When the medically tailored meals and food and grocery goes away.

If you haven't taught your patient self efficacy how to make that meal themselves taste good.

Because it doesn't taste good, they're not going to do it, then you've left them more dependent on the medical system.

And what I love about food is medicine.

It's about taking control of your health in a very foundational way.

Welcome to Culinary Medicine Recipe.

I'm so happy you're here.

I'm your host, doctor Sabrina Falke.

I was a primary care doctor for sixteen years and went to school for four years to specialize in culinary medicine.

In this work, I get to combine my passionate expertise in both medicine and food to teach people about food is medicine and to empower them to understand what ingredients optimize health and also how to cook those ingredients.

To make delicious meals.

On the show, I interviewed top chefs, doctors, healthcare visionaries, and food service professionals who are making great strides in the field of culinary medicine.

Join me as we continue to explore the amazing world culinary medicine where I will empower you to make changes to your health and wellness with great food right away.

Welcome to today's episode.

I'm really excited to be here with doctor Deb Kennedy.

She is a PhD in nutrition and also a chef.

Welcome, doctor Deb.

I'm really excited that we're having this conversation as I read your bio and see all the different alignments that we have not only with the work that you do, but also so many different hats that you wear universities, community settings, and I really really thank you for being here today to chat food is medicine and culinary medicine.

Welcome.

Thank you for inviting me.

I love it when I meet somebody who loves food as much as I do and loves to get in the kitchen.

Yes, this is getting ahead, but I love your last It's like, if you're not finding me doing all the million hats and I'm wearing, I'm most likely in the kitchen experimenting or perfecting.

I don't know if one can ever.

Perpect it please.

I don't know about you, but the more stressed I am, it's you know, some people meditate.

I cook because.

I just think about one thing when I'm cooking and it's real mindfulness for me and it always has been ever since I was little, growing up in a stressful family, that was the one safe, peaceful place, and I love it.

That is fantastic that you discover that at an early time in your life.

That's so good.

It's funny because I'm totally digressing before even get started.

But I find it so interesting when I talk about the pillars of wellness and finding that activity that is zen, and yes, for me it's chopping vegetables, and I realize for other people that may be the opposite of zen.

So our goal here is to help maybe maybe nudge a few people over toworth getting in the kitchen and chopping away.

Yes, we've been doing it for a million years, so you're welcome.

Everybody's welcome.

Okay, we're gonna get to business.

So food is medicine, culinary medicine.

These terms are buzzing around and I feel like they are more than they were before, which is really great.

And sometimes we can get lust in in the buzzwords.

So I would love for people to understand what is what is the difference, what is food is medicine?

And where does culinary medicine fit into that.

Right.

Well, I will start by saying in twenty twenty two, when the Harris Biden administration created that Hunger and Nutrition and Health Strategy Plan, that's when food is medicine took off.

Right.

That's there was one physician who had created a book on it, but no one really knew about it.

But once that started, I mean, it rose.

And I was part of the complementary Alternative medicine in the early nineties and the same thing happened.

It's shot like a rocket, right, And you know, food is medicine is really I and I wrote down the official definition from toughs because there's some nuances in it.

So it's food based nutrition interventions in healthcare intended to treat or prevent disease, centered in food equity, which I love, with a focus on nutrition security.

So what we tend to see is that food is medicine.

You can't like slice it away from food insecurity.

The two are really inter woven together, and it really is about providing food education, skill building in the realm of food.

So I like to say, when someone is given a recommendation or a prescription by their clinician, a dietitian or a medical doctor.

How do you translate that into what shows up on the plate.

That's the culinary medicine piece.

So the doc says.

You need to eat more vegetables, what is it you need to learn to do in your kitchen with your individual palette, what you've got in your fridge, and your cultural heritage to have that show up on the plate.

So right now, food is medicine is getting a lot of attention.

Culinary medicine still is kind of within the medical world.

And again it's the same thing we saw in the nineteen nineties when complementary alternative medicines started.

The docs wanted to learn how to be the act upuncturists and the herbalists and all that, and then I'll fade away, and then you'll have people who actually can be the at the elbow support because clinicians are so busy you know it as well as I that they aren't going to be out there in the community with individuals.

So culinary medicine has kind of been pushed to the side.

