8 9 5 1 4 9 AJLXXX10.1177/1559827619895149American Journal of Lifestyle MedicineAmerican Journal of Lifestyle Medicine
research-article2020
vol. 14 • no. 2
American Journal of Lifestyle Medicine
John La Puma, MD
Culinary Medicine and Nature:
Foods That Work Together
Abstract: Culinary medicine is a
new evidence-based field in medicine
that blends the art of food and
cooking with the science of medicine.
Intended to be of constructive use to
clinicians, patients, and families,
this column covers 10 practical ways
for eaters to enjoy preparing and
choosing foods, meals, and beverages
that work to prevent and treat disease
and to enhance one’s own natural
ability to stay and get well. The
column also identifies mechanisms
by which food and beverages work in
the body as culinary medicine. The
column identifies what-to-look-for
“chef’s secrets” for choosing fruits and
vegetables at the peak of flavor in your
own garden, in supermarkets, and
in farmer’s markets. Edible flowers,
herbs, and spices with special culinary
medical value are also described, as
are essential ways to choose and also,
when necessary, avoid them. Finally,
the corporate and professional office is
described as an ideal site for nature-
based stress reduction and burnout
reversal, in which both culinary
medicine and the power of nature
can be used to reduce the symptoms
associated with chronic stress.
Keywords: culinary medicine; food
as medicine; cooking; bioavailability;
specific diets; nature therapy; nature
as medicine; gardening; farmers
market; edible flowers; healthy recipe;
ChefMD; horticulture; xenohormesis;
burnout
Culinary medicine is a new
evidence-based field in
medicine that blends the art of
Kitchen
A core principle of culinary medicine
is bioavailability.2 Like in pharmacology,
nutrient bioavailability in food is
influenced by many factors:(for
example, cofactors, temperature,
cooking method). Here are 10 take-
The objective of culinary medicine is
to attempt to empower the patient
to care for herself or himself safely,
effectively, and happily with food and
beverage.
food and cooking with the science of
medicine. Culinary medicine is aimed at
helping people reach good personal
medical decisions about accessing and
eating high-quality meals that help
prevent and treat disease and restore
well-being. The objective of culinary
medicine is to attempt to empower the
patient to care for herself or himself
safely, effectively, and happily with food
and beverage.1
In this column, I will cover several
practical ways to enjoy culinary medicine
in your kitchen, garden, food market and
office.
aways about bioavailability you can use
now.
1. Combine leafy greens and avocado for
seven times as much lutein absorption
than if there was no avocado.3
2. Combine olive oil and tomatoes (or
better, tomato paste) for more
lycopene absorption4: tomato paste has
10 times the lycopene, gram for gram,
as do tomatoes, but only 25% of
lycopene is absorbed without fat.
3. Add two teaspoons of vinegar to a
high carb meal to reduce the coming
spike in blood sugar, insulin, and
DOI:10.1177/1559827619895149. From ChefMD/Chef Clinic®, Santa Barbara, California. Address correspondence to: John La Puma, MD, ChefMD/Chef Clinic®, PO Box
https://doi.org/
24039, Santa Barbara, CA 93121; e-mail: drjohn@chefclinic.com.
For reprints and permissions queries, please visit SAGE’s Web site at https://us.sagepub.com/en-us/nam/journals-permissions.
Copyright © 2020 The Author(s)
143
American Journal of Lifestyle Medicine
Mar • Apr 2020
triglycerides by 20%, all within an
hour.5
4. Add 11 walnuts before or during
consumption of a processed meat and
cheese dish to reverse brachial artery
stiffening within four hours, perhaps
from the walnuts’ arginine, and its
conversion to intravascular nitric
oxide.6
5. Combine foods of the same color in
the same dish to create better flavors:
for example, butternut squash and
yellow curry; more than one green
herb in a salad or frittata; and red
tomatoes with red bell peppers in a
ratatouille.
6. Eat turmeric-containing dishes with
both a tiny sprinkle of black pepper
and a few drops of a healthy fat to
improve the bioavailability of
curcuminoids; the black pepper’s
piperine inhibits the liver’s
metabolism of curcuminoids, and the
fat helps you absorb curcumin
through lymphatics.7,8
7. Leave the watermelon on the kitchen
counter: watermelon then has 40%
more lycopene and 139% more beta
carotene than watermelon stored in
the fridge, as carotenoid biosynthesis
is affected by temperature.9
8. Lower heterocyclic amine (HCA)
formation by 77% by marinating your
(animal) meat burgers in a rosemary-
containing marinade: the antioxidants
rosamarinic and carnosic acids and
carnosol in rosemary may inhibit HCA
production.10
9. Let the garlic you chopped rest for 10
minutes before cooking it, to allow its
allicin and thiosulfinate levels to rise,
so you get their antiplatelet
aggregation benefits.11
10. Add a little bit of a fresh brassica
(e.g., broccoli, kale, watercress,
cauliflower) vegetable to a cooked or
previously frozen brassica dish to
reactivate the detoxification effects of
the also cooked sulforaphane and
boost it in the finished dish.12,13
Garden
Gardening is rarely covered in a
medical journal, but like cooking, there
is evidence for gardening’s positive
effects on health14,15 and for plants’
synergistic effect on one another. For
example, intercropping systems can
work to improve growth, protect against
pests, and improve yield.16
Higher quality gardening and farming
yield higher quality fruits and vegetables,
giving rise to something every good
cook knows: the less you cook
something that is truly fresh and
well-grown, the better it tastes.17 From a
culinary medicine perspective, minimally
cooked produce from the garden often
has a high nutrient content: for example,
bell peppers’ vitamins, minerals, and
phytonutrients rapidly erode with any
cooking.18
To try growing yourself, grow
radishes—perhaps the easiest vegetable
to grow—even in a window box. Harvest
and put out a bowl of freshly washed
radishes with their edible greens, as an
appetizer, next to doctored-up hummus
or the latest nut-cheese. If Alice Waters
and Dan Barber can proudly feature
radishes, so can you.
