The Kitchen Prescription For Better Health

Dr. David Eisenberg has dedicated his life’s work to the truth of this adage: An ounce of prevention is worth a pound of cure.

Family tragedy catapulted him onto a mission that took him through Harvard Medical School and to China and back, armed with the conviction that Western medicine does not have all the answers.

For decades, he has been researching and teaching the food/lifestyle/health connection, leading him to create the “teaching kitchen” concept. Through conferences and partnerships, dozens of such facilities in hospitals, corporate cafeterias, botanic gardens, a library, and even one high school, are now teaching medical professionals, corporate employees, students, and curious citizens how to cook and eat in ways that can extend and enhance the quality of their lives.

Food Technology caught up with Eisenberg recently to understand more, including how the food industry can play its part.

You are a medical doctor. Conventional medicine tends to focus on treatment after illnesses occur. How did your interest in preventive lifestyle medicine evolve?

Both my father and grandfather were bakers. My father went to the bakery at four in the morning and came back at eight at night. He was my hero. As a kid, I went to the bakery on weekends to be near him. He had me crack eggs, braid challahs, and put cream into eclairs. As a consequence, I fell in love with baking and cooking and food. When I was 10, my father tragically died of a heart attack at 39. Three of my grandparents died within a year of his death.

As a preteen, I decided to go to medical school to understand what happened to all these people.

How did China figure into your career progression?

In 1971, President Nixon sends Henry Kissinger to Beijing. The New York Times sends an editor along who is rushed to the hospital with appendicitis. Three days later he still has post-op pain. A Chinese acupuncturist puts skinny needles in his kneecap and elbow and his pain is obliterated in seconds. This ends up on the front pages of The New York Times, and it is the pathophysiologic shot heard round the world.

I end up at Harvard College the next year, start studying Chinese and request an independent study around Chinese medicine. There's only one book on Chinese medicine in the nearly hundred Harvard libraries: The Yellow Emperor's Canon of Internal Medicine. In the first chapter, I'm stopped in my tracks by two statements. First, prevention is always superior to intervention. Second, how we eat, move, and control our thoughts impacts our health and determines our recuperative capacity.

Six years later, President Carter normalizes relations with China and The National Academy of Sciences looks for the first dozen Americans to be exchange scholars to Beijing. I go to China and study herbs, acupuncture, meditation, etc. I'm blown away by this continuing epiphany: What if we could teach people to eat, cook, move, and think more healthfully, plus become mindful in their enjoyment of food and their satiation?

The idea for a teaching kitchen was born in my head almost 45 years ago as an exchange scholar in Beijing as one of a dozen Americans among 1.1 billion people.

So, when did you start to act on this notion of teaching people how to cook and eat?

In the 1990s, I had the idea of putting teaching kitchens in hospitals to teach people a different relationship to food. I brought that idea to both the Harvard School of Public Health and the Culinary Institute of America (CIA). They suggested we start with a conference to educate health professionals about food, which launched the Healthy Kitchens, Healthy Lives conferences. We’ve held 18 of them.

We look at the science of foods we should eat more of or less of and why. The chefs then translate that into quick, healthy, delicious, affordable foods. The registrants taste hundreds of recipes over three days.

What happened next?

Then they get to make some of those recipes in the kitchens and take those recipes home. This experience transforms many of these people for life because they realize anybody can do this. The conference also teaches about exercise, mindfulness, and behavior change.

Did it work?

After doing that conference for about a decade, I asked people who had returned to the conference after some years if any of them had experimented with building kitchens in their hospitals. About 100 hands out of 400 went up.

In about 2014, I realized it was time to bring together universities, medical schools, hospitals, and corporations with kitchens being built as learning laboratories to see if they would share notes, successes, and failures and imagine a future where these teaching kitchens could be used both as learning laboratories and research sites. That led to the Teaching Kitchen Collaborative, of which I also am now the executive director.

You have been involved in a lot of research projects. Which ones changed your opinion and eating habits most dramatically?

I was the principal investigator on the first attempt to take all this information from that conference and put it into the Teaching Kitchen curriculum.

We did the first study with two groups of 20 CIA employees who were not chefs—administrators, people who took care of the facilities, the chief financial officer. They met every Thursday night for 16 weeks to watch the chefs cook, taste the foods, and observe the techniques. Every other Saturday they cooked. I'm fond of Michael Pollan's statement: “The night after you watch the NBA playoffs, is your basketball game any better? You can't just watch this. You must do it.”

This was, in the words of my culinary colleagues, “technique driven, recipe-inspired education.” Because, if you can make one clear soup, you can make 50. If you can sear a piece of meat, you can sear tofu and fish. If you can make one whole grain, you can make 40 whole grains and turn them into gorgeous salads.

