Culinary Medicine in UME : CulinaryMedicine.org

Culinary Medicine in Undergraduate Medical Education

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info@culinarymedicine.org
Office: (571) 266-6703

There is a clear need for improvement in nutrition education in undergraduate medical education. Physicians have a mission to treat chronic disease, and diet-related illness is the cause of the majority of conditions that future physicians will treat in their day-to-day practice. Currently there is a significant absence of nutrition education in UME programs [doi: 10.1080/28338073.2024.2418544] and there are recent calls [doi: 10.1177/23821205241228651] for innovation. [www.acgme.org/globalassets/pdfs/nutritionsummit/nutrition-summit-proceedings.pdf]

Recently published consensus competencies in nutrition [doi:10.1001/jamanetworkopen.2024.35425] link educational strategy that can help prepare for advancing education to meet patient population needs and demands.

See which medical schools have adopted the Health meets Food courseware.

Culinary Medicine programming offers a way forward for UME programs and teaches MORE than just nutrition and culinary skills.

Culinary Medicine Definitions

Key Stakeholder Population

To the healthcare professional:
Culinary medicine is a multifaceted field that bridges the gap between the most up-to-date, evidence-based nutrition science and culinary tradition. It is based on food is medicine principles: the augmentation of nutrition in health care to maintain health and to prevent and treat disease.

To the foodservice professional:
Culinary medicine is the convergence of fields, the breaking down of silos, and the uniting of the “two white coats.” Culinary medicine is the cost-conscious, smart solution to good health based on nutrition science and classical culinary techniques.

To the community nutrition educator:
Culinary medicine is the application of science and traditional knowledge coming together with familiar, generational cooking to inspire communities to achieve and sustain nutritious eating behaviors and better health.

To the consumer/community member:

Culinary medicine is empowering individuals to make decisions about nourishing their body to prevent chronic disease and maintain good health while still feeding their soul.

Advantages of Culinary Medicine in UME:

Knowledge and Competencies: Build hybrid knowledge and competency for medical students by teaching them skills that cross over from personal lifestyle health into their patient care application. This “double dip” as personal wellness initiative and patient care training synergizes learning.

Recruitment Tool: Culinary Medicine serves as a recruitment tool and distinguishes schools that offer this popular, active approach.

Interprofessional Learning: Promotes interprofessional practice experience, especially with dietitians, and develops team-based learning in a low stress, friendly environment.

Social Determinants of Health: Culinary Medicine programming teaches non-medical drivers of health management strategies, especially for food security: such as creating a SNAP-friendly recipe, meal, or food pantry box challenge.

Counseling: Teaches the ability to have practical food conversations and use motivational interviewing and goal setting to support patient behavior change.

Value Based Care Models: Responds to evolving payor models and equips trainees with innovative strategies to integrate into patient care, ranging from team-based care to electronic consults to shared medical appointments.

Adaptability of Health meets Food:

The American College of Culinary Medicine courseware is broadly adaptable to specific disease states or concepts, such as:

Teaching skills for integration of fiber to support managing cholesterol, treating constipation, and reducing risk for colon cancer.
Hands-on cooking classes teach the importance of flavor building for sodium reduction in the management of hypertension or heart failure.
Recipes reinforce ways to achieve satiety and deliciousness while promoting stable blood sugar in diabetes or weight management in obesity.
All coursework offers information on making food substitutions and creativity in food allergy cooking.

Relevance to a Variety of Specialties

Institutions are able to adapt the American College of Culinary Medicine curriculum to a vast array of learners. Currently over 50 medical schools use the Health meets Food courseware, and many of those partner sites use the curriculum in their UME programs, including George Washington University, University of Texas Southwestern, Tulane University, University of New Mexico, University of California – Irvine, and University of Southern California.

Family Medicine, Med-Peds, Internal Medicine – chronic disease prevention, management; equipping patients with support to care for themselves (promoting self-efficacy)
Cardiology – hypertension, anti-inflammatory diet patterns, congestive heart failure
Gastroenterology – IBS/IBD/GERD, celiac disease, allergy and intolerance, bariatric surgery, supporting patient with Eosinophilic Esophagitis facing elimination dietary approaches
Rheumatology – anti-inflammatory diet patterns
Psychiatry – the impact of diet on ADHD, food as an adjunct to mental health care, addiction recovery, alignment with emerging microbiome research and link to mental health
Surgery – perioperative optimization, critical illness recovery, bariatrics
Neurology – food and neurocognition, brain health overall, dementia prevention/MIND diet, ketogenic diet for seizure therapy
OB/GYN – maternal/child health, pregnancy outcomes
Family Medicine, Pediatrics and Med-Peds – building lifelong habits, reducing pediatric obesity, food allergy, PKU diet
Endocrinology – guiding patients with type 1 and type 2 diabetes on a lifelong dietary strategy to support disease management, Polycystic Ovary Syndrome

