Eat, Move, Think Better with David Eisenberg, MD

[00:00:00] Dr. David Eisenberg: We not only summarize what doctors and their patients should know about which foods to eat more of, less of, and why, but also how to cook them, how to shop for them, and then we go beyond that to also address the other parts of the Chinese dictum. Eat, move, think better. We talk about movement and exercise. We talk about mindfulness and behavior change. We talk about health coaching because all of these are the tools whereby people optimize their own health.

[00:00:30] Dr. Melinda Ring: This is Next Level Health. I'm your host, Dr. Melinda Ring, director of the Osher Center for Integrative Health at Northwestern University. On this show, we explore ways to take actionable steps towards optimizing our health with leaders in the integrative, functional, and lifestyle medicine fields who believe in science-backed and time-tested approaches to wellbeing. Let's take your help to the next level. Today we're diving into a topic that is truly at the heart of transforming medicine, how we can use food as a powerful tool for healing, prevention, and wellbeing. My guest today, Dr. David Eisenberg, has spent his career at this exciting intersection of nutrition, cooking, and medicine. David is a true visionary. He's someone who thinks out of the box and then it's like magic. He pulls a rabbit out of his hat to make things happen. A Harvard trained physician, board certified in internal medicine and a leader in integrative medicine. David has been a pioneer in advancing culinary nutrition in medical education and patient care. He currently serves as the director of culinary nutrition and as an adjunct associate professor of nutrition at the Harvard TH Chan School of Public Health, he's also the founder of the Teaching Kitchen Collaborative and the co-director of the Healthy Kitchens Healthy Lives Conference. David's work has played a key role in bringing teaching kitchens into hospitals, medical schools, and communities across the country. He's a leader in the Food is Medicine movement, which is now finally gaining momentum at the national level. And most recently, he helped establish nutrition competencies for medical education, a critical step toward making nutrition an integral part of healthcare. David, thank you for being here and welcome to the show.

[00:02:28] Dr. David Eisenberg: Thank you, Melinda. It's an honor and a pleasure and so many of the things I've been active in. You've been my partner, so thank you very much.

[00:02:36] Dr. Melinda Ring: Yes. Thank you. I always like to start with the story, so you really have a unique and personal connection to food and how it relates to health. So can you share a little bit about how those two passions came together for you?

