Dr. Timothy S. Harlan, MD, FACP, CCMS, a distinguished Professor of Medicine in the Division of General Internal Medicine and the visionary Executive Director of the GWU Culinary Medicine Program. Dr. Harlan’s journey is a captivating fusion of medicine and culinary expertise, where the art of healing meets the art of gastronomy.
From his early days as a dishwasher in a restaurant to becoming a restaurant owner by the age of twenty-two, Dr. Harlan’s relationship with food has always been a compelling one. However, fate had different plans for him, leading him to embark on a remarkable path towards a career in medicine. Armed with an undergraduate degree in Anthropology, he pursued his medical studies at Emory University. During this time, his culinary roots remained firmly planted as he continued to cater events, all the while noticing a glaring gap in the healthcare system’s understanding of the profound impact of food on health.
This realization prompted Dr. Harlan to pen “It’s Heartly Fare,” a groundbreaking food manual aimed at patients with cardiovascular disease. Since then, he has dedicated his life to translating evidence-based diet and nutrition information into accessible language for the general public. Dr. Harlan is also the driving force behind the immensely popular website, DrGourmet.com, where Mediterranean diet principles come to life in American kitchens.
But his passion doesn’t stop at publications. Dr. Harlan has held pivotal roles in the medical education field, serving as the Associate Dean for Clinical Services at Tulane University School of Medicine. He now stands at the helm of the Goldring Center for Culinary Medicine, a pioneering endeavor that integrates medical students, culinary students, and the broader community to foster a profound understanding of diet and lifestyle as integral components of healthcare. This innovative teaching kitchen is the first of its kind, designed to empower individuals to transform their health through the simple act of returning to their own kitchens.
Join us in this exclusive interview as we delve deeper into the culinary medicine revolution led by Dr. Timothy S. Harlan, where food becomes the prescription and health transforms from an aspiration into a tangible reality.
Dr. Harlan, thanks for the opportunity to interview you. Considering your unique journey from managing a restaurant post-high school, to opening your own eatery in Athens, Georgia, and ultimately transitioning to medicine due to a transformative health crisis, can you share the catalysts that drove this significant shift from culinary arts to medicine?
I went to college for the first time after closing my restaurant. The goal was to get a degree in hotel and restaurant management. At the time my partner was going through significant health issues – the details of which aren’t mine to share – but as I began to research her condition I found medicine fascinating. I was really fortunate that the pivot to medicine was the right choice. I love practicing medicine now 30+ years on.
How have your culinary experiences and enduring passion for food shaped your perspectives and approaches in medical practice, particularly at the intersection of food and health?
To support my partner’s health, I changed my style of cooking to create great food that just happens to be great for you. Food became the foundation of how I think about health and practicing medicine. Two former regulars at my restaurant were nurses who were at the forefront of patient education materials at the time. At their invitation I wrote my first book in medical school: a food manual for patients with cardiovascular disease.
Could you elaborate on how your culinary journey influences your roles as a physician, academic, and advocate for culinary medicine, specifically within medical education and patient counseling?
I feel that the foundations of great cooking that I learned early on were based on using real ingredients, and this foundation of good food that is great for you has been critical. We have so many extreme claims – don’t eat fat, do eat carbs, don’t eat carbs, eat more fat, vegetarian, vegan, gluten free, keto, paleo, high protein, etc. – and those are not generally well founded in the science. Good food is.
The middle ground, reasonable, and moderation are not very sexy in a world of flash, PR, and bestsellers, but it is very rewarding to offer patients the reassurance that that just eating food with real ingredients meets them where they live, is something they can sustain for the long term, and is affordable. Working with a large and diverse team to build out state of the art training for healthcare professionals and community members and being able to document efficacy affirms that good food that just happens to be good for you is the answer.
Can you recall any specific instance where your culinary background played a pivotal role in creating a health plan for a patient?
Almost every single day. I have a very traditional internal medicine practice and within that practice work with every patient to help them think about their health from a food-first perspective. I have no problem prescribing medication for hypertension, diabetes, and the like, but I make healthy food and recipes a central part of medical care. Patients are really craving the information and guidance.
One particular patient – this is early in my private practice – really brought this home to me. I was talking to her about getting more fiber, eating more fruit, and other ways to improve her diet, and she looked at me and said, “Just tell me what to eat!” And that’s literally what she meant – she wanted me to tell her what to have for breakfast, lunch, and dinner. She and I worked together to create a meal plan using my recipes and her health improved dramatically.