So I've been really loud about it, because when the medically tailored meals and food and grocery goes away, if you haven't taught your patient self efficacy how to make that meal themselves taste good.

Because it doesn't taste good, they're not going to do it.

Then you've left them more dependent on the medical system.

And what I love about food is medicine.

It's about taking control of your health in a very foundational way.

So when you said, you just mentioned that it goes away.

So can you like a medically tailored meal.

Or produce prescriptions?

What is it?

What do you mean when you say it goes away?

Right?

So in some states there are a hand like about a dozen states that actually give medically tailored or medically supportive meals, groceries and produce.

And what the government and research is asking us to do right now is dose and duration.

So if you come in and you have diabetes, how long do you need to receive that food for your hemoglobin A one C to come down?

And we know that happens quick because that's why everyone's studying diabetes and food is medicine right now, and your blood sugar levels, how long do we need to do it?

And then when you reach clinical parameters, that food no longer is being given to you.

For a lot of people in the healthcare field or outside the healthcare field.

This is incredibly confusing.

And what I have found, and I'd love to hear your take on this, doctor deb is there's this concrete Okay, we give a meal, so medically tailored meals.

Someone gets a meal they have to heat up in their house.

Everything has been done for them, and you can measure like you mentioned the parameter so hemoglobin a once see that being the measure for diabetes.

It's harder to measure how many meals somebody cooked at home or what ingredients they may have chosen to cook said meals with.

And in my experience with the work kind of nationwide and working on advocacy and really pushing things forward, that's been trickier with culinary medicine is looking at outcomes.

How do you measure the outcomes.

So people see that there's a decrease in healthcare costs in the big picture.

Have you had that experience, Well, yeah, this is all about So I have a background of value based medicine, and so you're touching on value based medicine, which is we're not just looking at the short term effect dropping in hemoglobin a once see, We're looking at the long term effect, right, is the patient going to become healthier and be sustainable when we look at it from you know, a healthcare standpoint.

That's why it's hard for there to be a cost structure that is sustainable because insurers and healthcare systems need the money now.

They don't want to wait the year, two years, five years, ten years to see these billions of dollars of savings.

If you look at the toughs research, I mean, we're talking billions of dollars of savings.

It will happen, It is there, but they want to see it now.

And you know, we talked a little bit beforehand, and you're a specialist in lifestyle medicine.

It doesn't happen just now, you know.

And that's the thing.

And I just want to bring up just a personal story.

So when I was in my doctor program in my twenties, I was diagnosed with non Hodgkins limb foma and I was given two weeks to live because there was no treatment back then.

And so I did a bit of chemo when it didn't work, and then I went and did holistic complementary alternative medicine and that took years.

That took years.

That wasn't a quick fix.

And so I always say to people like your decision to go on that healing path can take a while, but a lot of people like to look at it through the western medical lens of you take a pill and you're better, and I don't know, you take a Z pack, what you're going to feel better in about forty eight hours and it's ten days.

But that's not what it's like when you take ownership over your own health.

It is a choice that you make each and every day.

It's actually two hundred and twenty choices you make each and every day, and if the majority go towards health, well that's where you're going.

Thank you for sharing that story.

I am really the word happy is not the right word.

I am thrilled and honored that you are here in this world to have this conversation, and.

To think that you were so young.

I mean, you think of being in your twenties and all that was in front of you and what you were faced with, and I commend you for choosing the enduring path that has that you lived and are here thriving to talk about, but also being able to then.

Carry that forward in your work.

So thank you.

Yeah, I don't want anyone ever to struggle like I did.

I mean I was, I took my doctoral orals.

No one knew more about nutrition than I did.

I'm sorry.

The person that knows the most about nutrition is the person who's just about to get their PhD in nutrition, and I did.

I was a scientist, so I'm like carbs, fat, protein, good, bad.

It was all over the place, and I wished for someone to be there with me to let me know that, Yes, after chemo, all I could stomach was tutsuro lollipops and Pepper's Farm goldfish.

But that was just for a couple of days, and I didn't have to feel guilty about it.

And you've touched on this a few times.

That sense of the goal is.

To empower people to be able to do for themselves, and that skill set takes longer.

Yet we do have outcomes that show it that improves outcomes, and that is the goal.

With culinary medicine and also with lifestyle medicine, with CAM so complementary and alternative medicine, there's so much movement towards prevention improvement.