[00:02:51] Dr. David Eisenberg: at the risk of what my wife calls oversharing, I'll tell you the personal backstory. So on my cv, I'm a Harvard trained doctor, researcher, educator clinician. But -----basically I'm the son and grandson of professional bakers. My grandfather Max from Poland, my father Joseph, who ran a bakery in Brooklyn and I grew up going to a bakery every Saturday and Sunday to be with my dad 'cause it was the only time I could see him when he was in the same time zone as me. He would go to work at four 30 in the morning and come back at eight. So I spent mornings and afternoons with him on the weekends. ---And I fell in love with baking and cooking before I could read or write. And to this day, I express myself through cooking. I've cooked every day of my life when I'm not traveling, and I love to make delicious food for other people. It's one of life's greatest joys. So in my, uh, particular, family situation when I was 10 and my dad was 39. He had a heart attack and died. I had three living grandparents at the time, each of whom died within a year and a half of his passing of completely unrelated acute medical conditions, and as was the custom in the mid 1960s when all this happened. My mother chose not to discuss any of their illnesses with her four children. I was the second of four. She thought she would be protecting us from the extraordinary pain of loss. It doesn't work that way, and I decided really as a preteen that I wanted to understand what had happened. So I set out to study medicine somehow. As I entered my junior year of high school, 1971, president Nixon was trying to reestablish communications with China. And this is an example of how your life goes in directions you can't anticipate or know ahead of time. The op-ed editor of the New York Times, James Reston, who had been sent by the New York Times to follow Henry Kissinger, who had dared to go to Beijing at the height of the Cold War with China. Restin developed acute appendicitis. He was operated on by Chinese physicians Three days later, he still had post-op abdominal pain and the front page of the New York Times written as a tongue in cheek obituary to his appendix, said that his postoperative pain had been vanquished within seconds of two acupuncture needles being placed in his elbow and his kneecap well as a 16 or 17-year-old high school student who wanted to become a doctor. That was just the pathophysiologic shot her around the world. People around the world could not imagine that pain could be obliterated by a skinny acupuncture needle, and nobody had heard of acupuncture. The next year I entered Harvard College, obsessed with the notion of becoming a pre-med student and someday becoming a doctor, and I asked to do an independent study of Chinese medicine. There was nothing in English in all of the Harvard libraries on acupuncture to be used postoperatively, but there was a translation of the core text of all of Asian medicine from Korea down to Malaysia. It's called the Yellow Emperors Cannon of Internal Medicine. And there was a translation of that 25 century old text that had been translated in the forties. And I read it and in the first chapter it stopped me. Probably the most important reason I am talking to you about all this today is because it said two things that have been my North Star. First it said prevention is always superior to intervention, and it said this through beautiful Chinese poetry. And then it said, the way we eat, the way we move and the way we control our minds and our emotions not only impact our health, but actually determine our recuperative capacity. It stopped me in my tracks. I wondered could that possibly be true? Uh, I can guarantee you it was nowhere in the pre-med curriculum of Harvard College for a biology major in 1972, but I wanted to learn what of that was actually evidence-based, as we say now. So I learned Chinese. I was fascinated by China, and if you fast forward eight years in my life's journey, eight years later, president Carter, who just recently passed away, normalized relations with Beijing, the National Academy of Sciences asked for the first volunteers to serve as exchange scholars to the People's Republic of China. And I was picked as the medical exchange student. I spent 1979 and part of 1980 in Beijing at the Institute of Chinese Medicine studying Chinese medicine, and that was really my introduction to what was then called alternative medicine or complimentary medicine, and what is now thought of as parts of healthcare. It was also my introduction, not just to acupuncture and herbs and massage, but there were three Chinese chefs assigned to the eight Western physicians who were studying with me, and they allowed me to come in the kitchen and cook with them every night. So it was, uh, a free culinary education in healthy, delicious, local, affordable, seasonal, fabulous food. Chinese cooking is still probably my favorite. And it was my introduction to how the mind connects with the body because I had the. Opportunity to study Tai Chi at dawn for a whole year, and it was also over the year, the time that the idea for the relationship between food as medicine and lifestyle as medicine really came into focus for me

[00:09:17] Dr. Melinda Ring: Wow. Well, I love that food has always been a part of your life. I have to say that when I was that age, young and younger, and going to my, with my dad to work, who, he's a pathologist, I was spending Saturday mornings helping him with autopsies. Um, a much different experience in childhood. Uh, that somehow brought us back to this

[00:09:43] Dr. David Eisenberg: Yeah. But, how fascinating that it was a similar motivation to be with our dads.

[00:09:49] Dr. Melinda Ring: Yeah. Right, right. Yes.

[00:09:52] Dr. David Eisenberg: So anyway, that, that year in China, I came back and I had some very strong, tough love messages from my mentors at Harvard who said, now you need to finish your training and figure out how to evaluate all these things that you've seen. And to apply Western medical logic to distinguish things that work from things that do not work, and help us understand where East and West could learn from one another and create better healthcare. So that was the story behind the first part of my career, which was in the area of complementary and integrative medicine where you and I met a long time ago. But the story there was, as a research fellow. I wanted to assess the frequency with which people in the United States were using acupuncture and herbs and meditation and chiropractic, and that led to the publication first in the New England Journal and then in JAMA to showcase how many Americans were using these things without any knowledge of their physicians, how much money they were spending out of pocket. And therefore how important these were as sort of a, a shadow medicine within American healthcare. And that took everybody by surprise. It was also the basis upon which Congress created the Office of Alternative Medicine, which ultimately became the current National Center for Complementary and Integrative Health, because they used the data from those. Publications and prestigious journals say we have to have a scientific arm of the NIH to figure out what works, what doesn't work, and how we can take better care of the public. So that started me on really my first main career, which was to promote and study. And understand the benefits of complementary alternative and now integrative healthcare. And as you know, I founded the Osher center at Harvard. You are an Osher professor at Northwestern, so we share that lineage. I'm forever in debt to Mr. Osher, who's still alive at the age of 97, who I just saw a few weeks ago. that allowed me to set up a research center and a clinical center in integrative medicine, but maybe to the point of how we got to today and food as medicine at the height of my ascent, if you will, to getting grants from the NIH to being elevated to the position of a division chair to study complementary and alternative medicine at Harvard. I asked Barney Osher for a favor. I said, Barney, there's this gap in medicine that has always perplexed me. And the gap is simply that in all my years as a medical student and a resident, and now on the faculty, no doctors know anything about nutrition. Even fewer know anything about food or cooking. Will you backstop my crazy idea to bring together the best chef educators in the country with the best and most, um, well-recognized nutrition experts from the medical and public health fields to create a conference so that we could teach doctors what they need to know about nutrition and food. And he said, knock yourself out. And I had to ask his blessing because if nobody showed up at that conference and it were to cost hundreds of thousands of dollars, somebody would have to be responsible. And not only was it successful, but that conference, which is called Healthy Kitchens, Healthy Lives that you've participated in, has gone on now for 20 years. It's,

