients is

through culinary medicine. Circling back to the use of natural-yet-still-effective remedies as a

starting point or even a co-treatment for certain ailments, culinary medicine draws from the

methods of the past and the science of the present. Signs of promise in its efficacy has been

demonstrated repeatedly. Studies also show an increase in confidence among medical students in

dietary counseling, an increase in positive patient outcomes,36 and overall promise for the future

development of culinary medicine programs.

With that said, there are still challenges that must be overcome before culinary medicine

can grow and reach its full potential in helping communities. First of all, nothing is standardized,

meaning that there is a lot of variation between different programs.91 Despite preliminary

research showing promise, there is also still a lack of hard research measuring the efficacy of this

treatment program for patients, as most of the published research focuses on medical

professionals. There are various existing testimonials, but not enough experimental research. All

of these issues can be addressed with more resources, research, and teamwork. It has been shown

that culinary medicine is a promising field to invest in, and now it just needs to be further
90
Rodwin, M. A. (n.d.). The pharmaceutical industry, institutional corruption, and public
health. Edmond J. Safra Center for Ethics. Retrieved November 2, 2021, from
https://ethics.harvard.edu/pharmaceutical-industry-institutional-corruption-and-public-
health.
91
Polak, R., Phillips, E. M., Nordgren, J., La Puma, J., La Barba, J., Cucuzzella, M.,
Graham, R., Harlan, T., Burg, T., & Eisenberg, D. (2016). Health-related culinary
education: A summary of representative emerging programs for health professionals and
patients. Global Advances in Health and Medicine, 5(1), 61–68.
https://doi.org/10.7453/gahmj.2015.128
58
established. The more conversation there is regarding this field, the more attention that will be

drawn to it, thereby encouraging further definition and utilization.

I can only hope that I am personally able to experience a culinary medicine program in

medical school so that I can someday implement it in practice, no matter what specialty I choose.

I will continue to advocate for this type of training and creation of lifestyle interventions that

have been proven to be concrete and doable. And, throughout it all, my passions for both

cooking and medicine will remain engaged. How do you like them apples?

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Appendix A42

Map of the existing culinary medicine programs using the Health Meets Food curriculum from

Tulane.

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Appendices B, C, and D:92

Sample culinary medicine handouts for community members.

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Health meets Food Handouts. CulinaryMedicine.org. (n.d.).
https://culinarymedicine.org/community-class-recipes/handouts/.
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Appendix E

Tulane’s Goldring Center Culinary Medicine Curriculum Documents

All resources provided by Chef Heather Nace, RDN, LDN, Director of Operations at the

Goldring Center for Culinary Medicine.

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Appendix F44

Sample culinary medicine syllabus and class outline from the Culinary Medicine Curriculum that

began at Stanford

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Appendix G50

CHOP sample recipes for different regions

Sub-Saharan Africa: Goat & Root Vegetable Stew with Injera (4 Servings based on WHO
nutrition guidelines)

Ingredients

For the stew:

22 mL Palm oil
227 gm Goat meat, medium cubes (optional)
2 each Tomato, large, chopped
1 large Yam, sweet potato, taro root, squash, or pumpkin, chopped
178 gm Black-eyed peas (increase to 357 gm if omitting goat)
1 L Water or stock (vegetable, chicken, beef, or other meat)
1 bunch Taro, baobab, pumpkin, or rosella leaves, or collard greens, rough chop or hand-torn
(approx. 340 gm)

For the Injera:

*Begin at least 1 day early

22 mL Palm oil
187 gm Teff, flour (ground)
½ L Water
36 gm Salt

Preparation

1. One day ahead, mix teff flour with water in a large bowl; cover with a damp towel and let
stand at room temperature at least overnight (up to 3 days ahead for a stronger flavor).
2. Heat a large pot with palm oil over high heat. Add goat cubes and brown on all sides (skip this
step if no goat meat).
3. Remove meat from pot.
4. In same pot over medium heat, briefly brown tomato, yam, and peas
5. Add water to pot.
6. Add beef into pot.
7. Cook over low heat for about 30 min.
8. Add in taro leaves, and continue to cook for another 30 min, or until beef and vegetables are
tender and sauce is thickened.
9. Stir salt into injera batter before cooking.
10. Heat a large pan with palm oil over medium–high heat. Pour in enough batter to cover
bottom and move around until the bottom is evenly coated.
11. Remove flatbread when small holes appear in the top and edges lift away from pan.
12. Serve stew on top of injera.

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Additional notes
• Use animal fat for vegetable oil, if easier.
• Stew may also be done in a kettle over an open fire, or in a pot on top of a grill, without
changing method of preparation.
• Spices, if available, should be used. Turmeric, cumin, cinnamon, chili pepper, and curry are
good ideas; they will add lots of flavor and some body to the final product.
• Tomato juice or paste will help flavor the water or stock and help thicken the stew.
• Using taro or cassava instead of yam will lower the vitamin A levels a lot.

