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May13

Final Week: First Med Student Clinical Elective in Culinary Medicine

Posted in: Common Conditions, Food FAQ's, Wellness and Health

Last week I finished teaching and supervising the first medical student clinical elective in culinary medicine…and credit was given! Awesome!

Each day had assigned reading (peer-reviewed papers, book chapters from my ChefMD’s Big Book of Culinary Medicine) and viewing (culinary medicine FAQ from viewers and readers, Tulane University basic nutritional science review from their new Center for Culinary Medicine, and more).

As a parting present, I gave a become-an-olive-oil-expert taster, to the right: tiny quantities of differently infused oils (garlic, basil, fig) in tiny quantities: it’s also available online. Identifying flavors is something we’ll do more of next time, especially with herbs and spices. We did identify fava bean maturity, and note the way nutritional content, flavor and texture change as the bean matures (mature fava beans can be planted too).

The week was divided into one basic topic area per day:

1. Hospital and Clinic (seeing patients, meeting other med students);

2. Home, Garden and Kitchen (harvesting, cooking techniques and dish creation, presentation, clean up, with food safety and recipe reading and development);

3. Organizations and Community (participation in Foodbank teaching, food advocacy initatives, and food literacy classes);

4. Research and Writing (curriculum critique, study of questions which arose during the week, work on assigned projects);

5. Menu Analysis and Eating Out (read-between-the-lines assessment, how to order and taste, deconstructing flavors and texture, portion size, control and rate of eating);

6. Shopping (farmer’s market tour, farmer interviews, buying, seasonality, comparison with grocery store fare and products) and Conclusion (final turn in of projects and papers).

7. Rest.

We also integrated personal exercise into this, and that’s something we’ll do more of next time too: so important for students to know what they are asking patients to do. Although Santa Barbara is a paradise for walking, running, climbing and more, many of my own patients prefer to get their exercise inside, so they can count their numbers, which I fully support. Many of you know that I love the Smooth Fitness CE-3.6 Elliptical Trainer; the Sole E35 I previously recommended is sold out.

I don’t have the final numbers yet, but the elective appears to have provided about 60 contact hours in two weeks with 17 faculty members from 6 different disciplines: Internal Medicine, Professional Cooking, Nutrition, Public Health, Community Leadership, Organizational Development. You can read about Week 1 here.

The photo to the right is one idea of how culinary medicine relates to 3 of its contributing disciplines.

Although I believe that it is logically a part of medicine and medical practice, it may be that the people to undertake its refinement and day to day application are actually chefs and cooking instructors, more than physicians or nutritionists or dietitians.

Chefs meet people where they eat, and as more and more of our budget goes towards eating out, it is clear that cooks and chefs outside the home will continue to have an outsized effect on how people eat and choose food.

This, of course, is despite my own, Michael Pollan’s new excellent Cooked book, and Mark Hyman’s exhortations that the key to health is learning to cook. I think it is still the key: but it takes time and skills that the culinary medicine elective teaches.

But who should be its students, leaders and champions? And what should it do? Stay tuned.
Aug11

Basic Food as Medicine

Posted in: Food FAQ's, High Cholesterol, Media, Wellness and Health

I had the privilege of speaking with Joe and Terry Graedon, founders of The People’s Pharmacy, on their syndicated NPR show (free podcast here) broadcast today)!, about how we’re trying to make your health and health care awesome with the right food.

Their questions made me think about why it’s so important to help people wherever they are starting.

For example, I love farmer’s markets. I give market tours, I know many farmers personally, I created a PBS DVD library on how to eat healthy (available for a donation to PBS, which I support) and I love to cook locally grown foods.

But most people buy food shipped into supermarkets, and are worried and time-pressed about cooking.

So it’s become more important to me to show how to buy and cook any broccoli, even bad broccoli (as Mark Bittman writes) than to search out the most pristine, tight head. Or to explore the wonders of the youngest broccosprouts (highest in sulforphane, and patented by Johns Hopkins).