[00:13:49] Dr. Melinda Ring: 20 years. Oh wow.

[00:13:51] Dr. David Eisenberg: It's been sold out every time. Last year it sold out eight months in advance. And um,

[00:13:57] Dr. Melinda Ring: Amazing.

[00:13:59] Dr. David Eisenberg: uh, that's been a great joy. So that was the beginning of my fascination with the combination of medicine and the food community, realizing that they loved to learn from one another, teach one another. And at that conference, as you know, we not only summarize what doctors and their patients should know about which foods to eat more of, less of, and why. But also how to cook them, how to shop for them, and then we go beyond that to also address the other parts of the Chinese dictum. Eat, move, think better. We talk about movement and exercise. We talk about mindfulness and behavior change. We talk about health coaching because all of these are the tools whereby people optimize their own healthcare.

[00:14:47] Dr. Melinda Ring: And this, so you're right. I've been to this amazing Healthy Kitchens Healthy Lives conference several times held in Napa, in collaboration with the Culinary Institute of America, and so beautiful setting. One of the best, you know, I can't imagine better food and drink at any conference. And, um, yeah, really transformational. I think for people who attend, now that conference is primarily intended for health professionals Right. To then bring that back to their patients. Um, and I'm sure. You've gotten many requests for bringing similar sorts of conferences, trainings to patients, you know, to the public. I know I have patients who are asking for resources. Is that part of what led to the Teaching Kitchen Collaborative or, okay.

[00:15:40] Dr. David Eisenberg: Exactly. So we, we, had done the conference for eight or 10 years. It was a raging success. I should mention that probably the most unique aspect of the conference is that it takes place in this venue, which is actually a training site for chefs. So 400 people can cook at this place. And in addition to the didactic presentations from experts on which foods and why, and the science of exercise and meditation, all the attendees taste 300 dishes over three days, and then they go into the kitchens and for several hours they get an in-depth immersion in one or two culinary techniques. How to make a fantastic solid. How to make a marvelous whole grain side dish. How to sear a piece of protein or make several vegetables, five or six different ways from five or six different continents. And they realize with the help of a chef teacher that they can do this. And it's an epiphany. Now for nearly 10,000 doctors who have never held a chef's knife before, they can cook too. And if they can do it and feel proud and excited about it, so can their teenage child on the beige diet or their patient who may be struggling in all sorts of ways. So back to your question, we were doing this conference for eight or 10 years, and then I personally felt like what a pity it would be if we only taught doctors. Why not try to translate the same curriculum into something that could be used by patients and students and employees. And around that time, someone had suggested, I asked the audience if anybody in the audience had done what I had proposed from the first sentence of Healthy Kitchens, Healthy Lives 20 years ago, that the goal was someday to put kitchens in hospitals. And I said, have any of you built a kitchen in your hospital and a hundred hands went up.

[00:17:51] Dr. Melinda Ring: Wow.