Education on Billing and Coding for Lifestyle Medicine

It is critical for physicians to understand proper coding and billing practices for culinary medicine and lifestyle medicine. An extensive module reviews coding principles including for time, modifiers, Z-codes, shared medical appointments, and electronic consults.

Exposure to culinary medicine in training helps physicians envision careers that practice creatively, including integration of lifestyle counseling in routine practice to radical transformation of practice models through culinary medicine delivered in shared medical appointments.

Additional training, including certification in culinary medicine, offers a pathway for physicians to broaden their skills and integrate a broad array of clinical models.

Objective Mapping

The Health meets Food Curriculum Committee has evaluated USMLE objectives that are related to nutrition competencies and mapped those to course objectives. The goal is to ensure that Health meets Food programming optimally equips learners for Step 1 and Step 2 examinations. The team is currently evaluating the competencies proposed by the ACGME and will revise programming to meet those objectives.

Partner Site Benefits

Certified Culinary Medicine Specialist Tuition Waiver

Licensing sites receive 1 tuition waiver for the Certified Culinary Medicine Specialist Certification program for one member of your team, as well as in-person on-site training.

The ACCM provides in-person individualized training for your team to gain confidence and competence in leading the culinary medicine classes. ACCM staff will customize your training schedule to best meet your staff and learners’ needs. We recommend using the training classes as an opportunity to establish increased support for your culinary medicine program from different stakeholders.

Kitchen Design Support

No matter your budget, physical space limitations, etc., the ACCM team can help you creatively and strategically design a kitchen to meet your needs.

Partner Site Networking

The ACCM team can connect you to other partner sites around the country doing similar work to share ideas and collaborate.

Committees

Partner sites are welcome to join committees to collaborate and work with colleagues at partner sites to continue to expand culinary medicine offerings nationally.

GME Committee: Led by Dr. Jaclyn Albin, the graduate medical education committee is charged with discovering and disseminating best practices to help residency programs effectively implement Culinary Medicine programming.
Curriculum Committee: The curriculum committee supervises the creation of new programming for the Health meets Food courseware series. Led by Dr. Katie Balaram, the committee revises at least one module each month to ensure contemporary evidence-based information is up to date.
Dietetics Committee: With an expansion of utilization of the Health meets Food curriculum at dietetics programs, the committee leads efforts at helping partner sites implement Culinary Medicine. Led by Amy Moyer, there is an emphasis on best practices as it relates to interprofessional collaboration.
Culinary Medicine Interest Group Committee: With the dramatic expansion of Culinary Medicine programming and student interest at high levels, the CMIG Committee is crafting supporting information to help student groups organize sustainable organizations. Led by Maya Fiellin, the committee meets monthly to offer support to students nationally.
Clinical Practice Committee: Led by Dr. David Dungan, the committee evaluates and publishes best practices for using Culinary Medicine in clinical practice.

Research

The Health meets Food Culinary curriculum is firmly rooted in current diet and nutrition evidence. Accordingly, research on the curriculum’s efficacy is essential. Below are the research articles that have been accepted for publication in peer- reviewed academic journals.

Healthcare Professional Research Outcomes

Cooking up better doctors as teachers globally: a novel integrated nutrition and cooking class curriculum for pediatric residents to boost their competencies and attitudes in patient counseling (doi.org/10.1007/s12682-014-0199-9)

Multisite Culinary Medicine Curriculum Associates with Cardioprotective Dietary Patterns and Lifestyle Medicine Competencies Among Medical Trainees (https:// pmc.ncbi.nlm.nih.gov/articles/PMC7092396/)

Nutrition from the kitchen: culinary medicine impacts students’ counseling confidence (doi.org/10.1186/s12909-021-02512-2)

Community Research Outcomes

Medical school-based teaching kitchen improves HbA1c, blood pressure, and cholesterol for patients with type 2 diabetes: results from a novel randomized controlled trial (pubmed.ncbi.nlm.nih.gov/26002686/)

