Swana de Gijsel — ICE Doctor

Understanding Ultra-Processed Foods

aday — Sun, 02 May 2021 14:02:08 +0000

Understanding Ultra-Processed Foods aday Sun, 05/02/2021 - 10:02 Food is our medicine, but what if it causes disease? May 3, 2021

By Swana de Gijsel — ICE Doctor

The growing interest in the impact of food on disease and its role in the prevention or treatment of disease is being celebrated by the medical field and the culinary arts, and we as physicians are thrilled to be collaborating with a group of phenomenal chefs over the next couple of months to explore how the medical science of food, nutrition, and the art and science of cooking intersect.

Patients often ask us what they can eat and what to avoid. Is there bad food? The answer is yes, there certainly are bad foods: Think of certain berries or mushrooms containing toxins that are poisonous to humans or food that passed its expiration date.

The pandemic recently marked its one-year anniversary and many of us likely remember the run to supermarkets for toilet paper ... and food! Not knowing how the shutdown would unfold or what effect it would have on our food supplies, we found ourselves in survival mode and filled our pantries with canned foods, packaged or instant soups, chocolate and biscuits, and carbonated drinks — all food products we call ultra-processed foods. Interestingly, we also witnessed a revival of people processing their own foods by learning about fermentation and making sourdough, yogurt and kimchi, or distilling beer or kombucha.

It brings up interesting questions: Why are we processing food? What are processed foods, what are ultra-processed foods, and what are their risks and benefits?

Why are we processing food?

Historically, the planet started off with primarily unprocessed plant foods, soon followed by the addition of meat and fish. Processes like cooking, drying, salting and smoking were used for preservation. Agriculture added grains as well as dairy products to our diets and canning, salting, pasteurization and fermentation helped to increase shelf life. Dehydration, freezing, ultra-high temperature and refrigeration and vacuum packing were added in the last century, as well as additives and preservatives. In terms of the preservation process, a shift from home preservation to commercial preservation took place.

When more women started entering the workforce in the second half of the last century more convenient and readily available foods were required (1). This birds-eye view of the history of processing shows us how, from a health population perspective, processing food has been helpful for us to survive resource scarcity and address nutritional deficiencies in certain populations (think of adding iodine to salt to prevent hypothyroidism or fortified iron to grains to prevent iron deficiency). However today, many foods in the diet, such as bread, cheese, chocolate and wine, show little or no resemblance to their starting commodities and are technically highly processed foods and recent studies have found serious health concerns in regards to the so-called ultra-processed foods (2).

What are processed foods and what are ultra-processed foods (UPFs)?

An expert panel of food scientists and researchers developed a classification system called NOVA, which categorizes foods according to the extent and purpose of food processing, rather than in terms of nutrients (3). As outlined below, there are four groups and food products that have undergone the highest level of alteration from their original state end up in group 4, so-called UPF.

NOVA classification system:

Group 1 - Unprocessed or minimally processed foods
Group 2 - Processed culinary ingredients
Group 3 - Processed foods
Group 4 - Ultra-processed food and drink products

Many times this includes additives like sugar, salt, fat, and artificial colors or preservatives. It is estimated that UPFs account for greater than 50% of the calories consumed in the U.S. UPFs tend to be high in calories, sugar, unhealthy fats and salt, and low in dietary fiber, protein, vitamins and minerals. Since many foods are processed in some way, it is helpful to be able to differentiate between different levels of processing.

Here are some of the most common sources of UPFs in the American diet:

Ultra-processed foods including carbonated soft drinks
Sweet or savory packaged snacks
Chocolate and candies (confectionery)
Ice cream
Mass-produced packaged breads and buns
Margarines and other spreads
Cookies (biscuits), pastries, cakes and cake mixes
Breakfast cereals
Pre-prepared pies and pasta and pizza dishes
Poultry and fish "nuggets" and "sticks," sausages, burgers, hot dogs and other reconstituted meat products
Powdered and packaged "instant" soups, noodles and desserts

UPFs and Calorie Intake — What is the latest?

