Imagine this: At the end of your visit, your doctor hands you a prescription … for kale chips.
“It surprises some patients, but they love it,” said Linda Shiue, MD. “Patients never expect their doctor will give them a recipe, but food is one of the most powerful tools you have to improve your health.”
According to Dr. Shiue, kale chips are the perfect introduction to leafy greens for patients who hate vegetables, are looking for a healthy substitute for potato chips, or both.
She is one of a growing number of physicians who are incorporating the idea of food as medicine into their practice. As director of Culinary Medicine for Kaiser Permanente San Francisco, working out of the Mission Bay Medical Offices, her goal is to teach and empower patients, doctors and staff to learn how to cook to improve their health.
Dr. Shiue joins Ben Maring, MD, as one of a small cadre of Kaiser Permanente physicians who are trained chefs aiming to combine healthy food into primary care practice. Ben Maring’s father, retired Kaiser Permanente physician Preston Maring, MD, started a healthy food movement at Kaiser Permanente when he launched one of the country’s first hospital-based farmers markets at Oakland Medical Center in 2003. Today, more than 50 farmers markets operate at Kaiser Permanente facilities around the country.
One of the challenges to this approach is that medical schools often do not offer coursework in nutrition, and certainly not in cooking. “Food is one of the most ancient forms of medicine and healing, but somehow we’ve forgotten about that,” Dr. Shiue said.
“First, doctors need to learn about nutrition and healthy cooking,” she added. “Showing patients what to do — which ingredients to buy, how to cook — is the next step in empowering patients to take charge of their health and well-being.”
From a patient’s perspective, it might seem insurmountable to change an entire lifestyle — swallowing a pill might be more appealing.
But if presented with a recipe for banana “ice cream” with dark chocolate shavings as a way to incorporate more fruit into a patient’s diet? “That’s a win-win,” she said.
Dr. Shiue’s parents emigrated from Taiwan for graduate school, and she and her older brother were raised on the east end of Long Island, New York, where they were the only Asian family in town.
“I grew up curious about other people’s food, which was so different from what my mom was cooking at home,” she said. “My best friends were Jewish, Italian, Polish and Irish, so my curiosity in food was sparked by this exposure to different flavors.”
Dr. Shiue recalled her early experiences in the kitchen helping her mom stir things in the pot, eventually graduating to cooking simple dishes and baking occasional desserts for the family.
“My older brother and I were latchkey kids,” said Dr. Shiue, using the term that refers to children who stay home after school with little or no parental supervision. “My parents worked during the day, so I did some of my experimenting in the kitchen after school, unsupervised, cooking something up, using whatever we had in the fridge.”
She laughed as she imagined all the ways things could have gone awry. “But it made me very comfortable in the kitchen.”
Later, Dr. Shiue wanted to share her personal experiences in cooking and started her food blog in 2009.
“I hadn’t thought to share my blog with my patients because I thought of food as my personal hobby and not as part of patient care,” she said.
A light went on when she attended "Healthy Kitchens, Healthy Lives," an annual medical conference co-sponsored by the Harvard School of Public Health and the Culinary Institute of America, where doctors learn about nutrition and cooking. She realized her two passions didn’t have to be mutually exclusive.
“That conference propelled me to talk to patients about food and nutrition. That became my new tool — talking to and teaching my patients how to cook,” she said. “If I could empower my patients to make a change by setting them up with the tools they need, that could make a real difference in their health.”
After 15 years of practicing medicine, she felt a renewed sense of excitement for both cooking and medicine and began to teach cooking classes in community centers and other community sites across the Bay Area.
Attracted by Kaiser Permanente’s focus on prevention, Dr. Shiue joined the organization in September 2016. However, before starting her new role, she decided to take a sabbatical, during which she completed a six-month, full-time program at San Francisco Cooking School, which included a two-month stint at Mourad, a Moroccan restaurant in downtown San Francisco. She also enrolled in a Plant-Based Nutrition certification program from Cornell.
“I wanted to add more tools to my toolbox to help improve my patients’ health,” she said.
Dr. Shiue offers two courses of cooking classes at Kaiser Permanente San Francisco, one for physicians and one for members and the community.
For two hours every month, physicians trade in tongue depressors and scalpels for wooden spoons and kitchen knives to participate in the "Lunch With Linda" series, a class modeled after the concept of “See One, Do One, Teach One.” Participants observe her demo, learn how to cook hands-on and then share that knowledge with their patients.
These classes help Dr. Shiue reach far more people than if she were to try to reach them on her own. Recently, a group of physicians learned to make a Korean grilled tofu rice bowl called bibimbap, using an array of beautifully julienned vegetables of all colors.
Thrive Kitchen is a series of monthly cooking classes that’s open to the community, which features a changing menu of globally inspired, seasonal, vegetable-forward dishes. The goal is to demonstrate how easy — and delicious — it can be to eat healthily. Her dream is to create on-site teaching kitchens at Kaiser Permanente medical centers nationwide.
“It’s a lot of work, but I love what I do,” she said. “I get to combine my passion with my career, and what could be better than that?”