Multisite Medical Student–Led Community Culinary Medicine Classes Improve Patients’ Diets: Machine Learning–Augmented Propensity Score–Adjusted Fixed Effects Cohort Analysis of 1381 Subjects (pmc.ncbi.nlm.nih.gov/articles/ PMC8971690/)

Effect of culinary education curriculum on Mediterranean diet adherence and food cost savings in families: a randomised controlled trial (pmc.ncbi.nlm.nih.gov/articles/PMC10195617/)

Culinary Medicine Research Library

The research library collection is curated by the Clinical Practice Committee and updated monthly. The library is published with the goal of supplying research citations for current published manuscripts related to Culinary Medicine. It is sorted into collections and sub-collections that users are able to search by clicking on the dropdown menu labelled “Top Level.”

There is an option for synchronizing the database to the desktop version of Zotero.

Community Curriculum

The Culinary Medicine model is synergized by offering community cooking classes. By teaching healthcare professionals, they can become the force multiplier to help teach community cooking classes.

The ACCM believes in this model and includes the complete Health meets Food community curriculum series as part of a site license.

Community Curriculum Series cover Mediterranean diet principles, cooking techniques, nutrition fundamentals such as calorie density and nutrient density, menu building, shopping lists, and using leftovers, as well as detailed topics on how to cook and eat great food that just happens to be good for you.

6 *Lesson adult beginner* series** available for use in virtual and in-person environments	6 *Lesson adult intermediate* series** available for use in the virtual environment	6 *Lesson kids* series**
6 *Family* series	5 *Expectant parent* series

Healthcare Professional Curriculum

All modules offer an asynchronous component, including lectures, study guides, readings, quizzes, and supplemental materials. These can be used as standalone programming and woven into GME courseware as self-directed learning.

That learning is supported by case studies that can be utilized in the classroom environment or as part of the hands-on cooking classes.

Programming includes detailed support for planning and execution of hands-on cooking classes. This is supported by instructor materials, including recipes, patient handouts, shopping lists, equipment lists, discussion guides, and quiz keys.

The goal is to insure that Health meets Food programming optimally equips learners for Step 1 and Step 2 examinations. The team is evaluating the competencies proposed by the ACGME to insure programming meets those objectives.

Foundational Topics

Introduction to Culinary Medicine: A detailed overview of the Mediterranean diet and recent sources and studies examining the effectiveness in terms of treating diet-related illnesses. Review of methods of communicating these principles

to patients, along with an introduction to basic kitchen safety and knife handling skills and the practical implementation of into food your patients already enjoy: the Mediterranean diet translated for the American Kitchen in a way that helps patients eat great food that just happens to be great for them.

Weight, Management & Portion Control: This module reviews obesity indicators, caloric density, and portion control, and reviews the literature behind weight loss and weight maintenance. This course will help clinicians understand practical and realistic approaches to weight management.

Fats: An in-depth review of the physiological effects of dietary fats, common sources of fats, misconceptions around types of fat, and how to help patients understand the differences. In the kitchen there is focus on the purpose of fats in cooking, an exploration of viable replacements and substitutions for culinary fats, and recipes utilizing fat replacers.

Food Allergy and Intolerance: This overview focuses on techniques to diagnose, treat, and cook for food allergies or intolerances. The module explores the roles of local and organic foods, common plant phytochemicals, genetically modified foods, and common preservatives in immune and metabolic health, environmental impressions, and economic impact. The also covers hidden and little-known sources of allergens, and in the kitchen we will prepare lactose- and gluten-free recipes.

Protein & Vegetarian Diet: Detailed review of the biological need for dietary proteins, focusing on essential amino acids and their dietary sources. Detailed outline of the dietary needs and sources of protein and focus on a variety of types of vegetarian diets, research on health outcomes for different dietary patterns, possible nutritional deficiencies, and the ways vegetarians and vegans can ensure adequate protein intake. In the kitchen, recipes showcase different vegetarian diets, focusing on satiety and complementary proteins.

Sodium, Potassium and Renal Homeostasis: Participants examine the physiological effects of high-sodium diets and their prevalence in American culture, and take an in-depth look at the DASH diet, including studies examining its efficacy in reducing the need for medication in hypertensive subjects.

In-kitchen programming explores the principles of flavor building techniques in cooking while exploring salt’s role in flavor, incorporating reduced-sodium dinner options while discussing ways to reduce and replace sodium in meals.

