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The Cure for What Ails You Could Be in the Kitchen with DHMC Culinary Medicine Class

  • Auden McClure, of Lyme, N.H., and Tara Efstathiou, of Claremont, N.H., lead the Food as Medicine cooking class at the Lebanon Co-Op's teaching kitchen on Tuesday, Sept. 18, 2018. The class, which is put on by Geisel School of Medicine and Dartmouth-Hitchcock, focuses on teaching patients about the role of nutrition in dealing with illnesses such as diabetes, obesity and cardiovascular health. (Valley News - August Frank) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com.

  • Bobbe Ferguson, of White River Junction, Vt., peers into a pot of cooking quinoa during the Food as Medicine class at the Lebanon Co-Op's teaching kitchen on Tuesday, Sept. 18, 2018. The focus of Tuesday's class was the use of grains in cooking. (Valley News - August Frank) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com.

  • An instructor in the Geisel School of Medicine and Dartmouth-Hitchcock Food as Medicine class demonstrates the proper technique for cutting and removing an avocado from its skin at the Lebanon Co-Op's teaching kitchen on Tuesday, Sept. 18, 2018. (Valley News - August Frank) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com.



Valley News Staff Writer
Saturday, October 06, 2018

Lebanon — Before she attended what was then known as Dartmouth Medical School and became a physician, Auden McClure trained as a chef in Paris and worked in restaurants in New York City and Washington, D.C.

For the past five years, McClure has combined these seemingly unrelated skills as the leader of the culinary medicine program at Dartmouth-Hitchcock.

The team, which includes physicians, dietitians and health coaches, helps teach medical students, providers and patients of Dartmouth-Hitchcock’s Weight and Wellness Center how to integrate healthy food into their diets and make cooking an enjoyable part of their daily lives.

“It’s really a niche where I can use all the training I have,” said McClure, whose areas of focus have included obesity medicine, general pediatrics and weight management.

As obesity has affected more Americans in recent decades, chronic diseases such as diabetes, cardiovascular conditions and other ailments also have been on the rise.

To help people lose weight and develop healthy lifestyles, Dartmouth-Hitchcock has created a multidisciplinary program to teach people the skills they need to do just that.

In addition, as Geisel School of Medicine revamps its curriculum this year, it is increasing its emphasis on nutrition so physicians in training will graduate with a better understanding of how nutrition relates to various medical conditions and how they might help patients (and themselves) develop better eating habits.

“I think, unfortunately, cooking kind of skipped a generation,” said D-H dietitian Tara Efstathiou.

As modern life has gotten busier, with both parents often working and families’ schedules packed with activities, Efstathiou said her patients tell her that self-care such as healthy eating has moved down on their list of priorities.

In working with patients, Efstathiou acknowledges that their lives are busy and tries to help them find ways to fit cooking into what free time they have. A big part of it, she said, is having a plan and finding time on weekends.

“I don’t think that anybody intended to stop cooking,” she said. “Lives got busy.”

Healthy eating doesn’t have to be complicated or fancy, McClure said. A kid’s lunch could be apples, cheese and some leftovers. Simple things such as reducing people’s intake of sugary beverages can make a difference, she said.

“We’re trying to just get families back to basics,” she said.

The culinary medicine program is integral to the Weight and Wellness Center, said Dr. Richard Rothstein, a gastroenterologist and the chairman of Dartmouth-Hitchcock Medical Center’s Department of Medicine. The center, established two years ago, is focused on helping patients rethink their relationship with food and eating, and guide them in thinking about movement and mobility.

While the center’s patients have access to a variety of options to tackle their weight issues, from surgery to pharmacologic therapy and endoscopy, Rothstein said, “I think culinary (medicine) should be part of any therapeutic route that they take.”

This is necessary because even for those who opt for surgery, half go on to regain weight because they don’t alter their lifestyle at the same time, he said.

The need for such a center is apparent as, nationally, about two-thirds of adults and nearly one-third of children are either overweight or obese, Rothstein said.

“At one point we had hundreds on the waiting list,” he said. “We’re growing. We keep adding staff.”

A Cooking Class with a Twist

A Tuesday in September found McClure, Efstathiou and health coach Laurie Gelb leading a group of patients through a cooking class on grains. It was the fifth in a bi-monthly series of six EatSmarter Culinary classes that teach patients culinary skills, practical nutrition and links between diet choices and chronic disease.

Susan Caisse, of Charlestown, and Deej Parker, of Claremont, sat next to each other at a table equipped with a hot plate, sauce pan and water as they waited for the course to begin. The two women are co-workers at National Field Representatives in Claremont. Both, like all the class participants, have previously participated in D-H’s Healthy Lifestyles Program, which is another offering of the Weight and Wellness Center that provides patients with skills for healthy living, aiming for 5 to 10 percent total weight loss over the course of a year.

Caisee said she’s enjoyed the classes so far and has learned to use new ingredients and seasonings.

“Things you wouldn’t think to do yourself,” Parker said.

Gelb kicked off the class by asking participants how they had used the recipes provided in a previous class: a salad topped with eggs, potatoes, olives and salmon, and a spinach salad with chickpeas and balsamic vinegarette.

“How did it go for you?” she asked.

Parker said she didn’t use the recipes because: “I don’t like fish.”