Getting people to cook more–and people are catching up and catching on–is the key to helping them lose weight. Especially men.

Thousands of people (according to my Dear ChefMD e-mail!) want to change their cholesterol, blood pressure, back pain, constipation, irritable bowel, heart disease and diabetes. And those who have have great stories.

So if you were going to stock a kitchen medicine chest, like the one I describe in the ChefMD book, and you wanted just 10 foods instead of the 50 I name, what would they be and why? Here are mine:

Broccoli: detoxify carcinogens, reduce estrogen levels

Chilies: faster metabolism, better control of diabetes

Dark Chocolate: lower blood pressure, improve insulin sensitivity

Cinnamon: lower LDL cholesterol, improve insulin sensitivity

Fish: fewer heart attacks, fewer strokes

Garlic: less stomach, colon and rectal cancer; lower blood pressure

Nuts: lower cholesterol, improve satiety

Walnuts: protect brain cells, protect interior arterial linings against junk food

Wine (sensibly): raise HDL (healthy) cholesterol, reduce risk of heart attack, peptic ulcer disease

Yogurt: lower risk of antibiotic related diarrhea; reduce irritable bowel syndrome symptoms
Dec13

The Health Insurance You’re-Too-Healthy Penalty

Posted in: Aging and Costs of Aging, Wellness and Health

I got my annual increase in health insurance premium last month with no increase in coverage. “Starting with your January invoice…(we will bill you) an increase of $38 or a 14 percent increase from your previous monthly rate.”

Ouch. So I started shopping for alternatives. I have no health problems except a chronic battle to avoid overweight, work at being fit, and try to practice the lifestyle I preach. Luckily, I haven’t had to use my health insurance in 20 years.

I found another, similar plan from the same large national health insurance company. The new plan provides comprehensive coverage and is nearly identical, for $68 less than the new rate.

I thought: $800+ saved annually is certainly worth the hassle of a re-application and documentation of any and all health concerns encounters I could remember. I assumed the health insurance company wouldn’t or couldn’t transfer my data from one of its plans to another of its plans (though it would lower healthcare spending).

So I re-applied online, and got a call from MaryAnn RN. She informed me that I could continue with the application if and only if I had a physical examination, lipid and diabetes tests, height, weight, blood pressure and a documented past medical history.

Why? Not because I was sick. But because I was not sick. “It’s because nobody has eyeballed you in the past two years”, MaryAnn explained. I actually had seen an optometrist…but “they don’t count”, she said. “Besides, even healthy people can get sick.”

Indeed they can: acute illness does often arise unannounced, though chronic diseases often suggest themselves well before you get one.

Interestingly, the U.S. Preventive Services Task Force recommendations suggest a lipid test every five years and a diabetes test every three years, not every two years, as now required by the insurer.

Hmmm. An insurer leveraging its offer of insurance outside of professional guidelines for clinical testing? Unheard of.

Yet there it is: the insurance company penalty for being healthy. Healthcare spending wastefulness 101.

My triumph of being healthy enough to avoid having to see a clinician for 24 months is not rewarded by the disease treatment system that is most health care today.

Our disease treatment system values medical and surgical intervention. It doesn’t value eating well, exercising, avoiding tobacco, sensible drinking, managing stress and getting enough sleep: behaviors that aim to prevent disease and actually do.

MaryAnn suggested walking-in to a walk-in clinic. I’ve long supported these clinics: I like the idea of democratizing care for those who cannot afford it. Nurse practitioners do a great job of staffing these centers, which could also teach nutrition and give out my ChefMD recipes: many Walgreen’s still do, after I co-hosted Health Corner TV.

I haven’t decided whether to walk-in yet: a visit to a clinic will cost $100 and half a day (the nearest one is over an hour away). If my exam and lab work are acceptable and if the insurer doesn’t raise rates mid-year, not accounting for the time off work, I could still save money. So, I’m thinking about it.