Nutrition facts for meal with goat:

Serving Size 453 g (16Oz)

Servings 4
Calories 600
Calories from fat 130
Total Fat 14 g
Saturated Fat 6 g
Trans Fat 0 g
Monounsaturated Fat 4.5 g
Cholesterol 45 mg
Sodium 200 mg
Total Carbohydrates 89 g
Dietary Fiber 13 g
Sugars 6 g
Protein 32 g
Vitamin A 50 %
Calcium 6 %
Vitamin C 80 %
Iron 20 %

Nutrition facts for meal without goat (extra peas):

Serving size 453 g (16Oz)

Servings 4
Calories 540
Calories from Fat 110
Total Fat 12 g
Saturated Fat 5 g
Trans Fat 0 g
Monounsaturated Fat 4 g
Cholesterol 0 mg
Sodium 270 mg
Total carbohydrates 95 g
Dietary fiber 15 g
Sugars 8 g

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Protein 18 g
Vitamin A 50 %
Calcium 6 %
Vitamin C 80 %
Iron 8 %

Nutritional value of individual ingredients:

Palm oil
- High in fats, increases uptake of vitamins D, E, A, K
Goat meat
- High in protein, iron, and vitamin B12
Tomatoes
- High in vitamin A and vitamin C
Yams
- High in dietary fiber, vitamin C, and vitamin B6
Black-eyed peas
- High in folate, protein
Taro
- High in vitamin A and vitamin B6

Latin America and the Caribbean: Braised Pork Shoulder or bean cakes with vegetable rice (4
servings based on WHO nutrition guidelines)

Ingredients

For the pork shoulder:

30 mL Vegetable oil (preferably canola)

1 kg Lean pork roast
1 L Stock, vegetable or other (chicken, beef, fish, etc.)

OR

For the bean cakes:

453 gm Cooked black beans

1 each Egg
51 gm Masa harina or cornmeal
6 gm Salt
30 mL Vegetable oil

For the rice:

30 mL Vegetable oil

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4 ea. Corn or maize, on cob, fresh
1 large Squash or sweet potato (calabza or similar), small cubes
½ ea. Onion, chopped small
2 large Tomatoes or tomatillos, chopped
391 gm Rice
1 L Water or stock

Preparation

For the Pork:

1. Preheat oven to 350 F.

2. Heat oil in a large pot over high heat.
3. Brown pork on all sides; add in stock.
4. Place pot in oven and slowly boil for about 2 h, or until meat is tender and easily pulls away
from bone.

OR

For the bean cakes:

1. In a bowl, mix together beans, egg, masa or cornmeal, and salt, taking care to break up the
beans, until mixture holds together well.
2. Form bean mix into four patties of equal size, and set aside.
3. Heat oil in a pan over medium–high heat.
4. Cook each patty in the pan, about 5 min a side.

*These cakes may also be baked for 15 min in a medium-heat oven.

For the rice:

1. Brush corn with ounce of oil; roast over open flame or on grill until corn is a little brown.
2. With a knife, remove corn kernels and set aside. Throw away cob.
3. In a pot, heat oil in a large saucepot over medium heat.
4. Add onions and cook until soft.
5. Add squash and cook for about 3 min.
6. Add rice and tomatoes and cook for 2 min, until tomatoes begin to soften.
7. Add water or stock; bring to a boil, then turn down heat until almost boiling. Let cook, slowly,
until water is absorbed and rice is tender.
8. In pot, stir corn into finished rice.

Additional notes:

• Use animal fat for vegetable oil, if easier.

• Both pork and rice may also be done in a kettle over an open fire, or in a pot on top of a grill,
without changing method of preparation.

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• Spices, if available, should be used in all of the dishes. Chili powder (ancho, dark, cayenne,
etc.), cumin, and cinnamon are good ideas; they will add lots of flavor and some body to the rice
and final product.
• Tomato juice or paste will help flavor the pork and thicken the liquid.
• If easy to find, adding greens will help increase vitamins.

Nutrition facts for meal with pork shoulder:

Serving size 396 g (14Oz)

Servings 4
Calories 610
Calories from Fat 120
Total Fat 13 g
Saturated Fat 2 g
Trans Fat 0 g
Monounsaturated fat 6 g
Cholesterol 50 mg
Sodium 270 mg
Total carbohydrates 94 g
Dietary fiber 8 g
Sugars 5 g
Protein 31 g
Vitamin A 20 %
Calcium 6 %
Vitamin C 35 %
Iron 20 %

Nutrition facts for meal with bean cakes:

Serving size 425 g (15Oz)

Servings 4
Calories 540
Calories from Fat 90
Total fat 10 g
Saturated fat 1.5 g
Trans fat 0 g
Monounsaturated fat 4 g
Cholesterol 45 mg
Sodium 170 mg
Total carbohydrates 95 g
Dietary fiber 18 g
Sugars 5 g
Protein 23 g
Vitamin A 25 %
Calcium 8 %
Vitamin C 35 %

