My sister-in-law was once a diabetic. She’s not any more. This was not due to some miracle cure, but a common-sense change in her diet – she ate a lot more veg and a heap less sugar and fat. The pounds dropped off, and she eventually reached the point where she no longer needed her insulin, nor to see the doctor.
While diabetes cannot be “cured”, it can be sent into remission by a healthy diet. This is just one example of food-as-medicine, a subject that has interested me for almost as long as I’ve been cooking professionally (nearly 60 years) and one that is, at long last, gaining traction in Britain.
As a young cook doing charity work, I was appalled by how children learnt next to nothing about food at school. To me it seemed simple: if you learn to cook, you eat better and you learn, through doing, about nutrition and diet. Today, with the Britain’s medical system under such impossible pressures, the idea that food can solve many of its problems is an attractive one – and it might just catch on.
Recently, I went to Westminster Kingsway College to observe a group of doctors learning to cook. They ranged from an elderly psychiatrist in geriatric medicine to a young, not-quite-qualified GP, all self-selected medics attending the first module of the first course of its kind in the UK. An Introduction to Culinary Medicine is led by a young GP called Rupy Aujla, author of the popular cookbook The Doctor’s Kitchen, and whose aim is a relatively straightforward one: he is determined to get his fellow medics to realise that improving diet and lifestyle would help a lot of their patients, lessening the need for so many drugs, supplements and repeated prescriptions for ever-less-effective antibiotics.
If only doctors knew how much medicine there is in the average supermarket vegetable rack, says Dr Aujla, we’d all be a lot better off.
But, as he has written in The Daily Telegraph previously: “Nutrition is so obviously important to any member of the public that I’m often met with disbelief when I describe the mere 10 hours of lectures on the subject that I received during my five-year medicine degree.” Since he graduated almost a decade ago, little has changed – yet.
But the first shoots of change are appearing. Recently, Bristol Medical School ran a full month’s course, designed by Dr Aujla, on culinary medicine. It included modules on weight management and portion control, fats, the “Mediterranean” diet, vegetarian diets, protein diets, paediatric and geriatric diets. It is a specialist option for third-year medics and partners each student with a patient from a local GP surgery. The patients have some medical problem (perhaps obesity, kidney disease, an eating disorder, or high blood pressure), and the students and patients will devise diets and recipes to help their conditions.
Dr Aujla is no health nut; he does not claim magical properties for “super-foods” or weird diets. He just wants us to realise that good health largely lies in good diet.
It’s neither radical nor newfangled. Although we largely seem to have forgotten this, nature provided a good deal of medication before we got hooked on pills.
Our great-grandmothers knew that fish was good for you, for instance. They didn’t know why, and they’d never heard of omega-3s, the little miracle-worker found in oily fish, but they knew, back then, it was important. Today, we know more about why, but we don’t always put this knowledge to use. Professor John Stein, of the Institute for Food, Brain and Behaviour, says our brains contain five grams of DHA, the long-chain omega-3 fat that “oils” the brain for rapid thinking. Another omega-3, EPA, also from fish, helps to reduce inflammation, which can lead to hardening of the arteries, high blood pressure and heart attacks. It also helps relieve mental disorders.
For children, increasing intake of omega-3s can improve reading, and help those with ADHD and autism cope better. In adults, they can reduce anti-social behaviour and violence, because a more rapidly acting brain enables people to control themselves better. (Several studies in young offenders’ prisons have shown a 30 per cent drop in violence when inmates consumed a healthy diet including fish oils.) Omega-3 also reduces the chances of high blood pressure, heart attacks and depression.
And that’s just fish, and just some of its health benefits. If we ate more fish, a lot of fruit and veg and whole foods, and a little good-quality protein, we’d be doing ourselves and the medical system a big favour. But there’s still a long way to go.
Dr Aujla needs the buy-in of doctors or practice nurses, because they are the ones in touch with the patients, who can persuade them to give healthy eating a go. He’s quick to admit that our already overstretched GPs are too busy to give personal cooking lessons to patients, or even to spend much time counselling them on diet. But his hope is that, by themselves becoming clued-up about nutrients and proficient in the kitchen, family doctors will be the catalysts for change in their patients’ lifestyle.
It seems he is pushing at a half-open door: the Royal College of General Practitioners has already accredited four of his modules for inclusion among the optional courses doctors can take for their continuing professional development (CPD) requirement.
Culinary medicine is a discipline in its infancy in the UK, but in the United States, it’s far more well-established. The field was pioneered by Dr Tim Harlan at the Goldring Centre for Culinary Medicine at Tulane University, which was founded in 2012. Almost a quarter of medical schools now teach culinary medicine courses to trainee doctors in the US, where the 20 accredited modules include education around treating problems such as impaired renal function or congestive heart failure through diet. Dr Aujla is slowly adapting them all for the UK.
He’s a long way behind, but the Bristol course is a start. So is the session I witnessed, at which there was no shortage of enthusiasm. Lizzie, one of the participants, will join a Brighton practice in the autumn, working four days a week. She has already identified a community kitchen where, on her spare day, she will organise cookery courses for her patients. Another participant could see the benefit for his diabetic patients and thinks he might persuade the local authority to support courses for them in the local college. A third told me how important this sort of relaxed, enjoyable intervention with food could be for his patients with eating disorders. “It would be like AA,” he said, “with patients becoming a mutual support group.”
If reaction to this single course is anything to go by, it won’t be hard to convince doctors to embrace culinary medicine as part of their CPD. Arguably, though, to make the biggest difference, the subject must be taught at medical school, as it is in the US, and as Bristol Medical School is trying this year.
With the ever-increasing demands on teaching time, squeezing in another course would be far from easy, even if the gains are obvious. But if doctors don’t lead the way on this, then who?
Diet and nutrition could be key to saving our health service - yet there are only 6,000 dietitians and qualified nutritionists in Britain. It’s a tiny profession, and there are just not enough of them to help the millions of patients who could do with their advice. Besides which, advice on its own seldom works. As Confucius once told us, the best way to learn is by physically doing: “I hear and I forget, I see and might remember, I do and I understand.”