A Chef’s Unlikely Journey into Medicine

Growing up poor in rural Iowa, I never dreamed that I would graduate from both Harvard and Stanford. I always did well in school but growing up with divorced parents who had no higher education and valued making due with what you had, I was discouraged from pursuing my dream of becoming a doctor. My high school guidance counselor agreed. When I met with her to discuss options for my future, she asked, “What do you want to do with your life”? I said that I wanted to be a doctor. She laughed and told me I, “needed to find something more suitable to do,” and went on to suggest working in a local factory because (before the recession) they offered stable work and benefits.

I ultimately did work in one such factory to save money to move away for college. If I didn’t have support in my hometown, I planned to escape so that at least no one would hold me back. My first move outside of Iowa was to Minneapolis, Minnesota where I attended one year of college majoring in psychology. The decision to study psychology grew out of an understanding that if everyone told me I’d never be a doctor, maybe it was true. I reasoned that I could still help people by doing something that required less school, like being a counselor.

The school I attended was a religious school that turned out to be a poor fit given that I found some of the doctrine and actions of school officials to be morally questionable. Rather than realize that another college might be a better fit, I thought that maybe everyone had been right—maybe I really wasn’t cut out for college. Because I feared becoming an unskilled worker and following the same lifestyle that many of my relatives had, I decided to go to culinary school. I loved to cook and felt that culinary training would provide a better quality of life than no training at all. That fall, I registered for the accelerated two-year degree program at Le Cordon Bleu in Minneapolis/St. Paul. This was the first Le Cordon Bleu site opened in the United States and was filled with international instructors who broadened my views of the world and cooking. Despite waking up everyday and truly enjoying what I did for the first time, at the halfway point of the program, I still had a nagging feeling of something unfinished. I knew that if I got to the end of my life and looked back, I’d regret never trying to become a doctor.

This was around the time my culinary school classmates and I started planning for our final internships.  After some research and a number of phone interviews, I landed an internship at Chez Panisse, Alice Water’s famous restaurant, in Berkeley, California. Shortly thereafter, I found a pre-medical program at a Northern California school, Humboldt State University (one of the California State Universities), that I could afford with minimal loans once I got in-state residency status.

Once I got to Berkeley and started my internship at Chez Panisse, I knew Northern California was the place for me. It was the only place I’d ever been that felt like home. However, it was very different from anything I’d experienced before. At Chez Panisse, menus were decided each day based on what what was available at farmers markets and what local people brought to the back door from their farms and gardens. I’d never tasted or seen such fresh, delicious food! Growing up in Iowa, I’d seen plenty of farms with their scientifically engineered monoculture stretching for miles in every direction. I had worked picking produce in the summers alongside recent immigrants. This was totally different. At Chez Panisse, I learned about the politics of food and the cultural importance of sitting down with others over a meal. It was a revelation.

Later, to support myself while attending college at Humboldt State, I utilized my culinary skills for a variety of jobs—managing and teaching at a cooking school in an upscale kitchen retail store, being on-call for local restaurants in need of last-minute chefs, and eventually helping start a culinary and hospitality program at the local community college where I became associate faculty. I also volunteered to do cooking demonstrations at the Arcata Farmer’s Market (the most fun farmers market I’ve been to) to show people what to do with the late-summer glut of zucchini or the fill-in-the-blank vegetable they’d never seen before. Around this same time, I undertook self-study in nutrition and poured through books and scientific databases to try to figure out which foods and ways of eating were healthy. Then, I experimented with cooking techniques to turn that science and local produce into delicious, healthy food.

I had also taken up running in my free time and transformed myself from the overweight kid with high blood pressure who grew up eating McDonald’s with soda as their go-to beverage, to a healthy, active person who viewed their body in a new and positive light. It was while teaching cooking classes (that were not focused on healthy cooking) that people asked questions here and there about how they could eat to cure or improve a variety of ailments. As time went by, students came back to me with stories about no longer needing to be on insulin, improving their cholesterol, losing weight, and feeling good without being hungry all the time. I began teaching healthy cooking classes that were consistently oversubscribed. This was proof that people enjoyed eating healthy food—it just had to be delicious!

