Cherise Rohr-Allegrini for the Rivard Report
Thanks to the Goldsbury Foundation and Children’s Hospital of San Antonio, there is a new revolution in medical care. Maria Palma, chef and program director of Culinary Health Education for Families (CHEF), led an exercise Friday morning that is not the sort of thing most physicians experience when attending a medical conference.
Close your eyes.
Be present in the here and now.
When you eat, take in the colors on the plate, breathe in the aromas.
Think about each bite. Put your fork down in between.
What temperature is the food?
Is it soft, is it creamy?
What do you smell?
How does your body respond?
Does your mood change?
The Physician’s Culinary Medicine Conference at the Pearl Stable, which both entities sponsored, was no ordinary conference. More than 160 attendees from across the country learned not only about studies on cardiovascular disease and diabetes, but about umami, one of the five basic tastes, and how incorporating it into some foods enhances their flavor.
Why are doctors learning about flavor and what does that have to do with treating diabetes? First, ask your doctor how many classes on nutrition they took in medical school. The answer is likely none, or very little. In the past, our healthcare system has focused on medical treatment rather than prevention or life style changes. But by understanding more about nutrition, we can combat such diseases like diabetes and cardiovascular disease, attendees learned on Friday.
Chef Palma added a bright red bell pepper to a frittata she cooked in extra virgin olive oil,or EVOO. The EVOO is a source of oleic acid, a monounsaturated, omega-9 fatty acid which has been shown to reduce the “bad” cholesterol and insulin resistance in patients with Type 2 Diabetes. The bright red bell pepper is rich in Vitamin A, which is fat soluble. When you eat the bell pepper cooked in EVOO, you boost your body’s absorption of the Vitamin A.
“Throw away your fat free salad dressings, which often have added sugars, and use a simple homemade vinaigrette with EVOO," Palma said.
She and Celina Parás, CHEF nutrition education specialist, have been working with KIPP schools to teach kids and their families how to make simple foods healthier. Debating between that slice of bacon or slice of frittata? Eggs provide a higher quality protein than processed breakfast meats, advised Palma. Healthy foods need not be expensive: the cost of making the frittata that made this writer’s stomach growl on Friday was $0.61 per serving.
The CHEF program is focusing on teaching not just patients, but their doctors as well, how to consider diet in their treatment.
We know obesity is linked to Type 2 Diabetes as well as a plethora of other health problems. Doctors often tell their patients they need to “eat healthier,” “change their lifestyle,” or “lose weight,” but there is rarely guidance on how to do that. Friday’s conference aimed to do just that.
Dr. Stephen Pont, medical director of the Texas Center for the Prevention and Treatment of Childhood Obesity, said physicians need to think about where the patient lives – do they have access to a grocery store nearby with a price point they can afford? Does the store provide a range of fresh produce? We encourage children to be more active, but we need to consider the neighborhood setting. Are there safe playgrounds and sidewalks? What’s the school setting like?
If you hear “Fat Antonio,” how motivated are you to make a lifestyle change? Likely, not very. Shaming doesn’t work, especially with a population who already feel bad about themselves. Often, if a child is obese, their parent likely feels guilty for letting it happen.
We must remember that obesity is a disease, Dr. Pont said, it’s not who you are. Everyone has different genes, and therefore, different metabolic rates. There is no one right weight, there is no one diet that is optimum for everyone. Each diet must be adapted for the individual, and a doctor needs to work with the whole family. The pounds don’t matter as much as the healthy changes.
That’s where CHEF comes in, teaching families and physicians how to make healthy food choices.
Palma demonstrated making a simple snack – trail mix. This snack is packed full of essential fatty acids, vitamins, fiber and minerals. Attendees started with almonds and walnuts, then added a whole grain such as Cheerios, then pumpkin seeds. Finally, for some sweetness, they added cranberries to the mix, which provide dietary fiber, vitamins, and minerals, but are also a concentrated source of sugars.
It’s important to look for dried fruit with no sugar added and to add only a small amount, she said. You can buy pre-packaged trail mix, but something most don’t realize is that it’ll have more sugar and preservatives, and is more expensive.
“The best foods are those with the fewest ingredients on their labels," said Dr. David Ludwig of Boston Children’s Hospital and Harvard Medical School. "Better yet, buy foods that don’t have labels.”
Low calorie isn’t necessarily the answer. The type of calories matters as it affects how those calories get burned. Though society is long accustomed to avoiding fat, Dr. Ludwig said fat has its place. Multiple studies have shown that carbohydrates, and their sugars, are the problem, not fat.
Lowering your carbohydrate intake, and focusing the carbohydrates on foods with a low glycemic index, such as beans and lentils rather than rice or potatoes, will, most often, lead to weight loss and a better outcome for a person with diabetes. Ultimately, it’s not the quantity of calories that matter, it’s the quality.
When asked what kind of milk to drink, Dr. Ludwig recommended whole milk. Federal nutrition guidelines for school food haven’t quite caught up with new research, and require “fat-free and low-fat fluid milk in the school menu.” At the same time, chocolate milk is offered in our city's schools. Now, schools have taken that cup of whole milk with 13 grams of sugar and have doubled the amount of sugar, negating the benefits of the milk.
Frustrated parents and their doctors want to know how to improve health and nutrition in San Antonio schools. Dr. Pont, who also serves as the Medical Director of Austin Independent School District, advised participants to join their district’s School Health Advisory Council (SHAC) to push for better nutrition standards.
These councils are made up of district officials, concerned health professionals, and most importantly, parents. Yet San Antonio ISD’s SHAC rarely has more than three parents that participate on a regular basis.
With more than 200,000 individuals in Bexar County under the age of 20 diagnosed with diabetes, the CHEF program and Children’s Hospital of San Antonio has its work cut out for them. This revolution they’re leading, teaching families and physicians about nutrition, may just reverse the trend.
Top image: Maria Palma and Celina Parás of CHEF demonstrate how to make a healthy breakfast. Photo by Cherise Rohr-Allegrini.