When someone has a diagnosis and someone sometimes even reversal of diseases, which.

Is really good.

And continuing down the road of who pays for this, sometimes people think of preventive medicine or complementary ultrar medicine or lifestyle medicine is something that is only for certain people that can have that extra income to spend on these.

So how is it playing out?

And I realized this conversation and the answer to this is going to be very different even six months a year from now.

But how is that playing out with payers?

So insurance companies, medicare medical.

Yeah, so up until very recently, there were states that got what was called the eleven fifteen waiver, which is a medicaid waiver, and you're allowed to use that those funds from medicaid to buy the food that you want to put in medically tailored meals or produce prescriptions or medically tailored groceries.

And it's supposed to be for a year and you decide whether or not that's efficacious and feasible and sustainable and all that, and then it's supposed to go away.

And the best I mean, if you want to look where it's being done really well, look at Massachusetts.

Now.

The thing is just because your state has an eleven fifteen waiver and there are nineteen states that do and use it.

With food is medicine, you have to get the state to agree.

So I'm in Vermont and I'm almost finishing up a statewide survey of what food is medicine is happening here.

Now we've had an eleven fifteen waiver for decades, but doesn't mean the money's there.

This state has to pony up and say, okay, you can use this money from the state to pay so state pain is one option.

In medicine, you have what's called a shared medical appointment.

Now this was known back in the days of cam right.

So you as a physician, Let's say you're a breast surgeon and you know you're working with people with breast cancer, and so you invite ten of your patients in.

They're around a table and there might be an RD there and a chef who are talking about nutrition education, and the chef's translating that into what shows up in your plate.

And you have the patient all talking and use the doc pulled one out one at a time for maybe five minutes, look at prescriptions and blood pressure and all.

That that you need to do.

And then they go back and everybody's around the table talking about what works and didn't work for them.

So shared medical appointments is another one.

We also, my favorite is the one out of North Carolina.

So that is doctor Lumpkin, who is in charge of the Blue Cross Blue Shield in North Carolina.

And they have what's called the farm Share, so you have a coordination between the farms, the community centers, and healthcare.

That's the trifecta, right, those that grow it, and you know, the healthcare provider and the community based organizations are the one that kind of combine it all.

What he went in and said was, Okay, who has the most to gain here?

I mean, it's insurers in saving money and still in it's healthcare.

So who should be paying?

Right now?

I'll tell you.

In Vermont, we've got farmers.

Who are working like fifty hour weeks because ten of those hours they're writing great to provide the food for the clinician to give to his patient, and that's backwards.

So whoever has the most to gain, I say, should be the ones to pay.

So he looked around and he goes, right, who's already giving food to people in North Carolina and it was dozens of community based organizations.

He's like, why don't we fund them?

Because that system's already in place, And so Blue Cross Blue Shields in North Carolina is paying the community based organizations to reach out and provide that food, that support that culinary medicine skill building piece.

I love that.

That to me is my favorite because I always look at who is the most to gain.

I'm not talking in terms of how them.

We're just talking finances right now, and it's the organizations that are are overseen at all, and we already have a system in place within our communities, but we shouldn't also put the burden of all the financial burden on these local not for profits.

It's food banks, food shelves, and that's what we're seeing happening here in Vermont.

It's not sustainable.

People will get a CSA, a share you know, for a season, and then it goes away, and that's not fair for anybody.

In this scenario that you are talking about in North Carolina.

That's really great.

Like you mentioned this trifecta.

So then if the community centers are receiving the money, are they receiving it.

From the insurers?

Yes, okay, the insurers supporting them.

So Health Affairs April twenty twenty five was totally dedicated to food is Medicine and you definitely want to go pick that up.

It's actually free online.

Health Affairs April twenty twenty five.

And so doctor Lumpkin, he has an article in there just about this.

It's the newest, greatest.

We're starting to see trickles of research.

You know, what's working, what's not working, because we have to remember this is a very early phase development of a whole new system of you call it medicine.

I call it connection.

Yeah, so we don't know it all, no.

And I actually I like that you're bringing up the work because some people don't like the word food is medicine because you think of medicine, you think of a pill, or you think of the sterile environment of the healthcare system.

And a lot of this work and where people are spending their time are in their community setting.