Market
Optimal food growing and buying is
sometime challenging. Buying local,
organic, and from a grower you know
is an ideal and a privilege. Knowing a
farmer who covers crops annually to
improve food quality and care for the
earth is a privilege too. Growing some
of your own food helps you remember
the cycle of the seasons, appreciate the
connection between growing and
nutrition, be mindful of food waste
and insecurity, and enjoy the
satisfaction and beauty of tactile,
productive, creative, healthful time
outdoors.
Unfortunately, most farmers are
not growing optimally, most eaters are
not buying optimally, and neither can.
The demands of society, work, family,
markets, and many other factors make
it impossible at the moment, though I
believe that will change in some
groups, especially among the well-
informed. So what to do at the
market?
In the grocery store (or farmer’s
market), use your five senses. Try not to
buy produce already wrapped in plastic
or a box. A fruit you can eat in the next
few days will have two of these three
characteristics: it will be heavy in your
hand for its size; it will have a slight give;
it will be fragrant. Most common fruit
(except citrus and most apples) should
be firm with a slight give, but not rock
hard or very soft. Most common ripe fruit
is fragrant (except citrus, persimmons,
and pomegranates). Don’t use your
finger or fingernail to test ripeness—it
injures the fruit, and does not tell you
what you want to know.
Take avocados, for example. Avocados
are ripe when they are heavy in your
hand for their size, and give just slightly
to a gentle squeeze from your palm.
They are not fragrant. An avocado’s skin
color when ripe is avocado specific: Hass
and Lamb Hass darken; Macarthur,
Fuerte, Rincon, and Bacon stay green.
The best value in the market are
blemished avocados that meet the
aforementioned criteria. If you are in the
mood for a uniform exterior, look for
larger, just picked, not-yet-ripe avocados:
they often have a better flesh to pit ratio
than the small ones. Avocados with soft
or dark spots are often fine to eat, once
those spots are cut out and composted.
Those fruit with cuts through the skin,
mold, or squishiness, however, should be
composted straightaway.19
For vegetables, I also like ugly, as long
as the skin is not broken. I like heavy for
size vegetables which are fragrant, full or
turgid when appropriate. Generally,
uniformly sized peppers, eggplants,
squash, and many other vegetables have
had real flavor bred out of them and
“shipability” bred into them. Tomatoes
(and many other fruits- famously
bananas) also have been gassed with
ethylene on their way to market to fool
you into thinking they are ripe because
their color matures.
Look for outsider, misshapen, colorful
vegetables. One theory about why they
are better for you than perfect exteriors is
xenohormesis20: i.e. those with benefiting
from the stress of plants. Plants that have
sent out anti-invader signals carry them to
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American Journal of Lifestyle Medicine
the market and in their cells. And those
plants are not pretty. Do not buy pretty. If
you care about flavor you usually will not
find it there, but you will find higher
levels of anti-stress compounds21, which
are often highly flavorful.
Here are more market “secrets”:
•• An eggplant cap should be green in
most varieties, not brown, yellow, or
absent.
•• The corn tassel should be black, and
the husk filled out (no reason to rip it
all the way open: just feel along its
length).
•• Strawberries should not be white or
green at all, and should have their
tops attached.
•• Look for fresh basil with fleshy leaves
and thin stems so it can do triple
duty: as a garnish; a salad green like
spinach; and as textural crunch.
Texture, like acidity, is often the
missing component of greatness in an
otherwise good dish.
Edible Herbs
Herbs in cooking are leaves, and spices
are every other part of the plant,
including flowers. Everyone knows that
you eat the leaves of a lettuce plant and
the beans of a chickpea plant, but did
you know that the flowers of many
vegetables and herbs are also edible?
(Common exceptions: flowers of tomato,
potato, eggplant, peppers). The
nutritional value of flowers is substantial,
with flavonols, anthocyanins, and many
vitamins and minerals being
concentrated in them.22
Which flowers are edible? The list is
long: all the allium family (leeks, chives,
garlic, garlic chives, onion, shallot). All
brassica, lettuce, and herb blossoms,
from arugula to basil to chamomile to
dill to za’atar and three dozen more.
