How to implement

Instructions for implementing the 4-week cooking program of plant-based, olive oil recipes in a medical school or for patients are provided in this section.

Medical school -Implementation of 4-week cooking program

Medical school questionnaires 2018

Recipes Food is Medicine December 2018

View and print PDF "Food is Medicine" medical school Handout

These videos provide the background for the program, show some of the recipes being made, and a class.

Introduction

Vegetable fried rice recipe

Vegetarian chili

Video of a class

Manuscript on improving food insecurity in medical students with a cooking program

January 2016

The “Food is Medicine” 6-week cooking program began in October 2015. Physicians in local hospitals refer patients to the program and medical students from the Alpert Medical School provide the 6-week cooking program to the clients. Each week, the instructors make a recipe from the recipe booklet. When the participants are sampling the recipe, a nutrition topic is discussed. Classes last about 30 minutes, including recipe preparation and nutrition education. This instructional manual was developed for the medical students to help them implement the program. It can be adapted to programs at other institutions.

Food is Medicine

A “How To” Guide for Instructors

Introduction

Food is Medicine is a cooking program which began in October 2015 and is based on the program Raising the Bar on Nutrition. RTB was developed by Mary M. Flynn, PhD, RD, L.D.N., a research dietitian at The Miriam Hospital in Providence, RI and an associate professor of medicine at Brown University. RTB was a research study of clients from Rhode Island food pantries. The participants in the study enrolled in a 6-week cooking program that used recipes from a plant-based, olive oil diet that was developed by Dr. Flynn in 1999. The program’s goal was to teach the participants how to make recipes that are healthy, inexpensive, and tasty. The participants were given a goal of making 2 to 3 main meals each week from the recipes they were provided, or recipes they devised that followed the pattern of using 1 to 2 tablespoons of extra virgin olive oil, 1 to 2 servings of vegetables, and 3 to 4 servings of starch, but did not include meat/ poultry/ seafood. The participants were followed for 6 months after the cooking program. The results of the study showed that when participants used the recipes for 2 to 3 dinners per week, they spent much less on groceries, they reported a healthier diet, and they lost weight (JHEN 2013; 8:73-84).

The goal of the Food is Medicine program is to provide the 6-week cooking program to people who have risk factors for chronic diseases that can be controlled with diet. These factors include elevated blood glucose, blood pressure, and body weight and unhealthy blood fats (high triglycerides and/or low HDL). Participants in the program are asked to make 2 to 3 main meals each week from the recipes in this recipe book. If they meet this goal, they will see improvements in their risk factors.

This “How- To” guide has been designed to prepare instructors to lead the weekly cooking classes. There are also suggested talking points as examples of the type of information that should be emphasized during class. You can find nutrition information at “Nutrition Topics” tab on this website.

The goal of the Food is Medicine is to teach current and future health professionals on how they can use food to prevent and treat chronic disease. Participants will be referred by their physicians and their blood glucose, blood pressure, and body weight will be entered into their medical chart throughout the program. This will allow their health care providers to follow their progress.

Good luck!

The recipes and the food

The recipes for the “Food is Medicine” program were developed by Mary Flynn, Ph.D, RD. LDN. They are based on a diet she developed in 1999, which she calls a “plant-based, olive oil diet”. The diet is similar to the traditional Mediterranean diet. All of the recipes use extra virgin olive oil, vegetables, and a starch. The vegetables are mainly canned or frozen; this is because vegetables grown to be canned or frozen are kept on the plant longer so they have higher phytonutrient content compared to retail fresh. They are also all ready to use, which may increase the use of the vegetable; they are “shelf-stable” meaning they can be bought in advance and kept for a period of time; and many of them are available in food pantries.

Extra virgin olive oil:

It has to be extra virgin to have the health benefits. It is the phenol content of olive oil that provides the health benefits (not the monounsaturated fat content). A fair amount of the olive oil imported into the US that is labeled “extra virgin” is not extra virgin. This is an international problem and there are reputable olive oil producers who work hard to provide good oil. California has strict laws on what can be sold as extra virgin olive oil so olive oils form CA can be trusted. Participants will be provided with extra virgin olive oil, but they should also be told about the adulterated olive oil on the market.