A recent study in the journal Cell Metabolism evaluated the effect of UPFs on calorie intake. In this study, one group of subjects were fed an unprocessed diet or a diet of UPF for two weeks. Subjects in the UPF group consumed on average 508 calories more per day. The difference in calorie intake stemmed from a higher carbohydrate intake. It is estimated that an increase in calorie intake of 500 kcal per day can result in a weight gain of one pound per week.

UPFs and Cancer - What do we know?

In the NutriNet-Santé cohort study from France, subjects are asked to fill out a 24-hour dietary record every six months. Over the course of the study, a 10% increase in the proportion of ultra-processed foods in the diet was associated with a significant increase of greater than 10% in risks of overall and breast cancer (4).

How to Recognize UPF

Read nutritional labels. A rule of thumb: The more ingredients listed, the more processed.

How to Minimize UPF

Cook more and make informed choices of your ingredients and way of preparations.
Eat seasonally and preferably use locally and freshly sourced ingredients.

Stay tuned for our upcoming culinary medicine collaborations with chefs Michael Laiskonis and Barry Tonkinson, exploring health, chocolate and fermentation. Embark on your own exploration of food and nutrition in ICE's Health-Supportive Culinary Arts program.

References:
Processed foods: contributions to nutrition. The American Journal of Clinical Nutrition, Weaver et al. Volume 99, Issue 6, June 2014, Pages 1525–1542, https://doi.org/10.3945/ajcn.114.089284

Carcinogenicity of consumption of red and processed meat. Bouvard et al. Lancet Oncology NEWS| VOLUME 16, ISSUE 16, P1599-1600, DECEMBER 01, 2015. https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(15)00444-1/fulltext

Monteiro CA, Cannon G, Levy RB et al. NOVA. The star shines bright. [Food classification. Public health] World Nutrition January-March 2016, 7, 1-3, 28-38

Hall KD, Ayuketah A, Brychta R, Cai H et al., Ultra-Processed Diets Cause Excess Calorie Intake and Weight Gain: An Inpatient Randomized Controlled Trial of Ad Libitum Food Intake. Cell Metab. 2019 Jul 2;30(1):67-77.e3. doi: 10.1016/j.cmet.2019.05.008. Epub 2019 May 16. Erratum in: Cell Metab. 2019 Jul 2;30(1):226. Erratum in: Cell Metab. 2020 Oct 6;32(4):690. PMID: 31105044; PMCID: PMC7946062.

Fiolet T, Srour B, Sellem L, Kesse-Guyot E, AllÃ¨s B, MÃ©jean C et al. Consumption of ultra-processed foods and cancer risk: results from NutriNet-Santé prospective cohort BMJ 2018; 360 :k322 doi:10.1136/bmj.k322

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The Case for Culinary Medicine

aday — Sun, 08 Nov 2020 21:41:20 +0000

The Case for Culinary Medicine aday Sun, 11/08/2020 - 16:41 ICE's first doctors describe why medical students need nutrition and cooking education. December 3, 2020

By Swana de Gijsel — ICE Doctor

Culinary medicine is a new evidence-based field that blends the art of food and cooking with the science of medicine. Dr. John La Puma, one of the pioneers, published "ChefMD’s Big Book of Culinary Medicine" in 2009 and started drawing the landscape where culinary arts and medicine are intersecting. Culinary medicine aims to help people reach good personal medical decisions and encourage them to control their dietary intake while enjoying and being inspired by cooking and eating high-quality meals that help prevent and treat disease and restore well-being.

As two practicing medical doctors involved in medical education, we recognize the limitations of conventional teaching methods when it comes to nutrition. Lecturing medical students about nutrition in a large lecture hall would fall short. It is well established that doctors would like to be sources of nutritional information for their patients and often feel inadequately educated to fill that role. The medical community has come to admit that reading, understanding and studying a manual before trying out a new device might not be the most effective way of truly comprehending it, especially not for our curious medical students. Seeking a more interactive way to teach medical students about the importance and the implementation of nutritional concepts, we stumbled onto culinary medicine.