They also learned how to read labels, to shop more wisely, to think about behavior change with a health coach, and to be more mindful as they cook, eat, and live.

This sounds like the first expansion beyond teaching medical and health professionals. Is this leading to a broader plan to reach consumers?

Yes. This education can be applied to hospital patients, employees in a work setting, consumers at a YMCA. We now have teaching kitchens at botanical gardens. The public library of Philadelphia has a beautiful teaching kitchen. Imagine them in retirement facilities. Most importantly, imagine them in K–12 schools—the ultimate target—when children are young enough to see it as a fascinating skill. It's like teaching a kid to ski before they're six or seven. They're not afraid.

Let’s go back to the early focus of the teaching kitchens on health-care professionals. Is there research that indicates if they change their own eating and cooking habits, they tend to do a better job of convincing their patients?

The work of Professor Erica Frank in Vancouver has shown that doctors who participate in certain behaviors are more apt to advise their patients to participate in those same behaviors. The percentage of conference registrants who are MDs is growing, as is the percentage of MDs interested in participating in teaching kitchens. The field of culinary medicine is now sweeping medical schools.

What else needs to happen?

A bipartisan House of Representatives resolution approved last May I think will supercharge this trend. The American population is getting more obese, more diabetic, more expensive, yet doctors are not required to know how to advise patients about nutrition. The resolution says, either improve and increase nutrition education and demonstrate competencies among doctors in advising patients around food, or the U.S. Congress reserves the right to withhold $10.3 billion of funding for all medical resident and fellow trainees in the country. I think that's going to change the whole conversation.

Medical schools are going to be required to increase nutrition education. In my view, trying to teach doctors or dietitians how to advise patients about enhanced food choices in the absence of a teaching kitchen is like trying to teach people about the benefits of swimming without a swimming pool.

If a health-care professional is meeting with a patient once or twice a year for 20 minutes, no matter how much instruction they have had through the teaching kitchens, how much is it reasonable to expect them to pass on to their patients?

You've just described my life's work. No doctor can do this in three minutes of an 18-minute visit. I think some of the art in the doctor/patient relationship is getting the patient to appreciate they would benefit from a discussion about their relationship to food. That in and of itself takes training.

If a doctor can earn the trust of a patient, then it's a hand off if there's a doctor and a chef and a registered dietitian and an exercise physiologist working in a wellness or teaching kitchen setting as a whole and the referral is made.

If the light bulb goes off in the health-care professionals, then they can get the light bulb to go off in the patient, then there are resources, is that the answer?

There's still a missing link. The Teaching Kitchen Collaborative this year intends to launch its first multi-site prospective randomized controlled trial that would include several hundred patients at four university hospitals, each with a teaching kitchen and a team of a chef, doctor, registered dietitian, and exercise, mindfulness, and health coaches. The thesis is, if some are given usual care alone while others receive usual care plus a teaching kitchen, those that have access to a teaching kitchen once a week for four months then once a month for eight months will be changed. If we can show their biomarker changes—weight, hemoglobin A1C, blood pressure—we can go to the NIH (National Institutes of Health) and the private sector and say now we need hundreds of thousands of people in these studies. Because if we can show they change and it saves money, then the engine turns over—drop the mic.

Could that be the ultimate solution?

Here's the paradox: First, the biomedical community doesn’t necessarily think this can work because they haven’t seen enough evidence. Second, there's no money there for them; they get paid to take care of sick people, not to prevent illness. However, the group that pays the bills—the self-insured private companies of America—are incredibly fascinated by this prospect and would be willing to invest in it.

Here's the irony: The skeptical medical community that has no financial incentive and doesn't know how to do this yet does know how to evaluate it.

The business community is incredibly interested, would put money down on the table, but they don't know how to evaluate it. So, the paradox is how do we get the skeptical biomedical community and the interested business community paying our bills to say, "Okay. Let's see if there's a pony in that barn. Let's see if we can make this work.” Because God help us if we don't.

Is there a role for food manufacturers to partner with health-care professionals in helping people improve their eating and food preparation habits?

I think they must. There are food manufacturers who are knowledgeable about the health impact of their foods. Some food manufacturers want to make healthy, sustainable food made from regenerative agriculture. There are those that want to help us have a longer shelf life, or figure out better ways of freezing, canning vegetables, fruits, nuts, and legumes, etc., at the peak of their selection. They're all good guys. I would love those in the medical and behavioral science world to work with the food manufacturers.

Is there anywhere that's happening yet?