Studies have shown that using about 2 tablespoons a day of extra virgin olive oil will lower blood pressure, improve insulin sensitivity, decrease blood glucose, increase HDL, make healthier triglycerides and LDL (it is mainly monounsaturated fat so it does not oxidize; also, many of the phenol act as antioxidants and travel with the lipoproteins). Daily use of olive oil has also been related to lower body weight and less weight gain over time.

Preparing for class

Read the recipe before class and make sure you understand what ingredients you will be using and the steps in the recipe.

Arrive 15 to 20 minutes before the first class is scheduled to start.

Get out the ingredients needed for the recipe and prepare them as necessary:

•Open and rinse canned vegetables and beans.
•Remove any frozen vegetables needed from the freezer for them to thaw.
•Make sure ingredients are ready to be used when you begin making the recipe (e.g. put rinsed beans in a bowl to be dumped into the frying pan)

•Leave empty cans/boxes on the table so participants can see where the ingredient came from.

•Plug in the frying pan.
•If you need to boil water for making starch, turn on the water approximately 5 minutes before class starts so it is ready when you need it. Or make the starch in advance of the class.

Locate pots, pans, frying pan (or stove top) and utensils for cooking

Take out the dishes and cutlery for eating the meal

Locate participant intake forms.

Complete the weekly form asking the participants the key foods in the past week.

Class Time: Demonstrating Recipes and Checking In

Week one:

Staff will need to meet the participants in the foyer; it would be best if you could wear your lab coat or a badge so they can find you. Walk them upstairs and get them into the area. You can tell them that starting next week they can meet you at the Lifespan door and ring the bell (starting week 2, have someone near the door to let them in).

Things you will need per participant for week 1:

Agreement
Recipe booklet – they can take this home but should have access to one each week
Weekly attendance sheet
Food is Medicine – treating diabetes with diet

Before the class, have all participants sign the agreement. They will have been told about the agreement prior the class. The purpose of the contract is for both the participant and the staff to know the expectations.

Please always remember that the focus is on the participant; you should work to make them feel comfortable and help them to understand the material. Please avoid “side conversations” that are not class related (i.e., socializing) and remember to continually emphasize the nutrition messages we want them to learn.

Starting week 2:

At some point during class, be sure to assess if each participant is incorporating the key ingredients (extra virgin olive oil, vegetables, and starch) and/or other meatless recipes throughout the week. Make sure to encourage them to make substitutions to the recipe, and to try the recipe sometime during the week after they have seen it prepared in class. Feel free to offer suggestions or ask them for suggestions for how to change the recipe. You can have people share with the group, using the following questions:

•Did you have the chance to make the recipe last week?
•If yes, what did you add, change or substitute (e.g. spices, other vegetables)? Did you use extra virgin olive oil? How much did you use? Was the recipe meatless?
•Did you make any other meatless recipes that you would be willing to share?

Record whether and how the participants have incorporated the recipes onto the weekly attendance sheet. This can be done before beginning the recipe or while the food is cooking, as most recipes require the food to simmer for several minutes. After getting the conversation going, you can begin the demonstration.

For all recipes, please remember to constantly demonstrate the amount you are using. Participants should learn what does a half cup (or a serving) of vegetables look like? What is a tablespoon of extra virgin olive oil? What does 3 ounces dry weight and cooked of pasta look like or a ½ cup of rice? [note: potato recipes are not typically demonstrated, but an appropriate serving of potato could be discussed].

Keeping the Class Interesting: Talking Points and Mini-Lesson Plans

While you prepare the meal, you should share information about the recipes and healthy eating. The demonstrations are supposed to be informal; there is no pre-set lesson for each recipe. You should tailor your material based on where the conversation naturally goes. Here are some talking points to get the conversation started, and to work in as often as you can. Repeating certain messages every week will help reinforce the information. Remember, most of this information will be new to your class members.
General info for the recipes:

• The recipes are designed to be healthy, inexpensive, delicious, and quick (15-20 minutes)
• Our goal is to have you prepare 3 meals a week for your family with the recipes
• The recipes are for 2 servings. You can make less, or the whole recipe and have 2 meals.