[00:17:52] Dr. David Eisenberg: And that was 2014. And that's when I realized it's time to pivot from my former career in focusing primarily on different complementary integrative interventional techniques, and now try to imagine a collaborative of hospitals and corporations and community sites using kitchens to teach people how to eat, cook, move, think better. That was the birth of the Teaching Kitchen collaborative that you are a founding member of and have been very active and helped lead. But that's how it all started about 10 years ago when we realized people had heard the message that if we could put kitchens in medical settings and school settings and work sites, maybe they could be used as learning laboratories.

[00:18:43] Dr. Melinda Ring: I love that teaching kitchens are now being integrated into hospitals and corporate wellness programs, schools, um, community centers. And while, as you know, we don't have one. Accessible to patients on the Northwestern downtown campus. We have several across Northwestern's network, including a kitchen that's planned for the Bronzeville Clinic that's opening later on the south side of Chicago. I'm really excited about that. Our culinary medicine elective, the cooking of health elective for medical students. We actually go into the hospitals, kitchen where they prepare the food for the patients and we go in after hours and they let us use it for cooking classes. Um, so I think across the country, places are getting very creative with how they're making these accessible. There, there may be mobile kitchens. What are some of the success stories? What's some of the data to show that it actually is making a difference in terms of patient outcomes or their interest in food? Is there a growing body of data that it, it, it's, it's something that we should be investing more in?

[00:19:55] Dr. David Eisenberg: in 2010 or 12, I took the curriculum of Healthy Kitchen Healthy Lives and put it into a patient centered curriculum, and we did a pilot study involving employees of the Culinary Institute of America. We went to their campus in Hyde Park, New York. We invited two groups of 20 employees to participate as clinical subjects in a randomized trial. And we asked them if they could, would they be interested in learning how to eat, cook, move, and think smarter? It had little difficulty recruiting two groups of 20. They showed up every Thursday night in one of the kitchens of the Culinary Institute of America. They watched the chefs demonstrate one technique each week, whether it was soups or salads or proteins or cooking with vegetables, et cetera. And they also learned about how to shop and how to read labels. And they learned not only what to eat and how to shop, but the importance of movement and exercise. And they learned about mindfulness and how it applies to cooking and feeling when you're full. And they learned about behavior change and had access to a health coach who helped them figure out what their motivation was to change if they could alter their habits. That experiment worked. Everybody loved it. Participating. Nobody dropped out. They came to every class. The majority of people who were overweight or had lipid abnormalities or high blood pressure improved in all those areas. But it was a feasibility pilot. It wasn't a definitive clinical trial, but it worked. And perhaps more importantly, that pilot study convinced me and the others involved, including Alison Re, who's still active at the teaching Kitchen Collaborative and Jen Masa, who was my co-investigator, it convinced us that people felt liberated. These are people who had been on diets their whole lives, and for the first time, almost to a person, they said, now we know how to navigate. You know, one of them said, I liken the experience of a teaching kitchen course to Dorothy from The Wizard of Oz. She had her read Ruby Slippers the whole time, and what you've given us is the ability to choose healthy living and a healthy lifestyle whenever we want. That's when I knew this thing was ready to be scaled and tested in innumerable settings. Back to your question about success stories in different kinds of kitchens, I think there was another epiphany around that same time, well, I'll bring it up to um, COVID. We were beginning to see medical schools and hospitals experiment with kitchens, and some were more expensive than others, and some were popups and some were mobile. But during COVID, they all shut down. And you'll remember with me the sort of deer in a headlight since we all had, well, what do we do now? Nobody can come into our kitchens. We realized as a sort of collective epiphany that it's not about the kitchen. 'cause we could create a class online as long as the instructor had an iPhone or an iPad aimed at her or his face and her or his hands. And if that instructor looked at a monitor where 20 students or trainees were cooking at home, voila. We had an online interactive live streaming teaching kitchen class, and subsequently we all learned that it wasn't so difficult and that we could all do it, and you didn't need a two, five or $8 million kitchen to accomplish this. You asked me about the research base, and I'll just say that if anybody listening to this goes to the journal Nutrients and looks up the special series on teaching kitchens. There were 36 peer reviewed publications last year about teaching kitchens and their impact on dozens of patient populations, children on wic, adults who have diabetes, cancer survivors, vulnerable populations, you name it, and teaching kitchens, which again, are simply real or virtual. Venues to teach people how to eat, cook, move, think smarter. They all work and it doesn't matter which facility they come from, as long as the trainers have the right. Background and insight and skill, and the trainees wanna learn how to take better care of themselves. So I think I, I think that the applications of teaching kitchens are limitless and the science keeps suggesting that they work in just about every population and can be applied regardless of one's pocketbook.