So bringing people.

And the resources, so this just sounds absolutely incredible, really makes a lot of sense.

So we're deep diving into the United States, but of course there are people all over the world and culinary medicine and food is medicine is being talked about.

And I know, Deb you've had a lot of many years in your life that you lived in Canada, so I don't know if you've had any experience of how this is playing out in a place like Canada or elsewhere where the healthcare system is different.

Yes, So I spoke I'm actually going to speak at the Canadian Nutrition Society.

I actually gave a talk there on culinary medicine and a thousand people showed up and I was like, wow, definitely the interest is there.

And then I spoke to an organization and I don't remember the name of it right now, but in Canada.

It's what I love about how they're looking at it is they're looking at the different cultures and the essence of the food in those different cultures and really eating based on your cultural heritage, and they're looking at it more about connection to food versus medicine.

So I don't think it's maybe it's food as medicine, but it's like food as cultural something and I don't remember exactly what it is, but they reframed it and they're at the very very beginnings of starting to look into this.

So I do know that there are like the University of Alberta is part of the Teaching Kitchen Collaborative, so that they're doing work with that's a CIA Culinary Institute of America and Harvard can partnership with the Teaching Kitchen Collaborative, so they're they're providing some research there.

So there's a research hub out in Alberta.

But there's there.

They're a little bit behind, but maybe they're forward, right, you know, they're not calling in medicine, so maybe they're way ahead of us.

So I don't know.

Also, I know in in uh United Kingdom, there's a company called ned pro ne E d Pro and the physician there he reminds me of you.

He is he has a rounded black bag.

Of all these wonderful like food and you know, mindfulness and exercise and all that kind of thing.

So he does a teaching kitchen where and he's in India Africa coming to the United States where it's called Sea one Do one and then they go back to their community.

So they'll go for a day of cooking demonstrations.

They'll then the next day do the cooking themselves, and then they go back to their villages and they will actually make the healthful food for their villagers.

So it's a way to provide healthful food and it's a way for community members to make a living.

So we see it happening with different flavors in different countries.

In medicine, we have you know, see one, do one, teach one.

So it's the same concept and I know it too, Lane at the teaching kitchen at gold Ring, that is a big piece.

So the med students are taught how to make.

These meals, and then community members come and the med students are the teachers for it.

And that's of course still in the medical setting, yes, with community members and what you're describing sounds just that much more reality based and a lot of ways of going into people's own spaces and homes.

And that is one thing that I hope is coming through in our conversation for our listeners is that it's not one size fits all.

And I think that's the.

Part that there's such sterility of kind of this rubber stamp of this is the healthy meal.

And I'm doing kind of air quotes with that and realizing that what feels like love and home to me and you and every person who's listening is going to be different.

And I was born and raised in Mexico City, and the food that feels like love to me, it's gonna be very different than someone else who grew up in a different part of Mexico or who moved to different parts of the country.

And to help people be empowered.

And I know this is a lot of the basis of your work to empower people to then be able to take that information.

So teach the teacher essentially, or I don't know what term you use for it, but I'm hearing from you that a lot of it is that individuality that it really is to help understand the big pieces and then adding one spices the spice of life that again will be individual right.

So you know, COVID really showed the lack of trust that a lot of what we call the end of the road, the individuals that live at the end of the road, they're typically historically underserved, had very little faith in the medical system.

I took a note on that.

But also I'm going to mention the Food Coach Academy because I've been working on that for six years and instead of a recipe, I do a master recipe.

So, for instance, build a stew build a taco, build a casada, build a soup.

You choose what type of protein you want, what type of grain, what type of vegetable, and what type of herbs and spices.

That way, I'm not asking you to go out and get something you can't afford, might not like, and are going to end up wasting.

Also for me, I really you know, and I've been around the block.

I've been doing this for like thirty five years, and it all comes down to that connective piece.

And I know in every community there are leaders, and if we can train them to go train their neighbors, that's how we get to the places that we've not been able to get to in population health.

Yeah, and so I train these food coaches to honor an individual's decision making.

So it's all based on motivational interviewing, which I'm sure you know about in lifestyle medicine.

And when I started the Weight and Wellness Center at Dartmouth, that was one of the first things I did.