McClure suggested using chicken instead. It could be prepared in the same manner. She urged participants to use these proteins “like a condiment.”

The grains course guided participants through recipes for a curried quinoa pilaf and farro salad. Though people trying to lose weight are often warned away from bread and pasta, Efstathiou said that whole grains, complete with fiber and healthy oils, can provide a satisfying sense of fullness. In addition, they can support heart and bowel health.

The farro recipe included mixing the grain with pecans, dried cranberries and green apple, while the curried quinoa recipe included onions, edamame and corn. McClure and Efstathiou urged participants to think about how they might alter the recipes to suit their tastes or the contents of their cupboards.

“You just kind of mix and match,” Efstathiou said.

As teams of two participants began cooking onions for the quinoa dish, White River Junction resident Bobbe Ferguson said she joined the course at Gelb’s suggestion.

“I’m on a mission to get healthy,” Ferguson said.

For her, that means losing weight and reducing the medications she needs to take. The program has worked for her, she said. So far, she’s lost 22 pounds.

“It’s not about the weight loss,” she said. “It’s about learning how to manage (my) health.”

For her, that includes exercising and paying attention to portion size. She’s begun eating more plant-based meals and become more cautious in her consumption of meat and bread.

Nearby, Deb Hammond, of Canaan, waited for her quinoa grains to unfurl as they cooked. Though she’s always eaten a lot of fruits and vegetables, she also often eats white rice, she said. Processed grains such as white rice and white bread lack the fiber and other nutrients of whole grains, Efstathiou told the group.

The course has introduced Hammond to quinoa and other grains she hadn’t tried before.

“I really like this stuff,” she said. “I just got to get my husband to like it.”

At another table, Ginny Harrington and her wife, Deana McIntyre, of Lebanon, sampled spoonfuls of the farro salad.

“It’s very good,” McIntyre said, noting that she could taste the cranberries and the lime juice from the dressing.

The women count their carbs as well as their calories. Efstathiou said whole grains such as these contain protein that prevent a spike in blood sugar that can result from the consumption of simpler grains such as white bread or white rice.

The class leaders passed out plates, presenting the grains alongside a green salad. Before participants dug in, however, Gelb urged them to slow down, practice “mindful eating” and take the “chance to be grateful.”

Food for Doctors

Medical students also are seeking to improve their health and that of their patients by increasing their understanding of how nutrition relates to various health conditions, said Rima Itani Al-Nimr, a clinical research dietitian who is director of Geisel’s Nutrition in Medical Education program, which now is a little more than a year old.

“We’ve realized that we can’t graduate the complete physician unless we include a significant nutrition component,” Al-Nimr said.

Though Americans often rely on their doctors to provide them with the most reliable health information, physicians sometimes don’t feel comfortable dispensing nutrition advice “because their education has been so choppy in this area,” Al-Nimr said.

While Geisel has long had nutrition information embedded within the curriculum, Al-Nimr’s program aims to integrate nutrition information throughout. This effort coincides with the school’s ongoing curriculum overhaul, expected to go into effect next fall.

In this way, Al-Nimr said she hopes the school will empower medical students to help patients address nutritional problems that may affect their overall health. It may also empower these budding physicians to take better care of themselves and help to prevent burnout, she said.

To make this integration happen, Al-Nimr and her colleagues are reviewing lectures and seeking opportunities to add nutrition information.

Some of the skills students need to develop include learning how to assess patients’ nutritional status and get them the help they need to address concerns, Al-Nimr said. Part of that is talking with patients and taking measurements such as weight, body mass index, how much a patient eats, and how much weight they’ve gained or lost over time. Nutrition can play a particularly important role in patients’ recovery after certain types of medical procedures such as surgery and cancer treatment.

In some cases, physicians can learn to advise patients to make simple changes such as replacing soda with other beverages, but in other cases doctors need to know who to refer patients to for additional nutritional advice, Al-Nimr said.

“Almost every team has a specialist,” she said.

The school has already added several hours of nutrition material this year in courses such as metabolism, gastroenterology and microbiology, and in clerkships such as obstetrics, giving students a chance to practice counseling patients, she said.

So far, the school has “gotten a positive response from students,” Al-Nimr said. “They want more.”

One such student is second-year Geisel student Amanda Bastien, who took a culinary medicine elective with McClure and Gelb. Through the course, Bastien said she learned how to cook, to use knives safely and to help patients make healthier lifestyle choices.

“I, overall, found it super impactful in my training,” Bastien said in a phone interview. “I definitely foresee my future in being a physician focused on preventative medicine.”

In particular, she said, she learned how to show patients hands-on techniques they could apply in their daily lives, rather than simply telling them to make lifestyle changes.

The course “strengthened my ability to really connect with patients so they can make decisions.”

Bastien also has put these lessons into practice in her own life. Since taking the course, she sets aside a few hours every Sunday to plan and prep meals for the coming week, which often include roasted vegetables with various seasonings, frittatas with different vegetables and black bean tacos.

“A lot of our health comes from the decisions we make and the way we live our lives,” Bastien said. “I think that you can prescribe medications (but it’s) best to start with the things you eat.”

More information about D-H’s Culinary Medicine Program is available online at dartmouth-hitchcock.org/weight-wellness-center/culinary-medicine.html.

Valley News Staff Writer Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.