There's been no dialogue. Wouldn't it be great to know which people in the food industry want to work with those in my group to teach parents and children to make better choices, to assemble these things at home, to know where to shop for them in restaurants that are serving healthy ingredients that are delicious, affordable, and often either seasonal or [have] longer shelf life, because of the magic of technology? Why are we in separate silos?

What do you think it's going to take to start those dialogues?

I invite everyone in your profession to work with the leaders of the food as medicine and teaching kitchen community to help each other make this future a reality faster. We're doing similar things, but separately, so let's bring us together. There are soon going to be 51 members of the Teaching Kitchen Collaborative. Imagine if all of them were laboratories to test out and promote the healthier products of the food industry.

What do you wish you saw more of happening on the level of new product development?

I would like to see a way to get healthy, sustainable seafood to the public. That's a technology issue. Is there a way to get more vegetables—fresh, canned, frozen—to the public? Is there a way to get more pantry items to the public faster in a sustainable way? Let's start there. Then you can go all the way to alternative proteins, looking at which ones are healthy and how to make them delicious and affordable. We're all on the same path. 

One of the focuses of the new White House National Strategy on Hunger, Nutrition, and Health is food as medicine. What do you hope to see come out of this initiative and what do you think is the best way the government can influence the way Americans make decisions about what they eat?

At a recent conference, Harvard Law School professor Emily Broad Leib reminded us that most of the agencies giving out hundreds of billions of dollars in food, such as the U.S. Department of Agriculture’s SNAP (Supplemental Nutrition Assistance Program) and WIC (Women, Infants, and Children), are not the agencies that most medical people deal with, which are Health and Human Services, FDA (U.S. Food and Drug Administration), the CDC (Centers for Disease Control), the Department of Defense, and the VA (U.S. Department of Veterans Affairs). What if we brought them together?

I would argue that without teaching people which foods to eat, why, where to shop for them, how to cook them, we're just throwing out a lot of passive, "Here's the food. Good luck." I think instead of giving a person a fish, we need to teach a person to fish.

The medically tailored meal programs are getting much of the attention because the evidence thus far is if you give people medically tailored meals when they leave the hospital, they'll get better sooner, or they'll be less apt to come back to the hospital and the system will save money. But that's all downstream. I think we need preventive measures to help people make better choices before they are chronically ill.

How do you see the food as medicine trend evolving? What are you hoping to see in your lifetime?

I could see teaching kitchens in K–12 schools, in colleges, dormitories, in hospitals, in every medical school, in every nursing and registered dietitian program. I also imagine retirees would love teaching kitchens.

How far are we from that? Is there a teaching kitchen at a K–12 school that exists now?

There's a teaching kitchen in Cincinnati Hills Christian Academy that was just built last year. Now they’re trying to replicate it in downtown Cincinnati in their sister school where it's not fancy people. When you see the pictures of kids who are seven, eight, 10, and 12, learning to cook for their mom and dad and grandma, you just want to weep. It's so beautiful.

We also have members of the Teaching Kitchen Collaborative that only teach adolescents in poor urban environments. Some of these kids have never seen a vegetable, let alone cooked or eaten it. When they have enough skill to make a gorgeous dish for their grandmother who is raising them, or their girlfriend that they're trying to get a date with to go to the prom, and that person says, "This is the most delicious thing I've ever eaten," they will cook for the rest of their lives. That's the magic.

Why have you incorporated mindful eating spaces into your vision of teaching kitchens and hospital cafeterias?

Mindfulness is the practice of being present. When you apply it to food, it’s about being mindful of what you are cooking, buying, and eating. Most Americans are eating when they're reading, watching television, listening to music, doing homework, or talking endlessly. It is mindless eating that leads to obesity. A teaching kitchen that is not centered in mindful study and behavior is a fool's errand.

The first part is to teach people to be mindful. The second is teach them to explore what motivates them to change. It may be to see their daughter's wedding or be able to enjoy retirement with their wife or live to be healthier when they are a grandparent. If they don't know what motivates them, then even if we give them all the skills to cook and eat and think and live more mindfully, they will not do it.

What stands out to you as a big success story that has resulted from the collaborations among chefs, cooks, medical, and public health experts?

The first research conference on teaching kitchens had 120 people. The next one during COVID was virtual and free and had 2,700 people from 75 countries. The third one we did last year had 550 people who paid money—in person and online from 24 countries. The science and the relevance are growing.

What is your number one piece of advice for the food manufacturing industry?

See yourself as allies of those of us trying to help people make better choices and enjoy better, healthier, more sustainable food. Those in food technology and those in health and nutrition and lifestyle are on the same team. Let’s make it so.