The science of nutrition and how it relates to diet and health has been rapidly evolving. Let's take a closer look at colon cancer: Around 30 years ago we started recommending a high-fiber diet to lower the risk of colon cancer, based on an observation that countries with a low fiber intake had higher rates of colon cancer. When studies followed that put one group on a high-fiber diet, while the other group followed a lower fiber diet, there was no difference in the groups after three to four years. However, fiber does have a positive effect on the management of diabetes, diverticular disease and constipation.

Any amount of processed meat and more than around 18 ounces of fresh meat per week are most strongly linked with a higher risk of cancer. This illustrates that your food choices and food preparation can change your risk of certain diseases. Poor diet continues to be one of the biggest contributors to chronic disease and mortality in the U.S., killing one in five Americans every year. That’s a higher rate than other risk factors — pollution, lack of exercise, alcohol and drug use — combined. Currently, there is strong evidence of the effect of diet on the treatment and/or prevention of high blood pressure, heart disease, strokes, diabetes and certain cancers.

Interestingly, the preparation of our food has also been found to be significant. Home-cooked meals are typically lower in processed foods and can be adjusted to any budget. For decades Americans have been eating out or ordering in more and preparing less food at home, but the pandemic and subsequent quarantine has begun to reverse this trend.

We began implementing the concepts of culinary medicine in an elective at the Weill Cornell Medical College in 2017. The classes consisted of evidence-based didactics, small group cooking activities in a teaching kitchen, eating and discussing the nutritional concepts taught. We used a holistic and patient-centered approach. We also incorporated the cultural diversity of New York City. Students completed final projects designing and developing recipes tailored to the health needs of their patients, taking cultural preferences and socioeconomic factors into account. Not surprisingly, this innovative method of interactive teaching was far more satisfying for the students and educators. The sessions were led by a multidisciplinary group of doctors, registered dietitians and chefs. The feedback we received from the students was overwhelmingly positive: “Especially with medical students, we feel that we don’t have a lot of time and may not eat healthy as a result. This course can show how many healthy recipes can be easy to make.” Others shared: “Learning how diet can manage diseases was eye-opening and I believe should be incorporated into med school curriculum.”

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When polled, 100% of our medical students “agreed” or “strongly agreed” that this course has been beneficial to their education and think every medical student would stand to benefit from education in culinary medicine. We saw responses like, "This class should be essential to medical students. This information is crucial for every physician to know," and "I feel like this is a course that should be implemented in every med school curriculum because it is so important to understand that it is the foundation of health – and everything else stems from that."

Historically, nutrition has been denied a prominent place in medical school curriculum. Medical school, referred to formally as “undergraduate medical education” (UME), is the first stage of medical education. United States medical schools offer an average of 19 hours total on nutrition education over four years, much of which is devoted to non-clinical topics like biochemistry. Among physicians, only 14% of doctors feel qualified to offer nutrition advice.

See why one med student enrolled in Culinary Arts

According to Harvard’s Food Law and Policy Clinic, on average, students in medical schools across the country spend less than 1% of lecture time learning about diet, falling short of the National Research Council’s recommendation for baseline nutrition curriculum. Neither the federal government, which provides a significant chunk of funding to medical schools nor accreditation groups, which validate them, enforce any minimum level of diet instruction.

In New York, state legislators recently proposed a bill that would require practicing physicians to receive six hours of nutrition coursework or training every two years (currently “In Assembly Committee”). Our timing is crucial, the burden of diet-related diseases and the gap in nutritional education are pressing. And as health care providers we are being challenged to flatten the curve of mortality and morbidity and improve the knowledge of our students, health care providers and patients. We are looking forward to seeing you soon at ICE.

Meet ICE's doctors, Jonathan Waitman and Swana de Gijsel, and explore a career in Health-Supportive Culinary Arts.