Over the years I have hundreds of patients make slow, careful, deliberate, moderate change that has a huge impact on their health. The Culinary Medicine approach works and works well.
The philosophy of food as medicine is ancient, but its formal inclusion in medical education is seemingly novel. How did Tulane Medical School’s Goldring Center pioneer this integration, and what obstacles were encountered in the early stages?
Our Dean at the time, Dr. Benjamin Sachs, pulled together a group of faculty, students, chefs, business leaders and community members with the idea of building the first fully operational teaching kitchen at a medical school to teach medical students how to cook. The breakthrough came when the group landed on the idea of building the kitchen in the community and also teaching our patients and community members how to cook and eat healthy.
The initial challenge was the capital investment and the Goldring Family stepped up to support what they felt was a critical issue for the New Orleans community.
Subsequently, we faced building an curriculum for healthcare professionals and the community that offered meaningful, evidence-based training. Turning to the literature and research on Mediterranean diet principles offered a foundation for programming that is easily translated for the American kitchen.
How have the reactions been from students, faculty, and the broader medical community to this innovation, and how has the Health meets Food curriculum inspired other institutions to follow suit?
The last 14 years of working on this project have been amazing. The support of colleagues, students, faculty and leadership has been truly remarkable. I have attached some feedback from medical students below to offer a flavor of their investment.
In 2018 the courseware was spun off and is now managed by the non-profit Culinary Medicine Specialist Board. The support and engagement has been tremendous. The CMSB has a very dedicated and active 24 person Advisory Board. With their guidance the courseware is now used by over 60 academic medical centers across the country.
The main inspiration for adoption of Culinary Medicine programs in the early days was a group of dedicated faculty members across the country. However, in the last 6 years there has been a significant shift toward Dean’s offices and medical school leadership driving adoption.
Our feedback is that has been driven by a growing understanding that we have to offer better training to our medical students. The critical element is, however, the research by those dedicated faculty members to show the efficacy of programming for both healthcare professionals and for the community.
Health professions students who have participated in Culinary Medicine programming are clearly more knowledgeable and better prepared to counsel patients about food as part of their patient care. They are also more likely to eat healthy, follow Mediterranean diet principles themselves, and have higher MedDiet Scores. These large scale longitudinal studies have been replicated now using hands-on cooking classes in the virtual environment.
Similarly, the research with community members participating in both observational studies and randomized trials shows great outcomes.
These types of evidence is driving the transformation of nutrition in medical education. By its nature we are evidence based in the approach to patient care and in our training programs.
Here’s some of our research:
Healthcare Profession Training
Razavi, Alexander C.; Monlezun, Dominique; Sapin, Alexander; Stauber, Zachary; Schradle, Kara; Schlag, Emily; Dyer, Amber; Gagen, Brennan; McCormack, Isabella; Akhiwu, Ofure; Sarris, Leah; Dotson, Kerri; Harlan, Timothy. Multisite Culinary Medicine Curriculum Associates with Cardioprotective Dietary Patterns and Lifestyle Medicine Competencies Among Medical Trainees.
Virtual teaching kitchen classes and cardiovascular disease prevention counselling among medical trainees https://nutrition.bmj.com/content/bmjnph/early/2023/02/02/bmjnph-2022-000477.full.pdf?with-ds=yes
Community Members
Monlezun DJ, Kasprowicz E, Tosh K, Nix J, Urday P, Tice D, Sarris L, Harlan TS. Medical school-based teaching kitchen improves HbA1c, blood pressure, and cholesterol for patients with type 2 diabetes: results from a novel randomized controlled trial. Diabetes Research and Clinical Practice. 2015;109(2):420-6. doi: 10.1016/j.diabres.2015.05.007.
Zachary Stauber, Alexander C. Razavi, Leah Sarris, Timothy S. Harlan, Dominique J. Monlezun.(2019) Multisite Medical Student–Led Community Culinary Medicine Classes Improve Patients’ Diets: Machine Learning–Augmented Propensity Score–Adjusted Fixed Effects Cohort Analysis of 1381 Subjects. American Journal of Lifestyle Medicine. DOI:10.1177/1559827619893602
Razavi AC, Sapin A, Monlezun DJ, et al. Effect of culinary education curriculum on Mediterranean diet adherence and food cost savings in families: a randomised controlled trial. Public Health Nutr. 2020;23:1-7. doi:10.1017/S1368980020002256.