But what really ticks me off is the stupidity.

*I could have been seen for a blemish within the past two years by a physician assistant, been told that it was a blemish, and qualified for the cheaper, nearly identical health care plan, without any of these crazy new requirements.*

The insurer’s algorithms of “insured person eyeballed” apparently don’t care who does the eyeballing or what they eyeball. Any clinician (except an optometrist, I guess) will do.

I know I’m lucky. I haven’t fallen off a ladder or driven a nail through my hand at my urban mini-orchard, or ballooned 75# up despite being embraced by treats, great cooks and frequent travel, or developed a bump, rash, bleed or bruise that wouldn’t go away. And I work at staying healthy.

Too much, according to the health insurer. Never mind that helping people take control of their own health with what they eat and how they live is what matters most!

The insurance system in America penalizes the healthy if they want to have even catastrophic insurance…just like it penalizes those with chronic disease and pre-existing conditions, who want to have any insurance.

If you want to stay healthy, and see the doctor only when you choose, you might just have to choose a DIY health care plan, or be subjected to tests that you might not really want or might be unnecessary. In my opinion, that’s no way to care for people.

Now I’d like to hear from you.

Have you tried to stay healthy enough to avoid having to see the doctor?

Has your health insurance company worked with you, or against you?

What strategies have you tried to get the health insurance you want to have?
Nov9

Writing a Best-Seller: Resources!

Posted in: Uncategorized, Wellness and Health

In Las Vegas last week, I gave a talk last week to 75 physicians on writing, publishing and marketing–specifically, how to write a New York Times Best-Seller (see previous post for strategies).

I also love being with out-of-the-box people, who think beyond their training or degree, and are keenly interested in something else too. That was the MedicalFusion conference.

I prepared for the talk by researching the topic (there are real empiric data), and examining my own experiences.

It turns out that as fast as publishing is changing, some of the old truths still hold.

If you are swinging for the fences, you are best served by getting an agent, using a New York publisher, letting them amplify your message, and learning excellent media skills. And there’s no substitute for practice.

What put my last book (ChefMD) over the top was the NPR interview, confounding the conventional wisdom that only TV works to sell books.

I prepared for the interview, like I prepare for all interviews: by reviewing my handwritten 4 x 6 or 8.5 x 11 cards. I love high technology, but I have not transferred these to my phone, because the hands-on approach seems to work.

Here are 8 recommended hands-on resources about writing a best-seller: Seth Godin, of course, and Tim Ferris of Four Hour Work Week, twice; Dan Poynter’s self-publishing guide with suppliers; authorhive.com for book marketing; and for self-publishing: lulu.com, createspace.com and authorsolutions.com. See what you like!
Sep14

No Meds Rx III: Why Patients Stop: Communication

Posted in: High Cholesterol, Uncategorized

Why do patients stop taking their medication? 3 reasons: reminders, money and communication.

Nonadherence is costly, physically dangerous, unnecessary and important. One in four patients prescribed antihypertensives stop them within 6 months. One in three patients are off their statins within 12 months.

And not because they have lowered their cholesterol level with food (although they could learn how in the WSJ. Or by ChefMD video).

To improve the chances that people will take their meds:
*For clinicians: provide clear written instruction, anticipate side effects, and have another person available to answer questions within a few days of Rx.

In the office, have patients repeat back to you how they will take the meds and for how long.

*For patients: empowerment. Keep a daily log of blood pressures/sugars (here is one I use for weight control; adapt it). Is the medicine helping? You need to know.

Bring it every visit and ask the doctor to review it. Show how you were feeling when your blood pressure/sugar was high or low. Does the pharmacy’s have an automatic refill program? Use it.

*Both: discuss pill splitting (which ones?). A larger quantity purchase (means lower co-pays). Look for duplicate medications to omit. That’s the first thing I do when I look at a list.