[00:25:02] Dr. Melinda Ring: halfway through one of our culinary medicine training for the medical students when the med school was like, okay. And everything was like, we're shutting down. And the pandemic. And we, we uh, we surveyed the medical students and said, you know, do you wanna just stop or do you wanna see if we can make this work and just keep doing it over, over Zoom? And they all said, we wanna keep doing it. So during the pandemic, we converted to that. And we were very interested to find that, as I think others have that we. Got the same pre to post change in the medical students', comfort in counseling patients about nutrition, their knowledge about nutrition. But surprisingly to us, they said that they were more likely to cook going forward, having done so in their own kitchen versus when we brought them all together. And you know, there's, so, there's definitely more community and connection about cooking together. It's fun, it's different. But when you, but that's different. Then I did this whole thing all by myself. And so it, it, it really was powerful. So now what we've done post, COVID is during the classes, you know, we do some in person for that community aspect, but we still do some, uh, where the medical students are in their own kitchen. And that's led to some very interesting things where, you know, it'll be like, okay, you have to open this can, and you realize, oh, one medical student doesn't have a can opener. Uh, you know, these are things that we need to think about for our patients. They're not, not everybody has a bit mixer in their home or an immersion blender. How do we make recipes? How do we adapt them? How do we tell people like, you can swap this for this and it's still gonna work great. And, I think that does make it so much more accessible, for patients too, when. We think about, you know, asking somebody to come to another place after they're working one or two jobs, that can be a challenge. So really, I do think virtual kitchens are very exciting as an opportunity for healthcare.

[00:27:20] Dr. David Eisenberg: I agree, and I don't think it's either or. I think there will always be a place for, and at some level, superiority of learning in-person, hands-on in a group where the collective understanding of one another is richer. Just like in-person meetings still have some place in the world. But that said, if every teaching kitchen big or small can be viewed as a broadcasting studio. Think of the impact of scale. So if there are now hundreds of teaching kitchens and each could reach thousands of people virtually, that's a much bigger impact than just 20 people in a class. So I think this is part of the next phase. And as you know, because you're close to the work of the Teaching Kitchen Collaborative, which is in the midst of a multi-site randomized clinical study, having prepared that curriculum before COVID, during COVID and after COVID, we ended up with a model where the first two classes are in person, but all the rest are virtual.

[00:28:30] Dr. Melinda Ring: Mm-hmm.

[00:28:31] Dr. David Eisenberg: And our, our thinking was these first two classes, give people a chance to meet in person, give the chef a chance to make sure people are holding their knives and equipment properly. Give them a chance to bond as humans, and then they can work from home virtually for the next 3, 4, 12 months. And that may be the way of the future. Again, the opportunities to study. What are the best ways to use teaching kitchens? Are before us. And I think there's a lot of wonderful questions that will be asked in terms of what do you need at a minimum, how long does it take? At a minimum, how do you customize this for different groups and make it simpler, easier, more cost effective? Will there someday be a Peloton like version of this where people can just plug in when they're ready? But that's all now really within sight. Whereas 10 years ago that was all fantasy.

[00:29:26] Dr. Melinda Ring: I wanna shift for a second to talk about the nation. The landscape of the food is the medicine movement because really the past decade has seen incredible momentum, and now there's, well, we'll see, but you know, there's been federal backing from the departments of Health and Human Services. new things happening at the Medicaid level for coverage of food as medicine, and so we're really starting to see this at a policy level. And so you've championed this for decades, so beyond just teaching kitchens, how, you know, what does food as medicine, you know, just going back to that term, like what does food as medicine mean to you and why is it such a game changer. Why is it showing up now really across all, all areas of, the world in terms of something that we need to be focusing more on.

