Doctor dishes out the science behind healthy eating to med students

People have all kinds of reasons not to cook: too much hassle, too expensive, too difficult, too little time. Medical students, with endless hours of classes and studying and test taking, have such limited time that meals often are whatever they can grab on the go.

But with so much of modern disease related to diet, it is increasingly important that these future doctors understand nutrition and healthy eating and learn how to speak to their patients about it.

That's why I'm teaching a healthy cooking class to a group of students at the Lewis Katz School of Medicine at Temple University this fall, as part of the My Daughter's Kitchen program. Inspired by lessons I taught my own daughter, the program was created to teach healthy cooking to urban schoolchildren, and this fall it has grown to 35 classes taught by 70 volunteers at schools in Philadelphia and Camden.

I'm teaching the same lessons and recipes to these med students, with a little more discussion about the thinking behind the dishes and the ingredients we are using.

At our last class, I invited Bernadette Remshard, a retired doctor of internal medicine who wrote to me a few weeks ago wanting to become a cooking volunteer for the program. Remshard has developed a keen interest in nutrition and health over 25 years of doctoring in Montgomery County, mostly for homebound and nursing home patients.

"I think that most of the diseases we have in this country are the result of poor diet and lack of physical exercise," she said.

Like many doctors, Remshard champions the Mediterranean diet, rich in fruits, vegetables, whole grains, legumes, nuts, and fish. But, for these students, she also explained the science behind it.

She went into detail about foods that suppress the activation of the nuclear factor kappa beta pathway, which causes the production of cytokines and chemokines, that had these students nodding in recognition, as they began chopping ingredients.

Translation: Certain foods, like refined carbohydrates and things high in fat and sugar, activate the chemical pathway leading to systemic inflammation. When chronic, that inflammation can lead to or accelerate a host of diseases, including cancer, diabetes, obesity, arthritis. Conversely, studies have shown that a plant-based diet can reduce chronic inflammation and slow the progression of disease.

So Remshard was thrilled to see we were making lentil soup. And, as we unpacked the groceries, each ingredient won her approval. The deeper the color, the more nutritious the vegetable, she said, so the carrots met that criterion.

The lentils and chickpeas fell into the legume category; the onions, garlic, celery, bay leaves, and parsley would add flavor without too much salt and fat. "Everything in this recipe is in the Mediterranean diet," she applauded.

In this, the fifth week of class, the students have grown more confident, knife skills have improved, and with second-year student Mai Stewart as the expediter, jobs were handed out and performed efficiently.

Exactly how small to dice the celery was Hilario Yankey's only question. (About the same size as the onion so they will cook the same.) And David Pioquinto wasn't sure whether to throw the carrot peels into the soup. (No.) We were also making a simple Waldorf salad (Remshard applauded the walnuts and the substitution of fat-free Greek yogurt for sour cream). Bushra Anis added the entire container of yogurt, which was 5 ounces, instead of the 4 ounces called for in the recipe, so a little "doctoring" was required - just an additional dash of sugar, to curb the tartness.

As the soup simmered on the stove, Remshard told the students that in her experience, patients are much more motivated to change their diet when they are sick. Often, their loved ones get involved and get on board with the plan.

Because the first step in learning about nutrition is improving their own eating habits, I asked the students how they had changed or considered changing their diets as a result of the class.

Mai: "I'm not sure this class has changed my eating habits, but it has made me aware of the ease of cooking a healthy meal and the low cost of making a full meal."

Bushra: "I think more about the different food groups I eat on a daily basis. I've seen how healthy and cheap food is possible at home. And I try to be more aware of the things that I eat."

David: "I can't say my current habits have changed much, but I will say I do have a perception now that cooking is more manageable. I can now visualize cooking many of these recipes for myself, things that sound complex, like lentil soup, don't seem as difficult anymore."

Hilario: "A lot of the foods we make in the class are relatively quick to make, and, interestingly enough, they taste great. I am trying to incorporate a lot of the ingredients we use here into my food I make at home. For example, I am thinking more about how I will incorporate fish in my weekly meal plans. I know what to make this weekend - fish tacos and sweet potato fries."

mfitzgerald@phillynews.com

215-854-5744

www.philly.com/mydaughter

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Makes 6-8 servings

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1 onion, peeled and chopped

2 celery stalks, diced

2 carrots, peeled and sliced into coins

2 tablespoons olive oil

1 16-ounce bag brown or green lentils

2 garlic cloves, smashed and minced

2 bay leaves

6 to 8 cups chicken stock (look for reduced sodium)

1 14-ounce can diced tomatoes

1 14-ounce can chickpeas, drained

Sea salt and pepper

2 tablespoons chopped parsley

Parmesan cheese, freshly grated, for serving

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1. Heat the olive oil in a large stockpot or Dutch oven. Add the onion, carrots, and celery (known in the culinary world as mirepoix, a basic building block of flavor) and cook, stirring often, for 10 minutes.

2. Meanwhile, rinse the lentils (remove any small stones), then place them in the pot with the garlic, bay leaves, and 6 cups chicken stock. Bring to a boil, then lower to a simmer and cook until almost tender, 25 to 30 minutes, skimming off the foam occasionally.

3. Add the tomatoes to the pot and stir well. Simmer until nice and soupy, about 10 minutes.

4. Add the chickpeas, sea salt, and pepper to taste, and simmer for about 10 minutes longer, adding extra stock as necessary.

5. Stir in the chopped parsley and ladle into soup bowls. Serve with grated Parmesan.

Notes: Lentils from Abruzzi or Umbria in Italy or Puy in France are best, but regular supermarket lentils will do.

- From Good Cooking, the New Basics (Silverback Books)

Per serving (based on 8): 450 calories, 26 grams protein, 70 grams carbohydrates, 10 grams sugar, 8 grams fat, 2 milligrams cholesterol, 681 milligrams sodium, 27 grams dietary fiber.

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Makes 6 servings

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1/2 cup Greek fat-free yogurt

1/4 cup fresh-squeezed lemon juice (About 1 medium lemon, or 2 if very small)

1/4 cup canola oil

1 teaspoon sugar

1/2 teaspoon salt

Few grinds of pepper

1 head romaine lettuce, washed and dried

and torn into pieces

3 stalks celery, washed and diced

2 red apples, washed, cored, and diced

1/2 cup walnuts, roughly chopped

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1. Whisk together the yogurt, lemon juice, canola oil, sugar, salt, and pepper.

2. Combine the celery, apples, and walnuts in a medium bowl and toss with enough dressing to cover.

3. Place the torn romaine in a large salad bowl. Add the celery, apple, and walnut mixture. Serve with additional dressing, if desired.

Per serving: 96 calories, 2 grans protein, 7 grams carbohydrates, 7 grams sugar, 6 grams fat, no cholesterol, 131 milligrams sodium, 2 grams dietary fiber.

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