Cindy Kin, MD, a colorectal surgeon, started viewing food as medicine after lifestyle changes, including a proper diet, helped a patient heal and avoid surgery. Like most medical professionals, Kin had received little nutritional training, so she began studying the healing power of food.
Kin researches prehabilitation, where doctors help patients optimize their physical activity and nutrition prior to surgery. She incorporates nutrition coaching in the hopes that patients will carry the lesson with them and develop lifelong healthy habits. One of Kin's current projects compares colorectal surgery patients who eat low-fiber, high-saturated fat diets with those who eat diets high in fiber or fermented foods to see if change in diet influences the gut microbiome before and after surgery.
At Stanford Hospital, Kin and colleagues are actively exploring new real-food alternatives to nutritional supplements for recovering patients. She works alongside colleagues from food services and hospitality, as well as with nutrition scientist Christopher Gardner, PhD, professor of medicine, and dieticians.
Kin, who spoke on March 31 at the Stanford Food Summit, discussed what it means to reimagine hospital food and why it matters for patients.
How can food be medicine?
Many of the most problematic chronic diseases in America stem from lifestyle habits such as diet. These include hypertension, diabetes and high cholesterol. Often in medicine, we are treating with medication and trying to get people's numbers down, but if we couple that with a serious effort at changing people's diets, we'd see a lot more progress. Specifically in colorectal surgery, I believe that a good diet, before and after surgery, can support recovery. We need to give patients the building blocks to heal after we operate on them.
What are some challenges to that?
Food is medicine, but food is complicated, because it's also culture and comfort -- there are all these psychological things that we associate with food, and they can complicate a patient's transition to a healthy diet.
Do any big misconceptions exist among physicians and patients regarding nutritional care?
Right now, America is obsessed with protein. The keto diet is popular, as is the paleo diet. We've made sugar the enemy and protein our friend. But eating a lot of meat comes with a lot of saturated fats and a lot of cholesterol. There's a misconception that if you eat another animal's muscle, then you will gain muscle yourself. That's false: Eating an excess of protein doesn't translate to good health. People are giving up other important food groups like fruits and vegetables for protein. Fruit has received a bad rap because of its sugar content, but sugar that's packaged in a fruit is completely different from the sugar in Skittles. Fruit has many other nutrients, like fiber and antioxidants, that are valuable for the body. Unfortunately, these misconceptions are pervasive.
How have better nutritional habits helped patients?
We've done some prehabilitation studies in which patients enroll in a three-week program that coaches them on exercise and nutrition before they undergo surgery. We found that when participants ate more whole foods and less processed foods, they had more energy and they felt better. Their family members also got in on it, cooking different meals and exercising with them.
There may be some long-term benefits, such as a reduction in chronic disease, that magnify if the family is involved. Incorporating the family in these decisions is key to ensuring positive changes.
What changes have been made to the Stanford Medicine hospital food?
About 10 years ago, Jesse Cool, a local restaurateur and chef, began consulting at Stanford Medicine dining services. It really elevated the options in the cafeteria; it was farm fresh and thoughtful. They replaced the "wall of donuts" with healthier options; at one point there was a farmer's market once a week. They also moved protein options in the buffets to the end of the line so people would fill their plate with vegetables and whole grains first. They also offer more plant-based protein options.
Jodi Krefetz and Helen Wirth, two leaders in the transformation of food services and Stanford Health Care hospitality, are passionate about making hospital food tasty and healthy at the same time, which is a challenge when cooking about 2,000 patient meals per day while accounting for specialized diets and providing food for employees and visitors. At the same time, they are practical, as they have their cost considerations. They're also open to clinical input. For instance, we are currently creating a house-made smoothie and soup that can be a real-food alternative to supplements like Ensure, which are ultra-processed and high in corn syrup and other chemicals.
It's been a fun journey, considering opinions from surgeons, from patients, from dieticians and from the people in the kitchen, who are making it happen. I don't know if that's been done before -- to have clinicians and dieticians come into the kitchen to test products.
How does Stanford Medicine accommodate different dietary needs and use food to supplement care?
Physicians can order a certain diet for their patients, like carbohydrate-controlled diets for patients with diabetes, low-protein diets for patients who have kidney issues, or low-sodium diet for high blood pressure patients. For our surgical patients, we can order a post-operation diet consisting of food that's well-tolerated for patients who just had gastrointestinal surgery. The patients get a menu of what they can eat, and they can order food anytime.
While many hospitals cater to their patients, the Stanford Health Care dining team is enthusiastic about collaborating with clinicians among other people not typically involved in food development.
Incorporating a variety of professionals in the reimagination of hospital food has been a key driver in improving the patient experience and recovery.
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