[00:30:27] Dr. David Eisenberg: Well, I give a lot of credit to the Biden administration when they held, uh, the second conference in American History on Hunger and Nutrition in 2022. And during that conference, which hadn't occurred since Nixon's era, they talked about food as medicine. They talked about the need to get better access to healthy Whole Foods for people that were vulnerable and didn't have access to those foods. So usually when people think of food as medicine, they think about governmental programs like supplemental insurance, snap, wic.

[00:31:08] Dr. Melinda Ring: Wic.

[00:31:09] Dr. David Eisenberg: Um, but then there's also medically tailored meals and medically tailored groceries. Personally, I've always found that to be half of the solution, improving access to food, to people who have historically not had access to them, and ideally doing that with local agriculture 'cause that would also improve the planet and our economy for farmers. The other half to me is teaching people which foods they should be eating more of, less of, and why, and how to shop for them and how to cook them, and how eating is part of taking care of yourself along with exercise and mindfulness and behavior change. So in other words. From 2022 to the current time, every time I'm invited to a discussion, whether it's with the White House or people at Health and Human Services or the NIH I try to make the point, which I think is now being listened to, that improving access to healthier foods for people that need, that is half of the solution. The other half is basically teaching kitchens, teaching everybody what they need to know about selecting healthier foods, how to buy them, and how to realize that they can eat healthy, delicious, affordable foods all the time. If they knew more about how to shop and where to shop and how to cook. And when they were full, and to prove to them that you can do this on a modest budget, that it's probably less expensive than going out for a family of six to a fast food restaurant if you know what you're doing and you're eating things that are, you know, in your pantry and are local and seasonal. So that's part of where it's going. but in 2022, representative Jim McGovern passed a bipartisan resolution. Not very long after the White House meeting took place and he really said to the medical establishment, we in Congress realized that Americans are having higher rates of obesity and diabetes and costing more. And we've learned that you, the doctors, are not required to know about nutrition that can't stand. So either you fix that and demonstrate competencies in nutrition. Or do Congress reserve the right to withhold all your training funds for residents and hospitals, which is now $16 billion a year. So that's, that's one of the moments in the history of food as medicine that I think really was transformational. 'Cause he basically threatened the medical regulators and said, you've gotta teach doctors about nutrition and food. So that led to a summit among the medical educators in March of 2023, where the question was what do we do? And some very thoughtful, wise, people suggested to me, and I suggested to those in attendance that instead of saying, well, my curriculum is the best, or my curriculum is the best, what if we got all the people that taught nutrition in the United States and taught it well and got representatives of the top residency programs in every specialty to come together and identifying the, to identify the competencies that every doctor should know. About nutrition and food, what should every physician know about food and the things about food that are healthy or unhealthy, and what should they know about identifying which patients need to have a different discussion about their relationships to food, and how to have those conversations in a very sensitive, non-judgmental, unbiased, and empathetic way. You know, Melinda, you and I trained in an era when it was still delicate to talk to patients about what they would wanna do if they had a heart attack or a stroke. Do they wanna be on a ventilator or not? That's not an easy conversation, and I am older than you, so when. The first conversations were being invented to talk about, not just do not resuscitate orders, but people's sexual preference and sexual behaviors. This is in the seventies. That was unheard of and very difficult. These are difficult conversations. I would argue that talking to people about their relationship to food is also a difficult, nuanced, personal conversation. So we're gonna have to train the next generation to do it in a way that doesn't turn people off. And then helps gain their trust so we can refer them to dieticians, to exercise trainers, to teaching kitchens. So these are all examples of what came up at that conference. How do we imagine a consensus on competencies? And you are a co-author with me on our paper published just a few months ago in JAMA Network Open that published the consensus on what these competencies should be. As of this morning, I, I, I checked. The journal, it's been downloaded 21,500 times in five months, and people not only nationally, but around the world, are taking notice. What if all physicians in the future actually knew something about nutrition and how to translate nutrition science into advice for patients about what to eat and how to shop and how to live healthier lives? So that's where we are now.