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Plant-Based Culinary Arts

My Culinary Voice: Dr. Swana de Gijsel

aday — Thu, 24 Sep 2020 15:07:59 +0000

My Culinary Voice: Dr. Swana de Gijsel aday Thu, 09/24/2020 - 11:07 One of ICE's first doctors on staff shares her personal food journey. October 9, 2020

By Swana de Gijsel — ICE Doctor

This year, the Ģ��Ƶ hired its first doctors to better explore culinary medicine. After introducing Health-Supportive Culinary Arts and our first Director of Nutrition in 2019, we've added a registered dietitian and practicing physicians to study how food affects the body, wellness and mental health. Meet one of the doctors who is passionate about this endeavor.

As an inpatient physician at one of the leading hospitals in New York City, many people have asked me how I have been coping with the impact of COVID-19. It's had a devastating effect on many of our patients, their families, the health care system and its providers. I could not have made it through the pandemic without the incredible love and support from my family and friends nor without my passions: communication and nutrition. It has been the inspiration and pleasure of cooking and the joy and nourishment of food being shared and consumed that helped me to restore and heal.

Dr. Swana de Gijsel

Back in 2015, I attended the International Conference on Communication in Healthcare (ICCH) in New Orleans, and my personal and professional passions started to merge. I had an epiphany and there was a sensation of flow, a state of being effortless, full of joy and unconscious of time. I listened to the keynote speaker, Dr. Dean Schillinger, describe his diabetes prevention social marketing campaign, thebiggerpicture.org. The campaign empowered minority youth to change the conversation about diabetes in their community by using creative outlets such as music and rap lyrics, a language spoken by his target group. At that moment, a deep sense of potential infused me as I imagined the infinite ways I too could communicate with my patients and students about nutrition and make an impact.

The interface between creative communication and nutrition sparked a new dialogue in me, a new fascination, which has only gained strength since. For me, food, ingredients, homemade cooking and love have always been essential requirements to fuel a human being. In my childhood home — an ethnic conglomerate of Indonesian, Dutch and German lineages — I spent long hours at my grandmother’s kitchen counter, observing, smelling, helping. The ingredients were seasonal, the food delicious and the eating experience was treated as dedicated family time, and therefore, sacred.

Fast food was explained to me as being unrefined for the palate and, therefore, implicitly devoid of flavor. (I obviously disagreed as a child since I loved sweets as most children do.) Sparked by Dr. Schillinger’s presentation, I started imagining inviting my patients into my kitchen to create delicious food and then analyze its nutritional attributes while enjoying a meal together. I’ve been wondering how to phrase that invitation in a culture without a strong historical culinary tradition of its own, how to introduce exotic, diverse and wonderful cuisines to tickle the palate and to challenge the notion that healthy food can’t be exciting.

Shortly after visiting ICCH, I learned about the Culinary Medicine Program at Tulane University, where a group of like-minded doctors were teaching medical students, physicians and patients the profound impact of nutrition on health, right there at the stove. Fueled by the excitement of what I was learning, I sought and found support in the Food and Nutrition department at Weill Cornell Medical Center and College, where I collaborated with my colleague, Dr. Jonthan Waitman, and registered dieticians, physicians and chefs to bring a similar program to our medical school.

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Great memories of our culinary medicine elective. Hoping we can reunite in the kitchen soon again. #2019 #NYP #weillcornellmedicalcollege @dr.jonathanwaitman

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Over the last three years we have been teaching students from Cornell and Columbia. Without hesitation I would rank those sessions among the most fulfilling teaching moments in my career. Not only do students leave each session with a big smile on their faces, they are reenergized by the knowledge they gained in this innovative way of experiential learning inside a kitchen, cutting, cooking, smelling, tasting, eating and lastly communicating how this food can fit in diets for them and their patients.

Culinary medicine is a rising, dynamic movement and I am thrilled to be a part of it. The medical system is finally acknowledging the indelible role of nutrition in tackling obesity, diabetes and cardiovascular disease, as well as the importance it has on practising self care and improving well-being.

Explore Health-Supportive Culinary Arts at ICE.

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