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    Michelle Mudge-Riley
    Michelle Mudge-Riley, DO, MHA

    Disclaimer: MGMA does not endorse any solutions put forth in this column. We urge readers to explore the legal issues — federal, state and local — that might arise from a particular course of action.

    Life in north Texas (where I live) just got a lot more fun. I’ve discovered culinary medicine and the value it brings to physicians, physician staff and patients. It started with some research I did for the Academy of Nutrition and Dietetics, Washington, D.C., on how much nutrition education physicians get in medical school and training. Not much, it turns out. Most medical schools didn’t provide more than 21 hours of nutrition education for doctors, according to a landmark 1985 report by the National Academy of Sciences, Washington, D.C.  Another study2 published in the journal Academic Medicine in 2010 found that only 27% of medical schools provided the standard of 25 hours of nutrition education established by the National Academy of Sciences. Some medical schools provided even fewer hours.

    That got me thinking: Doctors have a lot on their plates and nutrition news comes out on almost a daily basis. To determine how many practices talk with patients about their food choices and how that affects their health, I came up with the following questions:

    • How many doctors are knowledgeable about the latest scientific evidence that distinguishes healthy foods?
    • Do most practices successfully engage patients to improve their food choices and lifestyles and see improved patient outcomes?
    • Can physicians serve as role models to engage and change the way their patients and staff think about purchasing, preparing and enjoying the right foods for best health?
    • Do practice professionals know they can get reimbursed for group classes?

    Then I learned about Dr. Gourmet, also known as Timothy Harlan, MD, an internal medicine physician who was a chef before going to medical school. Harlan, who is the assistant dean of clinical services at Tulane University School of Medicine, New Orleans, and executive director of the Goldring Center for Culinary Medicine, wants to add teaching kitchens to all medical schools. The idea is that medical students and physicians who know how to cook and eat well will be more effective in talking about nutrition with their patients. He uses evidence-based data and culinary demonstrations to show how to prepare certain foods and create healthy, delicious meals that fit with the goals of decreasing chronic disease and associated risk factors for chronic disease. I jumped on that bandwagon.

    Fast-forward eight months. I did a culinary demonstration at a group practice for a group of 20 patients — men and woman who were interested in substituting healthier ingredients for unhealthy ones. They wanted a tasty (and healthy) chocolate pudding. My goal was simple: Figure out how to create a healthy chocolate pudding. I wasn’t allowed to take shortcuts like using the sugar-free Jell-O brand pudding instead of the regular stuff. This had to be all natural, healthy and delicious.

    The event drew more than 20 patients, family members and a few doctors who wanted to learn how to combine the science of nutrition with the reality of delicious and healthy food. I was pleased to see many raised eyebrows when I explained that one of the ingredients was avocados. Yes, that’s right — avocados and unsweetened cocoa were the main ingredients in this all-natural chocolate pudding. Both contain a host of vitamins and antioxidants.

    Culinary medicine is the latest method of teaching doctors and patients how to combine the art of cooking with evidence-based nutritional research to help people understand how to purchase, prepare and enjoy healthy and delicious meals. It allows doctors to serve as role models and lets coaches engage patients and help them change behaviors to bring about measurable health outcomes for chronic diseases such as diabetes, heart disease and obesity. Doctors can get reimbursed by insurance companies for this training and reap the benefits of value-based reimbursement because they can report improved metrics in patients who have chronic diseases. And since 70% to 80% of chronic diseases (heart disease, stroke and diabetes) and more than 40% of cancers are preventable, who knows how many health issues could be avoided with just one group class.

    Contact Michelle Mudge-Riley at

    Chocolate avocado pudding recipe (paleo, gluten-free, vegan):

    1 medium avocado, ripe
    2 tbsp. unsweetened cocoa power
    2 tbsp. honey for paleo diet or 2 tbsp. agave nectar for vegans
    6 tbsp almond milk

    1. Cut open the avodaco and scoop out the pit. Cut it into large chunks and put in the food processor.
    2. Add the cocoa, honey or agave, and almond milk. Start processing on low and then move to a high speed until it is smooth.
    3. If the avocado is larger, add a bit more of each ingredient. If it is too thick, use a bit more almond milk. Add more cocoa or honey or agave to taste.
    4. Enjoy immediately or refrigerate and serve cold.


    2. Adams KM1, Kohlmeier M, Zeisel SH. Nutrition education in U.S. medical schools: Latest update of a national survey. Academic Medicine. Vol. 85, No. 9, September 2010: 1537-42.

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