Carbohydrates and Diabetes Mellitus: This module focuses on the physiological impact of digesting different types of carbohydrates and assesses the role of certain carbohydrates in promoting satiety, regulating blood glucose, and sustaining energy, with a further look into whole grains. Hands-on cooking focuses on strategies for reducing sugar consumption, especially in snacking, and discuss guidelines for healthier snacking and desserts.

Specialized Topics

Pediatrics and Nutrition: A Family Approach to Healthy Children: We discuss pediatric nutrition and examine childhood obesity statistics and consequences. We also examine current pediatric dietary patterns, common challenges, and provide guidelines for healthy alternatives, with a brief look at infant feeding. In the kitchen we look at the idea of “kid-friendly” meals and prepare different recipes that the whole family can enjoy.

Sports Nutrition: Review of the dietetic requirements of athletes, including hydration and increased protein needs based on lean body mass. We consider the different types of athletes and consider their unique nutritional requirements, while also touching on the macronutrient content of meals before, during, and after exercise. In the kitchen participants explore homemade sports drinks as well as pre- and post-event meals.

Cancer Nutrition: Prevention and Diet After Diagnosis: This module focuses on the effect that diet can have on both primary and secondary prevention for patients with cancer. This includes examination of foods and antioxidants linked to cancer risk reduction, with a focus on phytochemicals and their common sources; also discussed is the role of obesity and alcohol consumption in certain types of cancer. We explore the role of dietary support and counseling strategies during cancer treatment and prepare plant-predominant, antioxidant-rich recipes in the kitchen.

Pregnancy and Nutrition: Exploration of the guidelines for diet during pregnancy, including weight gain recommendations, changes in metabolism, caloric, and exercise needs. Review of recent research into maternal nutritional outcomes. This includes foods to be avoided in pregnancy, their sources, which micronutrients are important, and and the importance of portion sizes. Recipes include those high in these important nutrients while being mindful of nutrient density and portion sizes.

Celiac Disease: This module is a detailed overview of celiac disease, including diagnosis and treatment. The course includes a review of the evidence on non- celiac gluten sensitivity with review of the key points behind the pathophysiology and clinical workup for celiac disease as well as the co-morbidities associated with celiac disease. Participants learn about the psychosocial aspects of gluten sensitivity and cook gluten-free recipes in the kitchen.

Food and Neurocognition: A detailed overview of the evidence showing how glucose dysregulation causes impaired neurologic functioning. This includes a review of how modern diets contribute to increasing rates of dementia, understand the role of diet in ADHD, and review foods shown to be neuroprotective and likely to promote optimal brain functioning. Attendees discuss the negative impact of the standard American diet on neurocognition and the role healthcare practitioners can have in promoting improved cognitive functioning through dietary interventions.

Anti-Inflammatory Diet: In this module attendees learn about the relationship between foods, advanced glycation end products, and free radicals. The programming reviews the evidence about the role of diet in heart disease, stroke, COPD, cancer, Alzheimer’s, diabetes, and renal failure, as well as the inflammatory pathways where food has an impact, including a review of the evidence showing the relationship between pro-inflammatory ingredients and degenerative disorders while making delicious, easy to prepare meals.

IBS/IBD/GERD: Examination of the prevalence of inflammatory bowel disease, irritable bowel syndrome, and gastroesophageal reflux disease as well as their symptoms and how to differentiate between diseases of the digestive tract. This incorporates a detailed review of the FODMAP (Fermentable Oligo-, Di-, Mono- saccharides And Polyols) diet and which foods contain high FODMAP content and which foods contain a low FODMAP content, including strategies for discussing dietary changes to treat gut disorders. Recipes prepared showcase the different dietary needs of patients with each of the conditions.

Congestive Heart Failure: Students review the incidence, prevalence, risk factors, pathophysiology, mortality, and clinical workup for congestive heart failure (CHF) and the relationship between obesity and CHF. Programming presents the impact health care practitioners can have on controlling and managing symptoms through dietary intervention. Sodium and fluid restriction guidelines for patients in various stages of heart failure are reviewed with information on strategies to reduce salt intake, while also identifying the role and sources of micronutrients, fats, and whole grains for patients at various stages of heart failure.

HIV/AIDS Nutrition: Attendees review the stages of HIV infection and corresponding symptoms specifically in the context of diet and nutrition. Participants review the medical interventions that can be taken to help patients with HIV/AIDS to identify the role healthcare professionals can have in controlling symptoms of HIV through diet. Learn which factors contribute to the nutritional challenges for patients with HIV and AIDS.

