2/13/2018 We can prevent disease by using food as medicine - San Francisco Chronicle Opinion We can prevent disease by using food as medicine By Linda Shiue | January 25, 2018 | Updated: January 25, 2018 3:18pm 4 Photo: Linda Shiue https://www.sfchronicle.com/opinion/openforum/article/We-can-prevent-disease-by-using-food-as-medicine-12526155.php 1/7 2/13/2018 We can prevent disease by using food as medicine - San Francisco Chronicle Victoria Ramessar, or “Auntie Doll” to her family, is pictured in her kitchen in San Fernando, Trinidad, the last time she cooked for her family. We worried about Auntie Doll, a longtime diabetic with heart disease, when we learned she had stopped taking statins and rarely saw her doctor, both due to finances. Amazingly, she lived almost two decades after her heart attack. The last time she cooked for us, at her home in Trinidad, I understood one of the reasons why. She had figured out how to heal herself with food — she replaced the white flour in her roti (Indian flatbread) with her custom blend of oats, flaxseed and whole wheat, and made browning, the burnt sugar used to season Caribbean stews, with water instead of oil. Instinctively, Auntie Doll understood the power of food as medicine. In many cultures, food was the first medicine (this is not to minimize the benefits of modern medicine). Discussing nutrition is a way to empower patients to take charge of their own health. In an ideal health care system, basic coverage would be a given and affordable, and the medical system would begin to prescribe and provide access to food as medicine. Auntie Doll was able to survive through a combination of factors, of which her improved diet was one. Proper nutrition, along with exercise, stress reduction and adequate sleep, is a potent agent in prevention of disease. It is also one we can control. Educating the public about cooking real food and providing access to nourishing, health-promoting produce are key steps in this direction. In America’s system of primary medical care, where doctor’s office visits last 20 minutes, it’s certainly easier for a physician to write a prescription than to counsel on diet and exercise, but https://www.sfchronicle.com/opinion/openforum/article/We-can-prevent-disease-by-using-food-as-medicine-12526155.php 2/7 2/13/2018 We can prevent disease by using food as medicine - San Francisco Chronicle we already know this isn’t working. About 75 percent of visits are due to lifestyle-related conditions, at the cost of $2 trillion in 2005, or 90 percent of health care spending. Annual health care costs attributable to obesity alone exceed $100 billion. At least one-third of premature deaths are attributable to our overfed, but malnourished, society. Only 10 percent of Americans meet dietary guidelines. With the exception of certain cholesterol medications, which some studies showed can reverse heart disease to an extent, there is no pill that cures diabetes, hypertension, high cholesterol or heart disease. The best we can do with medication is to slow disease progression, and pills come with side effects. What actually can reverse diabetes and heart disease and also prevent cancer is a plant-based diet. Why not prescribe food, then, as an adjunct to medication? Practicing culinary medicine is a low-cost, accessible and culturally adaptable intervention. This entails educating patients about a healthy diet — one rich in vegetables and fruits and low in processed foods and animal products — and how to cook it. Physicians should share this message, given their role as trusted sources of advice on health, diet and wellness (even though the traditional medical school curriculum doesn’t prepare them to do so). It doesn’t take long to make a difference: physicians who spend 5.5 minutes talking to patients about nutrition can improve patient health enough to reduce or eliminate medications. I practice medicine by teaching patients to cook, knowing that about a third of Americans don’t know how. Changing both medical and food culture won’t happen overnight, and it will take many hands. The medical center of the future would include a teaching kitchen and nutrition education for all. Families with chronic diseases and limited resources would have access to fresh produce through food pharmacies, perhaps even grown on site. And patients who take on the big challenge of https://www.sfchronicle.com/opinion/openforum/article/We-can-prevent-disease-by-using-food-as-medicine-12526155.php 3/7 2/13/2018 We can prevent disease by using food as medicine - San Francisco Chronicle changing their lifestyle will have ongoing support from their medical providers, with the help of health coaches and technology. This vision may seem far-fetched until you consider the health care savings that could be realized by preventing disease: one study estimated that the broad adoption of a diet low in red meat and sugar intake would lead to $735 billion per year of global health-related cost savings in 2050. It’s time to return to the roots of modern medicine, and begin again to harness the power of food as medicine. Dr. Linda Shiue, an internist, is a chef and director of a teaching kitchen for patients in San Francisco. Twitter: @spiceboxtravels Auntie Doll’s Heart Healthy Multigrain Roti (Indian Flatbread) Yield: 6-8 rotis 1 cup whole wheat flour ½ cup rolled oats 2 T. ground flaxseed ¼ tsp. salt https://www.sfchronicle.com/opinion/openforum/article/We-can-prevent-disease-by-using-food-as-medicine-12526155.php 4/7 2/13/2018 We can prevent disease by using food as medicine - San Francisco Chronicle 1 cup warm water canola oil or coconut oil for greasing skillet 1. Make oat flour by pulsing rolled oats in a food processor or high-speed blender. 2. Combine wheat flour with oat flour, flaxseed and salt. 3. Add enough water to make a soft and pliable dough. Cover with a damp cloth and allow to rest for 20 minutes. 4. Divide the dough into 6-8 small (golf ball-sized) balls, then use a rolling pin to Photo: Linda Shiue roll each ball into a thin, flat circle, about a 5-inch diameter. Auntie Doll’s whole-grain roti, served with dal made with yellow split peas. 5. Heat a nonstick or cast iron skillet and add a thin layer of oil. 6. Cook until brown one side, then flip and brown on the other side. 7. Serve warm with dal or any other Indian dish. Trinidadian Dal (Yellow Split Pea Soup) https://www.sfchronicle.com/opinion/openforum/article/We-can-prevent-disease-by-using-food-as-medicine-12526155.php 5/7 2/13/2018 We can prevent disease by using food as medicine - San Francisco Chronicle Dal, which can be made with pretty much any legume, can be enjoyed as a soup or a side dish, depending on how thick or thin you make it. In Trinidad, it is made with yellow split peas and made on the watery side, served as a sauce alongside roti and curry. 1 cup yellow split peas 2 cloves garlic 2 tsp. saffron, turmeric or curry powder salt and black pepper to taste ½ sliced onion 5 cups water ½ tsp. cumin 1 T. canola oil 1. Bring water and a pinch of salt to a boil. 2. Add the rest of the ingredients except the cumin seed, bring back to a boil, then simmer, covered, for at least 30 minutes until the split peas are soft.. https://www.sfchronicle.com/opinion/openforum/article/We-can-prevent-disease-by-using-food-as-medicine-12526155.php 6/7 2/13/2018 We can prevent disease by using food as medicine - San Francisco Chronicle 3. Use a swizzle stick (a type of whisk used in Trinidad) or an immersion blender to thicken slightly. 4. In a small frying pan, heat a tablespoon or two of oil, then add cumin seed. Pour the spiced oil on top of the dal before serving. © 2018 Hearst Corporation https://www.sfchronicle.com/opinion/openforum/article/We-can-prevent-disease-by-using-food-as-medicine-12526155.php 7/7.