 Dr. Lapuma is clinical director of Chef Clinic, co-founder of ChefMD and the New York Times bestselling author. He has led clinical trials of nutritional interventions designed to improve obesity, hypertension, osteoarthritis, insomnia and diabetes. Dr. Lapuma hosts PBS's new national series, ChefMD Shorts, and his most recent book is Men Don't Diet, Men Refuel. Please welcome Dr. Lapuma. Thank you, Dr. Ross. And thank you all. Let me thank Mark especially for the invitation, the mentorship, the kindnesses, and real friendship you've shown over the years. And I'm so grateful for that and for so much else. And for all of you staying here through lunch or not through lunch, as the case may be, it turns out, and this is a modified title, I know that most of you are actually expecting a demo. And many of you know I've been to cooking school and taught cooking school and so I was really hoping to do a cooking demo. But sadly, there is no cooking in the law school. And I just really worry about the health of future attorneys. But I guess we can negotiate that in the next election. Instead, I am standing in a dangerous place between you and lunch on the south side of Chicago, just about to talk about food, not just any food, but comfort food. And so I want to ask your indulgence and then I'll dive right in and try to make it worth your while to stay. I want to ask first, with a show of hands, who here has suggested a food or a meal to a patient for a medical condition? Maybe 30, 40 percent. Okay. Who here has used a food or a meal for her own or your own medical condition? Also about 40 percent and it looks like a different 40 percent. So I want to try to talk with you today about how comfort food can cure. This is also not my title, but I'm happy to rise to the challenge. Here are three parts. What is comfort food? Went to prescribe it and comfort food is culinary medicine. This is Jamie Oliver's, the cover of Jamie Oliver's new book. Who here knows about Jamie Oliver? Only about 25 percent of us. Jamie Oliver is the naked chef, not for his lack of clothes and deadly go-blat kind of emulation, but instead for his food, which is unadorned, at least it used to be. Now, actually, and has for eight or ten years dramatically improved the quality of the food served to school children in Britain and has made a similar effort in the United States, not quite as successfully. Here he talks with Stephen Colbert. I'm going to play this clip. It's very short, so I may have to play it twice, which is fine, about what comfort food means. He's been talking about food and cooking food that is especially healthy. So short clip. This is the Colbert Report in 60 Seconds. Beautiful stew or curry or pot roast or meatballs that just kind of makes you feel like you want to hug or you're getting a hug. Yeah, yeah. Eventually your body hugs you all the time. You got that. Okay. I won't play it again. So this clip in 12 seconds summarizes our conflicting feelings about comfort food. On the one hand, it's incredibly soothing and on the other hand, it's incredibly unhealthy. Right? Well, maybe not. So this really begs the question, what is comfort food? I think comfort food is memory, history, culture, and identity rich, all those four things. Tasty food eaten to maintain or regain mood. Comfort food comes in four categories. Nostalgic, indulgent, convenient, and physical comfort. Those actually are not my categories, although the definition is mine. Those are categories derived from the psychology literature and reiterated there. Comfort food is not, despite what you might think, primarily macronutrient driven. It's not primarily carbs or primarily fat. Certainly not primarily alcohol and not primarily protein. It is, it does tend to be more indulgent than not, but I'll show you some comfort food shortly that actually might verge into healthy and we'll talk about what that difference is. Men and women choose very different comfort foods. You've heard Jamie Oliver describe the pot roast or the curry. Men generally choose meals as comfort food. It makes them feel cared for. It often reminds them of home and sometimes of their mom. They have positive triggers for comfort food. Men generally eat comfort food as a reward. Women, completely different. Women eat comfort food that is sugary, fatty, crunchy. They use it to console themselves. It's not a reward. And they feel guilty after eating it. That's a really big difference. Now there are good, that data comes from, by the way, from Cornell and Brian Wantsink who has studied behavior and food a lot. And yet there are good reasons for this both physiologically and psychologically. And comfort food is actually both. It's both physiologic and psychologic. In physiology and here are some of the abstracts that I found important and papers that I think are useful about using comfort food as self-medication. No one really knows the mechanism for this. Although a lot has been actually found in animals. Very different kinds of theories. Whether it's endogenous endorphin release or cholecysticindin release in the intestine because many much of comfort food is fatty and so that fills you up right away. Whether it's cortisol release and a modification