I trained everyone from the front desk staff to the clinician in motivational interviewing, and most of our patients cried because they said, no one ever asked me what I wanted to do.

People I usually I get yelled at because of my weight, and they were so relieved, and I'm like, check, remember this, that's.

Gold right there.

Okay, So if we're going back to who's paying for this?

Right?

So you mentioned your coaching academy.

Do you feel like it's been able to fit into our current healthcare system or who ends up paying for this?

Yes, I'm shaking my head.

No, people not yet, just like health coaches weren't yet.

You know, it took health coaches about thirteen years to create a certification to allow them to be able to be billed right, and we're almost there, some of us are there a little.

So I knew it took time, and I watched what was happening with health coaches, and I already started working with the American Culinary Federation to create this certification.

If something has to get into medicine, you know you have to be certified.

And if Medicaid Medicare picks you up, you know your golden and you're ready to go because you can have insurance base.

So our students come from different walks of life.

I have some that come to me that can't afford it, and I work with them to identify a local not for profit to pay for them to come, and I have and it's wonderful because they can start serving their community within the first class.

They can do some cooking demonstrations and it is so powerful.

So who would end up paying for them?

It would basically be again in that shared medical visit.

You know, that's a way you can capture several different experts at the table and pay them at once.

It's also philanthropy work.

We're not where we are yet.

We're following health coaches and they're not there yet either, so it's kind of the same trajectory.

I so appreciate your growth mindset, not yet, because we are moving forward, and I really appreciate that you see this as a long road.

It is so taking these greater conversations and the empowerment being a piece of it.

So if someone is being discharged from the hospital and they have congestive heart failure or diabetes, and they do qualify for a medically tailored meal, and then the goal then is slowly migrate to where they start making more decisions on their own and are empowered.

With the tools to be able to cook for themselves.

So whether it goes from a medically tailored meal to then a produce prescription.

So for them to know what is in that box, what is the vegetable, how do I cook it?

How does it fit into my cultural tastes and taste buds, and ultimately with culinary medicine, to be able to cook on a regular basis for themselves.

That's what I see as the beautiful spectrum of the movement.

Yes, how about you, deb what is your optimistic outlook?

Right?

So, but you are absolutely one hundred percent correct.

It is a movement with a moving target.

So our medical system right now is imploding in and of itself and that is not news to anybody, right, And how we can survive as a medical system is huge.

That's above everything else.

That's like the background noise.

And here comes this new initiative trying to fit in.

But the foundation is like wobb league because we don't know where the medical system's going.

And you know, it really is is going to take time.

Just like you said about the prescription, Your healing journey with food will take time, and you will eat things you love and things that you wish you didn't have to eat, But you're gonna learn how to make them tasty, and you're gonna mess up sometimes, right, And the same thing's happening with culinary medicine and food is medicine because the voice right now is mostly coming from a clinical point of view.

When we look at the.

Progression, So what happens when someone gets on a medically tailored meal or medically tailored grocery.

It starts with the clinician.

It starts with that prescription, and so we look at that step one.

Clinicians need to be trained in nutrition to know the importance and all of that, so we've got something to do on step one.

It then goes to the registered dietitian if they need something medically tailored, because the dietitian is the one in the medical system who knows how to do that, they're pretty much they got that covered.

We don't have to train them in anything new.

They know how to do that already, and then they'll pass it off to And what my research shows is one of several different types of individuals.

It'll either go to the community based organization, or it'll go to a coordinator within the office, or it goes straight to the farms, the CSAs and so we see in each part, each step there needs to be some training.

Some of my farmers are coming in to me saying they come to me, but they didn't have a talk with their clinician.

They're asking me all these medical questions.

I don't know.

I don't know how to answer them right.

And we're learning.

We have to learn each step of the way.

But you can have fun along the journey because I know we all want to be like better now.

I want to be better now.

Oh that's the nuance in life, people, I can tell you, and yes, I want it to be better now right away.

And that's not how it happened.

But I have good stories along the way.

Oh that's good.

That's really a good way to start wrapping up.

Now you've mentioned a couple of your hats.

I am holding one of your incredible books here, The Culinary Medicine from Clinic to Kitchen, and it is an incredible resource.

I know it's one of many of your books.

Yes.

So when I was part of the teaching kitchen collaborative that we've brought up many times, I was the first person in charge with the first cohort.

