Written by Rupy Aujla
Nutrition is so obviously important to any member of the public that I’m often met with disbelief when I describe the mere ten hours of lectures on the subject that I received during my five year medicine degree.
Unfortunately, not much has changed since I graduated almost a decade ago, in 2009. Over the years, hundreds of medical students have contacted me to complain that their courses lack an emphasis on the role food can play in good health. They worry that they’re missing out on a crucial aspect of healthy living, and that their patients will suffer as a consequence. I can only agree.
Lifestyle related diseases such as diabetes and heart disease cost the NHS around £16bn a year; the outlay is so astronomical that we’re now spending more treating these conditions than we spend on either the police force or the fire brigade. And yet, medical schools have not yet woken up to the need for robust nutrition training in the curriculum. Go to see your GP and there’s a fair chance that they simply won’t know enough about nutrition and how to prescribe lifestyle change – even after five years of schooling in medicine.
In fact, many practicing doctors don’t consider nutrition to be a conversation that they should tackle with their patients – perhaps due to their lack of fundamental grounding in the subject. As a GP and an emergency medicine practitioner, I believe we need to change this attitude – although I do empathise with them. When the system forces practitioners to perform consultations for multiple complicated conditions, within a nine minute time slot and up to 40 times a day, it’s no wonder most people are offered a pill. We have created a culture where the patient expects a quick fix and the doctor is pressured to offer it – hence why, according to an NHS survey in December, half of Britons are now taking prescription medication.
If we don’t appropriately educate our health professionals on the breadth and utility of other evidence based health interventions, the only option they will have heard of is a pharmaceutical one.
The situation needs to change. As much as it pains me to point this out, in the UK we are woefully behind the United States when it comes to schooling new doctors in nutrition. In 2012, Tulane Medical School in New Orleans began offering their students an elective ‘Culinary Medicine’ course. For each of the modules, students watch an online lecture and read relevant nutrition papers, before attending a hands-on cooking class in the school’s purpose built culinary school. Students are introduced to the kitchen, taught basic knife skills by a chef and introduced to a clinical case study by a doctor that forms the basis of their discussion. After following the recipe instructions and cooking a meal in pairs, the groups of students share a family meal and discuss the ingredients, how they were cooked and the relevance to clinical cases.
The course has proven to be so popular among students and the faculty that these modules are now part of their compulsory medical education. Tulane constantly evaluate their course to make sure it reflects the evidence base, and they now have over 20 modules looking at nutrition for specific health complaints such as diabetes, congestive heart failure and mental health. They’ve even published papers in peer reviewed journals evaluating why the method of teaching in a culinary school learning environment is more effective than didactic lectures.
Tulane’s course is now available for qualified doctors, and the school licenses it to almost a quarter of all medical schools in America (which incidentally is more than the number of medical schools in the UK). The school is also working on research to demonstrate how effective lifestyle information delivered to patients by doctors on discharge from hospitals can significantly reduce re-admission rates in congestive heart failure and diabetic patients.
This movement needs to happen in the UK. We face a tsunami of chronic disease that threatens to wipe out NHS resources within a decade unless we start addressing the root cause of ill health: our lifestyles. The response from medical schools and the NHS is characteristically slow and that’s why I’ve decided to start this movement myself.
In the early months of 2017, I decided to write The Doctor’s Kitchen, a cookbook to motivate everybody to look at their plates as positive health interventions. The book is a journey through different cultures and cuisines, aligning the science of food in medicine with the culinary arts, and complemented with 100 recipes. After sealing a deal with Harper Collins, I decided to use a significant proportion of my advance to do something about the state of nutritional education in the UK. I personally licensed the course content from Tulane medical school and spent a large amount of my time this year updating it for a UK audience, working closely with the course director, fellow doctor and former chef, Dr Tim Harlan from New Orleans.
I’ve since had the course accredited by the Royal College of GPs, and I’ve started Culinary Medicine UK, which will work on a non-profit basis to teach health professionals how to cook. Our first course will be in alliance with Westminster Kingsway Culinary school in February 2018 and in July we’ll offer an intense four week course to medical students at Bristol University.
As health professionals, we have a role in nurturing a culture that recognises the power of our plates, and sees that they are the answer to the tidal wave of lifestyle related disease in this country. We need to teach doctors how to cook and the value of evidence based nutrition. We need to equip them with the skills to have a conversation with patients about lifestyle medicine. And we need to work alongside school and industry initiatives to elevate food as medicine into a mainstream concept in the pursuit of a proactive, healthier population.