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Iron 30 %

Nutritional value of individual ingredients:

Vegetable oil
- High in fat, increases uptake of vitamins D, E, A, K
Pork
- High in protein, iron, vitamin B12 and vitamin B6
Black beans
- High in protein, iron, calcium, vitamin B6
Egg
- High in protein, vitamin D
Masa Harina
- High in protein, vitamin B6
Maize
- High in protein, iron, vitamin B6
Squash
- High in vitamin C
Onion
- Low nutritional content
Tomatoes
- High in vitamin A and vitamin C

Eastern Asia: Brown Rice Stir Fry with Bok Choy, Mushrooms, Eggplant, and Tofu (4 Servings
based on WHO nutrition guidelines)

Ingredients

44 mL Sesame oil
340 gm Tofu, extra firm, 1” dice
10 gm Garlic, chopped small
½ head Bok choy, chopped
100 gm Shiitake (or other) mushrooms, cleaned
1 each Eggplant, large, cubed
30 mL Soy sauce
870 gm Brown rice, cooked

Preparation

1. Gather all ingredients and equipment.

2. Heat sesame and vegetable oil in a wok or pot over high heat.
3. Add tofu to hot pan and brown on both sides.
4. Add in garlic, bok choy, mushrooms, eggplant, and soy sauce and stir constantly until
vegetables are tender.
5. Stir in rice to warm, and serve.

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Additional notes:

• Use animal fat for vegetable oil, if easier.

• Stir-fry may also be done in any sort of pan or kettle over an open fire or grill without changing
method of preparation.
• Spices, if available, should be used, especially ginger, red pepper, and lemongrass.
• Any easy-to-find mushroom can be used instead of shiitakes.
• Noodles can be used instead of rice; Buckwheat soba or rice noodles are good alternatives.

Nutrition facts for meal:

Serving size 368 g (13Oz)

Servings 4
Calories 610
Calories from Fat 160
Total fat 18 g
Saturated fat 2 g
Trans fat 0 g
Monounsaturated fat 7 g
Cholesterol 0 mg
Sodium 530 mg
Total carbohydrates 93 g
Dietary fiber 8 g
Sugars 5 g
Protein 21 g
Vitamin A 35 %
Calcium 8 %
Vitamin C 20 %
Iron 15 %

Nutritional value of individual ingredients:

Sesame oil
- High in fat, increases uptake of vitamins D, E, A, K
Tofu
- High in protein, iron, and calcium
Garlic
- Low nutritional content
Bok choy
- High in vitamin A and vitamin C
Shiitake mushroom
- Low nutritional content
Eggplant
- Low nutritional content

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Appendix H60

Culinary medicine recipes utilizing mint

ORANGE LENTIL SALAD

Serving size: 1/2 cup

Serves 8
Ingredients
7 ounces split orange lentils, picked over and rinsed
2 pinches salt
3 tablespoons fresh lemon juice
3 tablespoons extra-virgin olive oil
1 clove crushed garlic
2 tablespoons chopped spring onion
2 tablespoons chopped fresh thyme
1 Lebanese cucumber, cut into ½ inch cubes
Directions
Place lentils in a small pot, and add water with a pinch of salt to cover the lentils. Bring to a boil
over medium heat; then immediately remove from heat and drain. Rinse lentils in cold water and
drain in a colander.
Transfer lentils to a salad bowl. Add lemon juice, oil, garlic, mint, parsley, and cucumber cubes.
Let sit for at least 30 minutes at room temperature for flavors to blend. Add salt and pepper
before serving.

GRILLED ZUCCHINI

Serving size: 1/2 cup

Serves 10
Ingredients
Zucchini:
6 firm medium zucchini, sliced diagonally into thin rounds
Pinch sea salt
Pinch ground black pepper
Vinaigrette:
3 tablespoons extra-virgin olive oil
6 tablespoons balsamic vinegar
2 cloves garlic, chopped
4 tablespoons chopped fresh mint

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Directions
Prepare zucchini: Season zucchini rounds with salt and pepper. Heat a grill pan over medium-
high heat. Working in batches, roast zucchini rounds for about 1 to 2 minutes on each side, until
dark lines appear. Transfer to a large bowl.
In a small bowl, combine oil, vinegar, garlic, and mint. Pour over zucchini rounds, and mix to
coat. Let sit at room temperature for at least 30 minutes before serving, to allow flavors to blend.

BANANA AND MINT GRANITA (“ICE CREAM”)

Serving size: 2 scoops

Serves 8
Ingredients
6 medium bananas, peeled, quartered, and frozen
2 tablespoon chopped mint
4 seedless grapes, frozen
Directions
Remove bananas from freezer and defrost at room temperature for 1 to 2 minutes. Transfer to a
food processor, add the chopped mint and process until smooth.
Remove grapes from freezer and cut into halves, then slice thinly. To serve, scoop pureed
bananas with a small ice cream scoop and top with grape slices.

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