[00:36:38] Dr. Melinda Ring: Yes, that was an amazing accomplishment and it's really exciting to see that step forward for ensuring that future doctors actually learn about nutrition and learn it in a meaningful way because, you know, medical schools are certainly incorporating it, but sometimes. They're learning it only in the inpatient setting. What do you give somebody who's in the intensive care unit by iv? How do you treat somebody who has a very specific condition, but not really the practical discussion around food and nutrition and somebody's health? I think it's important to acknowledge in all of this is that while we're talking in these competencies about training physicians, , , but we have to have this, uh, as a community effort where things are happening in the communities, whether it's through coaches, registered dieticians, nutritionists, chefs who can teach people in community centers and YMCAs and things like that. We definitely, and you and I, are focused on medical education, like that's a critical aspect, but it has to be a real team approach for it to be effective.

[00:37:54] Dr. David Eisenberg: Uh, I think you highlight two more things that we should share. One is when you bring this opportunity to medical students to learn about nutrition and cooking, they jump at it instantly and they have a blast. And it's fun. It's sort of an anti burnout. Educational component. And I think medical students, just like the public, are just amazed that this has never been discussed before. And I think the public assumes doctors know about nutrition and how to advise them about food when we are not required to prove any competencies there. And I think medical students and residents all want this. They repeatedly say, we're not, we're not trained to talk to our patients about this. So every time we give them an opportunity to participate in or experiment with a teaching kitchen, they jump at it and they love it. And you have had extraordinary success in showing that it works for medical students who then

[00:38:49] Dr. Melinda Ring: Oh, we, we just ran a, uh, you know, our most recent two week elective, and about halfway through one of the medical students said, I haven't eaten this healthy.

[00:39:02] Dr. David Eisenberg: Yeah.

[00:39:02] Dr. Melinda Ring: Maybe ever, because he was cooking healthy food and then had the leftovers and he is eating and he's like. I feel so much better. And it was almost like a, you know, this is a fourth year medical student, like, like a shocking note. Like, wow, eating differently actually makes me feel different. And how important that is, both for his own wellbeing, given the burnout rate and you know, what he has going forward into an intense residency. But then also just like that aha moment of, oh, this is important for my patients and how they feel.

[00:39:38] Dr. David Eisenberg: You know, the, the reason we were able 25 years ago to get Harvard to approve healthy kitchens, healthy lives was a body of literature by a professor named Erica Frank, who documented that a physician's personal behaviors, if they didn't smoke, if they wore seat belts at the time, if they use sunscreen, those behaviors were the strongest predictors of how they would advise. Advise their patients. To lead their lives so that that's what got it approved. 'cause we had to have some scientific rationale for teaching people to cook and eat and move and think better. 'cause we said if doctors learn to take care of themselves, they're much more likely to advocate for that in all of their patients.

[00:40:23] Dr. Melinda Ring: Absolutely, so I know you and I are in conversations now and are presenting at conferences in the very near future. You know, we have, so, we have these 36 nutrition competitions for medical students and residents. Um, the goal is that those serve as. Uh, hallmarks for what a medical school should be or, or graduate medical education should be included in the curriculum. But you and I both know that that's easier said than done, and that, that I, I know in conversations at my own institution. Uh, you know, people who are not in medical education, may not realize it's not so easy, um, that there's already an extensive core curriculum that medical schools are required to cover. And so even if a school believes that nutrition knowledge is critical for future doctors, like Northwestern believes, finding space for that content is a big challenge. So what do you, what do you see as ways that we can ensure that the competencies are actually implemented in a meaningful way rather than just like a checkoff, like Yeah, I kind of talked about that. We mentioned a sentence in a lecture, uh, about it. Uh, like what are, where are we gonna go with this in the next few years?