The recipes are plant-based, comprised primarily of vegetables and whole grains:

• A serving of most vegetables is a half a cup. A typical serving of leafy vegetables (e.g. spinach) is 1 For frozen spinach, however, 1/3 cup frozen is equal to 2 cups fresh. So 2/3 cup of frozen spinach is equal to 4 cups fresh or 4 servings of spinach.

** try to demonstrate vegetable servings with every recipe

• A healthy diet contains at least 4 servings or 2 cups of vegetables/day.
• The recipes rely heavily on canned and frozen vegetables because they are as healthy, if not healthier, than retail fresh as they are kept on the plant longer than most fresh vegetables. Frozen and canned vegetables have similar vitamins as the fresh version but some studies show they have higher content of the phytonutrients that decrease disease risk. You can also buy them when they are on sale and keep them longer in your house (freezer) as they don’t go bad. Participants can use fresh, frozen, or canned vegetables for any of the recipes.

Extra virgin olive oil is a healthy source of fat:

• Daily use of olive oil has been shown to make insulin work better (which helps control diabetes), lower blood pressure, increase HDL and is related to a lower risk of heart disease and some cancers. The health benefits start at 2 tablespoons a day.
• Olive oil adds flavor to foods, and makes vegetables taste better
• Adding fat to meals (i.e. olive oil) helps you stay full longer, which decreases desire to snack and is helpful for weight control. Several studies have indicated that people who use extra virgin olive oil on a regular basis weight less and gain less weight over time compared to people who do not use olive oil.
• It must be extra virgin olive oil to get the health benefits
• Many brands of olive oil sold in the US but made in other countries are labeled “extra virgin”, but are not extra virgin olive oil. Extra virgin olive oil from California, Greece, and Australia are ones you can trust to be extra virgin.

The recipes are meatless:

• You do not need meat daily
• A diet that does not include meat is healthier than one that includes meat
• Meat is very expensive, even when on sale
We do not store extra protein we eat as protein; extra protein is stored as fat
• Meat is not the only source of protein; Protein is found in bread, pasta, rice, beans, and vegetables. Diets without meat/ poultry/ seafood can contain more than enough protein.

Other:

• Fast Food restaurants: food purchased here are very expensive and not healthy. The recipes you will get are fast to make and use inexpensive ingredients.
• Use the grocery lists with the recipes to help you look for what’s on sale

Plant-based (i.e. meatless) meals

Health benefits

• Plant-based diets emphasize fruits, vegetables, grains, beans, legumes, and nuts
• Plant-based foods are components (phytonutrients) that will improve your health
• Sausage, luncheon meats, processed meats, and red meat have been shown to increase the risk of heart disease, some cancers and are related to early death

Cutting costs

• Meat is often the most expensive part of the diet
• Working in a few meatless meals per week can reduce overall spending on groceries
• Canned and frozen vegetables and legumes are particularly inexpensive replacements for meat

Getting enough protein

• Most people can get more than adequate protein without red met
• Protein is found in all starch products (bread, cereals, rice and other grains, potatoes, beans). You can get all the protein you need from plant products.

The Food is Medicine program has a goal for participants of eating 2 to 3 plant-based meals per week. These plant-based meals are healthy, very affordable, and taste good. Incorporating meatless meals just a few times per week can improve health.

Wrapping up Class and Follow Up

After you finish making the meal, and serving it to the participants, you can open it up for any questions or comments while people are eating. You can also use one of the previously mentioned mini-lessons to bring up some nutritional issues while participants are eating. When participants finish eating, you can give them any leftovers in Tupperware containers. Then they are free to go!

After the participants leave, follow these steps to ensure that future classes go smoothly:

Put away reusable food items, making sure that everything is labeled as you do so

Wash the dishes, and cooking essentials

Wipe down tables/ counters and the areas where participants ate

Make sure that the floor is clean

Return cleaning supplies to where they are stored

Make sure you have written down who was there, and what recipes they used (and how)

Leave the area clean and neat.

Please email me if anything out of the ordinary happens or if you have any feedback.

I hope that you enjoy this experience and it helps you learn how to use food as medicine.

Thank you!!

Mary Flynn