Most of these taste like a slightly more
bitter, pungent version of the herb.23
Borage blossoms are one of my favorites:
they taste like cucumber. Nasturtium
(Tropaeolum majus L.) blossoms are
among the easiest to grow and best-
studied.24 The flowers are beautiful; you
can eat and pickle the buds; and the
flavor of both flowers and buds is
peppery. They have antimicrobial,
antifungal, and expectorant effects. Try
them sprinkled on salads or on a just
out-of-the-oven pizza. Really.
A word to the wise: do not eat a weed
or a flower growing out of your garden
or lawn or someone else’s unless you
know what it is and how it was raised.
Flowers from a florist are often imported
and sprayed with chemicals; roadside
herbs and edible flowers in parks may
have had the same treatment, plus
petroleum and waste products.
Office
Could specific plants on your desk at
work improve medical problems? Possibly.
In our 4-week multisite pilot program,
we gave plants and sent inspirational
texts to clinicians and executives. Those
who selected air-cleaning plants and
tried anti-inflammatory herbs and spices
had significantly better scores on the
Perceived Stress Score (PSS-10) and
Maslach Burnout Inventory (MBI) than
they did at the start, improving back
pain, depression and palpitations, among
other stress-related symptoms. (P < .05;
unpublished data). Was this culinary
medicine at work?
We do not know a fraction of why
nature and food work as medicine, but
we do know what often works to
prevent and treat common chronic
diseases. The scientific evidence for both
nature therapy25,26 and culinary
medicine27 is accumulating. Finding more
of what nature and food have to offer to
patients and clinicians is a path ahead.
Recipe
Here is a vegetarian recipe that you
could make vegan with nutritional yeast
and toasted sesame seeds instead of feta,
or omnivorous by adding marinated
roasted chicken thighs. Also, dried
cherries may replace the cranberries, and
small baby carrots may replace the
cauliflower.
This recipe illustrates some of the
principles mentioned above: the olive oil
helps you absorb the carotenoids in the
cranberries and Brussels sprouts; the raw
Brussels sprout helps you detoxify more
efficiently; the fiber in the recipe helps
you feel satiated—full and fully satisfied.
Roasted Winter
Vegetables With Cranberry
Studded Quinoa
Preparation time: 10 minutes
Cooking time: 20 minutes
4 servings
359 calories per serving, 31% from fat
Ingredients. 1-1/2 cups low-sodium
vegetable broth
3/4 cup organic mixed color quinoa
1/4 cup dried sweetened cranberries
3 cups cauliflower florets, quartered (10
ounces)
8 ounces small Brussels sprouts, halved
lengthwise, with one reserved and sliced
thin
3 tablespoons virgin olive oil
1/2 teaspoon each salt and freshly
ground black pepper
1/4 cup organic barbecue sauce
8 ounces organic extra firm tofu,
drained and cut into 3/4-inch cubes
1/2 cup toasted pumpkin seeds
1/2 cup crumbled feta cheese (optional)
Preparation. Heat oven to 450°F. Bring
the broth to a boil in a medium saucepan.
Stir in quinoa and cranberries. Reduce
heat; cover and simmer 15 minutes or
until most of liquid is absorbed. Turn off
heat; let stand covered 5 minutes.
Meanwhile, arrange cauliflower and
Brussels sprouts on a 15 × 10-inch jelly
roll pan or baking sheet with sides.
Drizzle oil and sprinkle pepper over
vegetables; toss well to coat and sprinkle
with salt and pepper. Bake 12 to 14
minutes or until the vegetables are
browned on the bottom and crisp-tender.
Transfer to a large bowl. Add barbecue
sauce and reserved Brussels sprout; toss
well. Add tofu; toss lightly. Spoon cooked
quinoa mixture onto 4 serving plates; top
with vegetable mixture and pumpkin
seeds, and feta cheese if desired.
Nutritional Analysis per Serving.
Total fat (g) 17.0
Fat calories (kcal) 153
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American Journal of Lifestyle Medicine
Mar • Apr 2020
Cholesterol (mg) 12.6
Saturated fat (g) 3.5
Polyunsaturated fat (g) 1.9
Monounsaturated fat (g) 4.4
Fiber (g) 6.9
Carbohydrates (g) 49.8
Sugar (g) 16.6
Protein (g) 17.9
This recipe is adapted from Roizen M,
La Puma J. Cooking the RealAge Way.
New York, NY: HarperCollins; 2003.
Declaration of
Conflicting Interests
The author(s) declared no potential conflicts of interest with
respect to the research, authorship, and/or publication of this
article.
Funding
The author(s) received no financial support for the research,
authorship, and/or publication of this article.
Ethical Approval
Not applicable, because this article does not contain any
studies with human or animal subjects.
Informed Consent
Not applicable, because this article does not contain any
studies with human or animal subjects.
Trial Registration
Not applicable, because this article does not contain any
clinical trials. AJLM
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