The Geriatric Diet: The module is designed to shed light on elderly patients’ physiological changes, nutritional needs, risks for malnutrition, and adaptive approaches to food preparation and consumption. The module covers how to screen for malnutrition, develop dietary interventions, and counsel elderly patients and their family members about how to eat healthfully in their later years.

Mindfulness and Motivational Interviewing: This module is an in-depth look at the techniques and usefulness of mindfulness and motivational interviewing on lifestyle, diet, and health for our patients. It explores the way the principles of mindfulness impact development of therapeutic approaches through basic principles and practices such as the OARS method.

Eating Disorders: Participants learn to distinguish between eating disorders including anorexia and bulimia syndromes as well as to understand binge eating disorders. The module reviews information on other eating disorders, including rumination and pica, as well as strategies for treating eating disorders through medication, psychotherapy, and culinary interventions. This module has no kitchen component.

Myths, Fad Diets, Supplements and Controversies: Students explore nutrition-related fads, myths, and misconceptions. Programming reviews optimal conditions for weight loss and management and an exploration of the literature on proven methods of supplementation and nutrition, and how to evaluate nutrition research. In the kitchen students prepare nourishing recipes and discuss ingredient quality, while introducing sensory evaluation of food.

Polycystic Ovary Syndrome: Attendees explore the pathophysiology, signs and symptoms, and diagnostic criteria of PCOS. The module also details the role of weight in PCOS, particularly as it relates to insulin resistance. In kitchen, objectives include the roles of complex carbohydrates and fiber in PCOS management.

Bariatric Diet: Participants explore bariatric surgery as a treatment for obesity. The module reviews types, risks, and expected weight loss of surgical options as well as pre- and post-operative expectations. Students discuss the role of nutrition and recommendations for eating pre- and post- surgery.

Food Safety and Sanitation: This is a comprehensive module that covers identification of unsafe cooking situations and cooking

safety, including details about the temperature danger zone, cross contamination, and cooking temperatures. The programming is a thorough look at the most common causes of food borne illness and explore the steps that can be taken to prevent food borne illnesses when it comes to storage and reheating foods.

Billing and Coding for Lifestyle Medicine: Attendees develop an understanding of how lifestyle counseling and preventative care can be better incorporated in their practice through Z-codes and specific CPT and HCPCS codes for nutrition counseling. We will deliver a thorough overview of the essential components of obesity counseling and help develop your approaches based on the USPSTF 5-A Approach in scheduled visits recommended by CMS guidelines.

PKU Nutrition: Comprehensive review of the current guidelines in management of PKU (Phenylketonuria) and work to develop an increased understanding of the required dietary modifications in PKU as a model for inborn errors of metabolism. Participants learn optimal treatment for plasma PHE and will be able to describe how a patient with classical PKU and one with a milder mutation vary in treatment needs. This module also reviews current therapies such as long-chain polyunsaturated fatty acids and large neutral amino acids as well as the medical necessity for medical food supplements (metabolic formula) in patient care.

Enteral and Parenteral Nutrition: Programming examines the research-based findings of the impact of enteral and parenteral nutrition on patients. Students develop an increased understanding of enteral and parenteral nutrition’s advantages and disadvantages.

Food Security – SNAP & WIC Programs: The module provides definitions of food security in vulnerable populations as well as the link between food security and chronic long-term disease risk. Participants review current research on the impact and outcomes of food security, especially in the pediatric population, and the impact of food insecurity in the family. Programming covers pathologies that may result from issues with food security and factors for community members with increased risk of food insecurity compared to those who are food secure.

Food Security – Older Adults: Participants investigate age-related decline and pathologies that contribute to issues with food security. Programming covers factors for older adults with increased risk of food insecurity compared to those who are food secure. The course connects food security with chronic long-term disease risk and helps healthcare professionals design strategies and models applying to older patients.

Food Security – Food Banks and Medically Tailored Meal Programs: Students explore the impact of food banks and medically tailored meals on vulnerable populations.

Pharmaceutical Treatment of Obesity: This module covers the impact of obesity on individual health and its associated health care costs. Participants learn about the current use of anti-obesity medications; the indications for anti-obesity medications; the neurochemistry of obesity, appetite, and satiety; and anti-obesity medications’ effects on weight reduction and metabolic profiles of patients.

Systemic Approaches to Obesity: This module describes obesity as a multifactorial disease process and reviews the complications of obesity. This module also helps learners understand a multifaceted approach to the management of obesity.