Photo is of Dr. Graham at the Victory Greens rooftop garden. Courtesy of Christian Johnston.
Dr. Robert Graham is a board-certified physician of both internal and integrative medicine who is currently a culinary student at New York City’s Natural Gourmet Institute. He is trading in his white lab coat for chef’s whites with the goal of expanding his toolkit both for use as a healthcare provider and as an advocate for a new model of integrative, lifestyle-focused healthcare.
Inspired by a growing body of research that shows that doctors are more likely to encourage healthy eating habits in their patients if the doctors themselves eat well, he has taught more than 200 healthcare workers and medical residents how to prepare healthy and delicious plant-based meals.
He currently sees patients at Physiologic, an integrative health and wellness center. Through his practice, FRESH Med NYC, he promotes a paradigm shift away from the conventional approach of “a pill for an ill” and towards addressing the root causes of disease, with a food first approach.
He is also responsible for the creation of “Victory Greens,” the first educational and edible rooftop garden at a hospital in NYC. He plans to replicate the program at other hospitals in New York City, New York State, and beyond.
Food Tank had the chance to sit down and talk with Dr. Graham ahead of a summit focused on the subject of “food as medicine” that he is co-hosting in partnership with the Food Policy Center at Hunter College New York City.
Food Tank (FT): What inspired your decision to step from the doctor’s office into the kitchen and trade your white lab coat for chef’s whites?
Robert Graham (RG): Somebody’s got to do it. Why wait for someone to come along while I’m capable of making the change we need to see? I always wanted to be a doc, I have loved being a doc, and I still love being a doc. But I feel I can do more.
My decision to become a chef comes after 15 years of watching patients battle ailments that could be remedied with a change of a diet. And the impacts of poor diet don’t only land on them as individuals, but collectively on us as a nation.
Years and years of research have clearly and undoubtedly established that food is the number one cause of poor health in America. Poor diet is causing nearly half of all United States (U.S.) deaths by way of the number one killer, heart disease, as well as stroke and diabetes.
So, there I am watching these numbers climb from inside the clinic and the hospital. I’m watching people die of things that can be remedied. Remarkably, despite how widespread the problem is, fewer than 25 percent of doctors feel that they’ve had sufficient training to provide nutritional advice to their patients. Nutrition is virtually ignored by our healthcare system, both in education and clinical settings.
We even offer our patients in our hospitals the exact foods that landed them there in the first place: high-fat, high-salt, highly-processed, and highly-sugared foods.
And, finally, cost of care. There are very few conditions for which our current healthcare delivery models reimburses doctors for nutritional advice. It doesn’t reimburse for cancer. It doesn’t reimburse for gastrointestinal diseases. The two big ones it does reimburse for are end-stage renal disease and diabetes. Not pre-diabetes, even though we know that food interventions at that point are the most effective tool to prevent diabetes. Only once a patient has diabetes are nutrition visits reimbursed to deal with it.
Being born and raised in a house where food was such an important factor in our everyday lives really allowed me the opportunity to appreciate and share the importance of this connection between food and healing. To me, cooking is one of the most beautiful forms of showing love to someone.
I felt that maybe I could make a bigger difference by working with the food industry and organizations like Food Tank and Meatless Mondays and progressive food companies. It’s an embarrassment how medicine and healthcare have taken a backseat to health. Hippocrates, over 2,000 years ago, said, “let food be thy medicine and medicine be thy food.”
FT: How would you like to see the relationship between doctors and food service professionals change, other than having every doctor become a chef?
RG: That’s one of the criticisms that I’ve had thrown at me: that not every doctor needs to be or can be a chef. But there’s research that shows that a physician’s own health behavior is the greatest predictor of their counseling their patients to pursue that same behavior.
We have to work on strengthening our collaboration. Each of us is a vital part of the healthcare team: doctors, farmers, chefs, nutritionists, health coaches, and policymakers. We all need to have an active role in working together to improve health outcomes and reduce healthcare costs.
Besides teaching more doctors how to cook more healthily, one of my goals is to develop medically-tailored meal plans. People are confused about what to eat and when to eat and why to eat. I think through my degrees in public health, medicine, and now cooking, I’ll be able to cook for patients, consult with food companies and develop tailored meal plans for my patients’ conditions.
There are some studies looking at the impact is of medically-tailored nutritional meals for patients with specific health conditions like diabetes and heart failure. They’re small sample sizes, but they’re promising.
FT: What challenges have you faced as you continue to tackle this problem from different standpoints and how has confronting them changed your perspective?
RG: My biggest perspective shift has been towards the understanding that if food is the biggest health problem in our society, it also has to be the solution.
I break up my perspective into four categories: education, clinical, research, and community and policy.