 

Fast-forwarding a bit…it wasn’t until I was in my first months at Harvard Medical School that I realized how entrenched the idea was that it was “pointless to waste time counseling patients about diet and exercise because they’re never going to change” (direct quote from one of my attendings). In my cooking classes, I had seen first-hand that this wasn’t the case. The realization that there was a disconnect between traditional medical care and engaging with patients in ways that could truly help them improve their health by making healthy behavior changes was what steered my career in a new direction. I aimed to combine what I knew about nutrition and cooking with internal medicine (specifically, primary care and obesity medicine) focused on caring for those in underserved communities. While not discussed in detail in this autobiographical sketch, I also spent a significant amount of time in college focused on helping other kids from underserved backgrounds learn the skills needed to apply, and matriculate, to college. Working with the underserved is not only a passion of mine, but also cathartic in the sense that my own background, while I wouldn’t wish it on others, was not for naught. It has served as a great resource for understanding the nutrition and social problems rampant in underserved communities in the U.S. It has also helped me to be a better doctor.

Just knowing about medicine, nutrition, and the problems of the underserved wasn’t enough. If the related recommendations I made weren’t accessible for those who needed them, then what use was this knowledge? While in medical school, I elected to take an extra year to obtain a master’s degree in public policy and administration from the Harvard Kennedy School of Government and do concurrent leadership training through the Zuckerman Fellowship and the Center for Public Leadership to better understand how to navigate systems in order to make social and policy changes to improve access to healthy food and medical care for all.

At the end of June 2014, I finished internal medicine residency at the Harvard-Cambridge Health Alliance Internal Medicine Residency Program along with other activities in the Boston area including teaching nutrition at Harvard Medical School and serving as Co-leader for the Harvard Chapter of Primary Care Progress, a grassroots organization focused on innovation, education and research in primary care. A highlight of the Boston chapter of my life was being awarded an honorable mention for Food Hero by the City of Cambridge, Massachusetts for, “individuals and organizations with a lasting and significant commitment to the fair, healthy and sustainable food culture in the city.”

As I began to plan my future after residency, I knew that my work in medicine needed to focus on prevention of disease. With the exception of screening for a limited number of diseases, the medical system in the US is reactionary, focused on treatment of diseases after they occur. This leads to needless suffering among many who may not have developed their medical condition(s) in the first place had they learned the knowledge and skills necessary to live a healthy lifestyle and had access to the resources needed to put this knowledge into action. An additional interest of mine was to equip health care providers with the lifestyle tools needed to treat chronic, lifestyle-related diseases—like obesity, diabetes, and heart disease—instead of using only medications and invasive treatments. Medications and interventions are often life-saving when used appropriately. However, they can come with side effects—sometimes fatal ones. (Medical errors are the third leading cause of death in the US.) Using them in isolation makes no sense. This is analogous to trying to treat someone with alcoholism with medication and interventions without trying to help them quit drinking.

I initially thought that further training in preventive cardiology might be one way to pursue this focus. However, I soon learned that cardiology programs are not required to teach about nutrition, physical activity, or many other lifestyle treatments. This was truly mind-boggling for me since 80% of cardiovascular disease can be prevented through lifestyle factors including healthy diet, regular exercise, keeping one’s weight in a healthy range, and avoiding smoking. I set out to find another option and found the Postdoctoral Research Fellowship in Cardiovascular Disease Prevention at Stanford University School of Medicine‘s Stanford Prevention Research Center. So, it was back to California once again!

As part of this fellowship, I completed a master’s of science degree in epidemiology and clinical research through the Health Research and Policy Department at Stanford. I completed the fellowship in 2018, but remain affiliated with Stanford as Clinical Associate Professor (Affiliated) and continue to blend my training in medicine, public policy, research, nutrition, and culinary arts to focus on improving education and access to delicious, healthy food for medical professionals and the general public. My areas of academic interest include culinary medicine; community-based research using lifestyle change interventions for those in underserved communities with, or at risk of, diabetes, cardiovascular disease and obesity; shared medical appointments as a method to treat chronic disease; obesity and weight loss; diet quality; food insecurity; food literacy; food pharmacies; teaching nutrition and cooking skills; and medical education around lifestyle-based prevention topics.

In addition, I am co-director the the Teaching Kitchen Elective Course for Medical Students at Stanford, and a teaching attending for Stanford Internal Medicine residents. I practice primary care both at Fair Oaks Health Center, a safety-net community clinic that is part of the County of San Mateo Medical Center system, and in the General Medicine Clinic at the Palo Alto Veterans Affairs Health Care System (PAVAHCS). At PAVAHCS, I also practice obesity medicine and run the MedGroups Program—a series of in-person group medical appointments and 1:1 telehealth visits that I created to focus jointly on lifestyle and medical management of obesity. I also a Fellow of the American College of Lifestyle Medicine where I have served on the Board of Directors and published the first, comprehensive, open-source Culinary Medicine Curriculum for health care professional training programs.