[00:41:53] Dr. David Eisenberg: Well, First of all, I agree with you that publishing the competencies is really just the first step. Now we have to identify the best practices. How do you teach these well and make them effective, and how do we then measure the competence of the medical student or the resident, which is part of our paper? We said in our paper. I think it was the most explosive part of the whole publication, that all the people reviewing these competencies agreed that they must be on licensing and certification exams. These were no longer nice to haves. These were must haves in order to be a licensed physician. That brings me to the second point, which is I think Jim McGovern and Congress, the people that passed the bipartisan resolution are not gonna let up. Until medical schools demand that this shows up on national board exams and licensure exams for every specialist. How can you be a cardiologist or an endocrinologist, or a pediatrician, or an OB GYN or a family medicine doc and not know how to advise your patients about food? You know, I think that paper unroofed the scandal. 'Cause the public thinks, well, my doctor surely knows about this. Well, they don't. So our job, now that we've listed some of the competencies, and even in the paper we said this is a limited list of competencies. There are others that are even more apparent that aren't in the literature yet. Like how do you help patients make sense of what's on the internet? How do you advise patients about diet when they're starting on these new anti-obesity GLP one wonder drugs? Those are competencies. We don't have them yet, so I think our shared work will be too. Collaborate with educators across the country and say, what are the best examples of how this is done? Personally, I think some of the strategies that will be used will be to, to teach people in, in kitchen settings, whether they're physical kitchens or virtual kitchens. But I don't if you've seen me share this slide where I say trying to teach people the benefits of a healthier diet and how to achieve it, uh, without a kitchen or some experiential learning around food is like telling people the benefits of swimming in the absence of a swimming pool. It's like, it doesn't make any sense. We have to get very practical, but I think this comes now to where we are politically regardless of which part of the political spectrum, anybody is listening to this podcast. RFK Junior does want to invest more in prevention over intervention. He has said that he wants to improve the food supply and remove toxins. He has talked about the need for more nutrition education of the public and of health professionals, so I think we may now have some wind at our back in this new administration. To say, okay, now the government sees this as a priority, so maybe they will invest in research about teaching kitchens. Maybe they will invest in helping us create best practices to train all doctors in these educational competencies, and maybe they will invest in making the healthy choice the easier choice as we set up ways to imagine the future of our kids' relationship to food personally. I think ultimately there has to be home EC 2.0 where every kindergarten through grade five kid is in a kitchen, learning about where food comes from, how to grow it, how to make it delicious, and how to go home and eat it with their family. And if that were to happen, imagine how much prevention would take place and how much less disease burden and cost the country would be faced with 30 years from now.

[00:45:37] Dr. Melinda Ring: David, thank you so much. This has been such a rich conversation and I think you provided so much context for. The food as medicine movement and where it's going, where it is, where it needs to go. So before we finish, I have one final question for you, and that is, from your own experience, from your own voice, what's one piece of personal wisdom that you would share to help people reach their own next level of health?

[00:46:09] Dr. David Eisenberg: If you have a child or a grandchild, teach them to cook

[00:46:14] Dr. Melinda Ring: Hmm.

[00:46:15] Dr. David Eisenberg: because that's how I started. I taught each of my three children to cook as soon as they could stand next to me, and that was our time every day to catch up and be together. But I think the impact is much greater because if you teach children a healthy relationship to food and cooking, a few things can happen. First of all, once you teach them to make something that they find delicious, if they have a sense of mastery, and then they make it for their mother, their father, their grandmother, their grandfather, and that brings family members to tears. Then they will want to cook their whole lives. That's part one. It's the engine that drives people to understand the joy of making delicious foods for people they care about. Second, they now have a completely different understanding of how to read a menu or how to go shopping, or how to enjoy a meal in a restaurant. So it changes their relationship to food forever, and it probably changes their worldview on how our food choices impact the climate and the globe. And certainly for younger people today, that is front of mind. So teach your children or your grandchildren to cook, enjoy meals with them. It's the gift that keeps on giving.

[00:47:41] Dr. Melinda Ring: Beautiful. Well, David, this has been such a pleasure. Thank you for all the work you're doing to transform medicine and health through food and research and education. Uh, and for anyone who wants to learn more, we'll link to David's latest research and the Teaching Kitchen Collaborative and the Healthy Kitchens, Healthy Lives in the show notes. So thank you again for being here.

[00:48:05] Dr. David Eisenberg: Thank you, Melinda. The pleasure is all mine. I appreciate it.

[00:48:08] Dr. Melinda Ring: Thank you for joining me on this episode of Next Level Health. I hope you found some inspiration and practical insights to enhance your wellness journey. Don't forget to leave a comment on YouTube or review on Apple Podcasts. I'd love to hear your thoughts and suggestions for future topics or speakers. Be sure to follow Next Level Health with me, Dr. Melinda Ring as we continue exploring the path to healthier, happier lives together.