My job was director of best Practices, so I was to find out what curricula already existed, what competencies already existed.

There were crickets, there was little to know.

So I asked them at the time if they wanted to take that on and I would lead it, and they said no, and they had so much else going on.

So I'm like, Okay, I'll go do it myself, because that's what a stubborn iris from and does.

I'll go do it myself.

So I gathered forty experts from around the world in nutrition, medicine, dietetics, flavor, motivational interviewing, mindfulness, all of that, and we came up with nutrition recommendations and then we bunted it over to a dozen chefs and said, okay, chefs, the docs are the experts are saying they need that people need to eat more fruit.

What is it they need to learn to do in the kitchen?

And so together they all called over twenty five hundred articles.

So it's very research based, and we came up with culinary competencies for nutrition recommendations and the one that you just went through from clinic to kitchen, the essential foods, that's the first one, and then the second one is maximize flavors, and then we have one called in the Kitchen if you want to learn how to build a teaching kitchen.

The diets and the basics, The basics, The basics I love because that's everything from what goes into influencing someone when they eat.

Everything from the music that's played behind you in the restaurant to did you just exercise?

Are you smoking?

Are you male?

Are you female?

There are so many factors that go into it, and that's what I love because I like the science and the art when it comes together.

So that is I birth those babies.

Let me tell you that was a four year project, a labor of love, and I just hope people get as much out of it as I did in my whole.

Team Lucky World, Thank you for your birthing.

I can't imagine what that must have been like.

That's many children, very very quickly, back to back.

I wanted thirteen, but that didn't work out because of my cancer.

I did end up having two, so I think big all the time.

I love it.

Yeah, it's interesting.

The TKC just a few weeks ago launched a toolkit that they've they've birth into the world.

So I don't know if you take a look at that.

Yes, I saw that on teaching kitchens.

Yes.

So as we finish up, I'm going to ask you, so you mentioned the books.

When you think back to.

These thirty years and counting of the work that you've done, what is one that you are incredibly proud of that you just that you just sit in all your career years and say, wow.

Maybe it could be the books, but what else other than the books?

I was listening to a podcast.

What would your younger self say of where you are now?

Would she know that where you are?

And to me, while we have our students going through the Food Coach Academy, I had somebody reach out who just joined, who was fifty years of age and had four heart attacks already, and he wants to do this before he thinks, you know whatever, and that he wants to give back.

This is everything coming together for me.

It's about loving everybody for who they are and seeing beyond it all and just the connection piece.

It takes my science mind, my medicine mind, my cooking mind, and my just can't we all get a long mind?

And it came together in the Food Coach Academy and I didn't realize it till I'm getting feedback from students and people that they're helping.

I got there.

I wanted to be a.

Clinician like nobody's business, but I I didn't know I had non Hodgkins lymphoma for ten years before, and I knew I couldn't stay up for the twenty four hours, so I'm like, oh, I'll just go get a PhD instead.

That's easier.

Not people.

But it all led to the place that was supposed to lead to, where we're healing people through food, through their ability to heal themselves because they can.

They can.

I have nothing else to add to those beautiful finishing words.

How can people reach you?

So my website is probably the best way.

Doctor DEEB.

Kennedy dot com.

That's Dr dB Kennedy all one word dot com.

And I'm also on LinkedIn.

I got a lot of followers on LinkedIn.

I'm very worthy on LinkedIn, very opinionated.

So if you want to hear some of that, follow me on LinkedIn.

Thank you so much.

This has been really insightful and really a joy to have this time together.

Thank you, Thank you so much for inviting me.

This was a real treat.

Thank you for listening.

I hope you got as much out of it as I did.

We will be taking a short pause for summer, and if you missed any of the first or second season episodes up to this point, it's a great time to catch up on what you've missed.

I hope you are able to enjoy a pause and a change in your routine over the summer, and we'll be back with further episodes.

Please leave us a rating and a review, and mention our show to others who you think could use this information.

That could be your doctor, It could be somebody who works in the food service industry who's interested in the health components.

It could be a friend that is working on their health journey.

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Until next time, Sanud and Bona Pettie.

All content provided our opinions expressed in this up episode art for informational purposes only and are not a substitute for professional medical advice.

Please take advice from your doctor or other qualified healthcare professional.