In terms of education, it’s simple: people are confused. Nutritional science is a very complex science. Nutritional advising for patients has been marginalized because of the inadequacy of our educational systems from preschool to postgraduate residency. Nutrition has also been marginalized in our society. Home economics classes taught us back in the 1970s and 80s how to cook. Now we’re on the third generation of kids who do not know how to cook. There is no room for it in any curriculum. To try to rectify this, I’ve hosted cooking classes for doctors and nutritionists on Mondays over the last 7 years, as part of the Meatless Monday Campaign at the Natural Gourmet Institute.
On the clinical side, as I mentioned before, the issues are very low reimbursement and little nutritional counseling. Our clinical model right now is volume-based. The more patients you see, the more money you get. Instead, we should have a value-based system. The Center for Value-Based Medicine suggested value-based medicine (VBM) as the practice of medicine based upon the patient-perceived value conferred by an intervention. We should have a system that values good clinical outcomes, not just volume of patients we can “fit” into our day. More is not better. Better care is better!
In fact, in our volume-based system, good clinical outcomes, like better glycemic control in a diabetic, makes the system less money because that patient doesn’t have to see the doctor as often. We don’t do value-based medicine because we’re not reimbursed and we don’t do it because we’re not taught it. It’s very hard for doctors who are not trained in this model to really have an intelligent, evidence-based conversation with their patients in a clinical encounter unless they have the time to do a bunch of self-education.
As far as research goes, the question is: can food be as effective as medicine? I think some of the studies that we’re starting to see, like the Diabetes Prevention Program, have proven that it can. Lifestyle changes, predominantly focusing on considering food to be medicine, have a better long-term reduction in the rate of developing diabetes than just medication alone. I’ve always supported the idea that ‘a pill for an ill’ won’t work with lifestyle-related illnesses.
Finally, on community and policy. In America, food insecurity is a big issue. I don’t like the term ‘food deserts,’ because there is food in most of them. the issue is that it is mostly bad food. I refer to them as ‘good food deserts’ or ‘food swamps’ because there’s a scarcity of good foods. Even those of us who like to cook were often never taught how to. We spend more time watching cooking shows than we actually cook. People in societies that cook more meals have better health outcomes and less disease burden. Cooking is medicine too. I’ll discuss policy later.
FT: You are ultimately talking about making major changes to the way two industries interact–the food and health industries. What inspires you to keep doing this work when you’re up against such a powerful system?
RG: Wendell Berry once said: “People are fed by the food industry, which pays no attention to health, and are treated by the health industry, which pays no attention to food.” I want to really flip that model.
I feel that both of these systems are equally sick and equally broken. If we can take them both and consider how to link the chef-doctor or the doctor-chef with farmers, we’ll have healthier systems. What we eat is a result of the choices we make, but also of the choices our farmers make.
A poor diet is not just about an individual’s choices and their individual responsibility. It’s about the system that makes eating poorly the default for most Americans.
Our farming model is unsustainable, with monocropping techniques, use of pesticides, antibiotics and an aging farmer population. Our healthcare model is also unsustainable emotionally, as the rates of suicide among doctors is alarming, and economically, as every year a larger percentage of our GDP goes to healthcare. The interaction between these industries is going to be the future.
FT: From your experience as a practicing doctor, can you recommend a few primary changes or interventions that readers can prioritize in their own lives?
RG: I have 13! I call them Dr. Graham’s Bakers Dozen.
- Eat more greens and beans.
- Eat off of smaller plates.
- Smallest meal of the day should be in the late afternoon or evening.
- I love that Michael Pollan quote: ‘Eat food, not too much, mostly plants’ and I would add ‘and cook them.’
- Local and organic is best. I choose local over organic, but organic when you can. People should look to the Dirty Dozen and Clean Fifteen lists by the Environmental Working Group.
- Drink water, not calories. Specifically, sugared beverages have got to go. There’s the quote by Walter Willet “that if we get rid of sugared beverages, we could almost halve the obesity epidemic overnight.”
- If you can’t read it, don’t eat it.
- If your food comes in a box, eat the box because at least it contains fiber
- Slow down. Chew your food. Sit down with family if you can.
- Aim for full, not stuffed. The Okinawan principles of “hara hachi bu”. Eat to 80 percent full.
- Other people matter. If you hang out with people who have a health-focused mindset, you tend to be healthier by association.
- Listen to your gut. The role of the microbiome and the impacts on both our metabolism and our overall health and wellbeing, it is going to be the next emerging health trend.
- Cook more!
Come visit us at FRESH Med NYC at Physiologic in Brooklyn and follow us @freshmednyc.
Our motto is “When it comes to our health, it all starts with food but in the end, what we truly want in life is to be happy.”