This is a study that is ongoing now in collaboration with the NIH:
Farmer N, Powell-Wiley TM, Middleton KR, et al. A community feasibility study of a cooking behavior intervention in African-American adults at risk for cardiovascular disease: DC COOKS (DC Community Organizing for Optimal culinary Knowledge Study) with Heart Disease. October 2020:1-18. doi:10.1186/s40814-020-00697-9.
Can you discuss how culinary medicine enhances traditional medical curricula and the influence it may have on future medical practices? How have medical students and physicians received the integration of culinary knowledge into their learning and practice?
It is well documented by our public health colleagues that short, simple messages repeated over and over are amazingly effective at helping patients. This is well borne out by the smoking cessation literature, and we have been having the conversation with our patients about stopping smoking for decades. It has proven quite effective.
In short, when we talk the talk, patients do listen.
Interestingly, when we walk the walk ourselves (as healthcare professionals have done in quitting smoking ourselves) and then talk the talk about that walk that we walk, patients listen at an even higher rate.
The key is that nutrition education is somewhat more complex than smoking or not smoking. Providing the training in Culinary Medicine and a deeper understanding of nutrition from a food-first perspective will lead to improved quality of counseling and better patient outcomes.
In preventative healthcare, how essential is it for physicians to be proficient in culinary medicine and how can it revolutionize patient counseling and outcomes?
This is a new(ish) skill for physicians, but an essential one given the dramatic impact of food related morbidity and mortality today. When I give lectures I challenge my colleagues to look at the patients in their waiting room and ask themselves, “How much of their condition is related to food?”
We have had great partnership with our dietitian colleagues for a very long time. These proficiencies are not in any way meant to supplant their expertise but to augment that counseling and care. Our experience is that physicians who counsel prime their patients for greater success when they do work with a dietitian.
Could you explain the concept of culinary medicine?
Culinary Medicine is an multi-disciplinary approach combining the art and science of food and cooking with the evidence-based practice of medicine. It involves incorporating culinary knowledge such as meal preparation, knife skills, and recipe modification, to improve the nutritional quality of the foods we and our patients eat. The foundation of that nutrition knowledge and culinary skills is used to help individuals make healthier food choices and improve their health.
Culinary Medicine leverages the role that food plays in health and empowers people to implement healthy food choices.
Key aspects:
Culinary Skills: Teaching individuals the skills to prepare nutritious and balanced meals using a variety of cooking techniques.
Nutrition Education: Providing individuals with evidence-based information about the nutritional value of foods and meal plans.
Taste and Flavor Development: Training on the use of herbs, spices, textures, flavor building and cooking methods to maximize taste.
Disease Prevention and Management: Using evidence-based nutrition and culinary knowledge to prevent and manage illness.
Behavior Change and Mindful Eating: Supporting individuals in making positive, sustainable change, emphasizing mindfulness around food – being present and attentive while eating to savor the experience.
Food Accessibility and Affordability: Addressing issues related to food security, access, and affordability.
How can physicians and other healthcare providers incorporate it into their practice?
There is a range of avenues for us to implement programming. At the simplest level is making nutrition a key part of the history and physical, and incorporating culinary medicine principles into patient counseling and therapy plans.
We have colleagues across the country who are implementing a variety of strategies, including electronic consults – both healthcare professional to healthcare professional and healthcare professional directly with patients.
Other sites have implemented teaching kitchens as part of their practices and are conducting hands-on community cooking classes as shared medical appointments. This is in large scale multi-specialty groups, private practices, hospital systems, and faculty practices.
The Culinary Medicine Specialist Board has a very active Clinical Practice Committee that is helping evaluate, shape, and publish these methodologies and processes. These types of programs and future developments are driving the adoption of Culinary Medicine programs.
Do you advocate for the installation of teaching kitchens in hospitals, and if so, how can this enhance patient health outcomes?
Of course. If you had told me 10 years ago that so many medical schools and hospitals would have active teaching kitchens, I would have scoffed. It just seemed so improbable. I and many of my colleagues do believe that this is becoming the standard of care both in medical training and in patient care.
Should culinary medicine be a staple in every medical school’s core curriculum, and is there a need for further emphasis on this?
There are many of us across the country who believe this should be implemented in the curriculum as the standard of care. I am certainly one of those. I do believe that we are moving in that direction now very quickly. There has been a major shift with academic leadership clearly seeing the need for incorporating meaningful nutrition programming into the curriculum.
Given the educational voids in medical training, how critical is it to amalgamate more culinary and nutritional education into medical curricula, and what challenges have arisen with the expansion of the curriculum?
Well, of course I think that it is critical. The challenge is that we in healthcare have gotten really good at doing what we do the way we’ve been doing it. That is, we have been perfecting great interventions and practicing episodic and interventional care for millennia and have gotten especially good in the last 40 years.
Unfortunately, in that 4 decade period there has been a dramatic rise in the access to calorie dense, nutrient poor, ultraprocessed food with the perception of being cheaper that is poisoning us. The majority of illness now is related to food and there is now clear and deliberate movement to address the issue.
The challenges are now mostly ordinary and routine: funding, training, finding a place for programming in the curriculum of healthcare professionals, infrastructure. Not really much different from trying to initiate any other change in healthcare, but collectively these are daunting. Colleagues across the country are working through this step by step, brick by brick, meal by meal.
Can you discuss the development process and transformative potential of the Health meets Food Culinary Medicine courseware for medical education, patient care, and communal well-being?
In 2014 we sat down to brainstorm what the future of Culinary Medicine might look like. We arrived at a Venn diagram with the three intersecting circles of healthcare professionals, chefs and foodservice professionals, and the community. It is critical that we approach this as a systematic way. Training each group and having the three of them understand health from a food-first perspective is the transformative model that allows us to work together for substantive change.
At the time the Culinary Medicine Specialist Board already had robust programming for healthcare and the community, and we have since developed a similar model with programming for culinary schools and certification in Culinary Medicine for chefs and foodservice professionals. Helping those in foodservice understand how to create great food that just happens to be great for you in the same way as we have been doing in healthcare and the community is the combined platform we need for sea change.
Given existing evidence gaps, what diversified and rigorous research methodologies are required to evaluate the comparative efficacy and optimal application of various foods as medicine interventions on physical, social, and mental health outcomes and healthcare utilization?
With food as medicine interventions predominantly reliant on philanthropy and displaying variable availability in peer-reviewed literature, how can consistent funding and equitable access for patients be ensured, and what role can policy reforms play in institutionalizing these interventions as a standard component of evidence-based disease prevention and treatment?
Your preferred pronouns: Doctor / him / his / he
The place you grew up in: Mostly Atlanta, Georgia until I was in my teens and then in New Jersey for high school.
The place you currently call home: Foggy Bottom, Washington, DC
Job title: Associate Professor of Medicine, Executive Director GWU Culinary Medicine Program
As a child, you wanted to be: An adult.
One word you would use to describe our food system: Abundant
Foodie hero: Graham Kerr. As a kid in the 60s and early 70s I watched The Galloping Gourmet assiduously. He is just amazing and made cooking look both exotic and effortless. Real ingredients and great food and classic techniques.
Your breakfast this morning: A slice of cheese toast (it’s a Southern thing), a banana, and tea.
Favorite food: If I have a favorite single ingredient, that would probably be smoked paprika. I really don’t have a favorite food, but given the opportunity I won’t ever pass up a great Indian restaurant. Rich aromatics, great healthy food, terrific foundational ingredients, and spice, spice, spice.
Favorite dessert: I am not a sweets guy and almost never have dessert. If I do eat something sweet, it is generally something caramelized like toffee or peanut brittle.
Last meal on Earth: Probably cheese toast.
Food As Medicine social media must follow:
https://robertlustig.com
https://www.linkedin.com/in/jaclyn-albin-mp-doc/
https://www.facebook.com/OldwaysPT/
Food newsletters, websites, or books you can’t stop reading:
https://www.foodpolitics.com/
https://culinarymedicine.org/
However, I tend to get my information directly from peer reviewed research literature.
Your proudest “Food” moment: Last night. I am learning to make a Japanese rolled omelet. There are techniques in cooking that always seem so remote or risky or out of reach but are actually pretty easy when you think them through.
Your favorite ingredient that heals: Soups and stews. I know that is not a single ingredient, but for me it is the totality of ingredients in a recipe that is what healing is all about.
If you were to bring a gift as a meal, what would it be? Not sure. The questions seems so circumstantial. If it is for a summer cookout, a great composed salad like a Lemon Basil Orzo Salad. If someone is sick, soup like a great Broccoli Cheese Soup or Creamy Vegetable Soup is just the trick For a potluck you can’t beat a simple Chili.
If it is for a dinner party, one doesn’t really take a meal to a meal but I like to take Pickapeppa Sauce (instead of the traditional wine). This is an amazing Jamaican chutney that my parents began using back in the mid-60s. They’d pour it over cream cheese and spread the combination on crackers. If you have not had it, do so. It’s amazing.