of the cortisol response as you respond to stress or exorceratonin synthesis from all those carbs because actually there are often a lot of carbs. Or if it's just the body's way of telling the brain, you can relax, you refuel, you've got lots of high energy food. No one really knows. Similarly the psychology of it is puzzling as well. The popularity of mac and cheese and chicken pot pies is way up after September 11th. But it wasn't the fat or the carbs or the calories. It's because people knew what to expect when getting those dishes and we often, as you remember, didn't know what to expect after September 11th. So this is really quite complex and interesting. However too much comfort food, as Stephen Colbert was pointing out, can make David go from this to that. We don't want that but in fact it happens to too many of us and there's a reason for that. It's because when you have too much comfort food, really too much any food, you gain visceral fat and men that changes testosterone to estrogen and men and women it increases inflammation and cytokines and you blunt your insulin response, you just feel awful and that's what happens. But it doesn't have to happen. This is Paula Wolfert. Who knows who Paula Wolfert is, anybody? One, two. Paula is a colleague and friend who probably knows more about Mediterranean cooking than anyone in this country. Her books are The Slow Mediterranean Kitchen and Coos Coos, Another Good Food from Morocco. She's the doyen of Mediterranean cooking and interestingly she has Benson's disease which as you know is an atypical variant of Alzheimer's disease, sort of a visual analogue of it and so her memory is going and so she's trying to use culinary medicine, her food is medicine, to forestall the neurologic loss and it's actually being successful. She's blending avocados and blueberries and three kinds of coconut into a blender every morning and giving herself a shake and in fact her deterioration is stabilizing, although of course she's doing other things as well. Paula wrote for PBS what we did a series on comfort food about her recipe chicken smothered in cracked green olives which by the way has two small chickens and four quarts of cracked green olives. That's a lot of cracked green olives. This recipe, my chicken smothered in cracked green olives, is the dish I was going to make for my son. She wrote, who is coming home for Christmas. I thought it would bring back family memories of living in Morocco when he was growing up. The smothered was very important here because it's over the top. It's pushing the point. It's making memories in Technicolor. I'm comforted by making this memory for my children. So another aspect of comfort food, we see someone who prepares it with love and remembers with love how it was prepared and here actually are some of the foods that we ourselves either save for a sick day for soothingness or used to celebrate. This is actually Paula's chicken with cracked green olives and some preserved lemon on top and lots of parsley. But more familiarly, macaroni and cheese, cheeseburgers and french fries, you notice the little beef on top, mashed potatoes and gravy, deep to Chicago pizza because we're here. Why else? Spaghetti and meatballs because we're anywhere. Chilaquiles which is a dish of tortilla chips with a chili sauce, cotea or another Mexican cheese on top and a fried egg which we used to make at Topal Bombo at 11.30 at night after serving. Although that egg looks like it's not quite runny enough and of course that's an interesting kind of preference because I really haven't said and want to now that comfort food among all other things is intensely personal. It's not just culturally memory identity rich, it's personal. What your comfort food is is for you and it says individual as people are. This is matzabal chicken soup which of course is one of the more, which looks like a more traditional healthy food. I mean it's broth and carrots and a little bit of parsley and whatever matzabals are made of. And then we move to ice cream pecan pie. This is a pecan pie ice cream chocolate chip cookies and you should pay attention by the way to the chocolate chip cookies outside on the side table I'll tell you why at the end of the talk. A glazed cinnamon roll and a frosted cupcake. Some people believe that the frosting on the cupcake is a separate comfort food from the cupcake itself. That probably deserves really like a federal grant, I don't know. And you can in fact buy a meatloaf cupcake here in Chicago, combining the snackiness of cupcakes and the meal of meatloaf. I don't really know who would buy it but I'm sure they're all really popular. And then donuts. You might be interested to know that the glaze on a donut is trans fat combined with powdered sugar. They take a little bit of Crisco, they put powdered sugar on it and they put it under donut. Fried chicken and waffles because we're very close really to the mecca of fried chicken and waffles and then a tool called Wandy who himself is not a comfort food but instead has written a really great book called Being Mortal which I recommend if you haven't read it you should because I think it has the potential to make public a debate about end of life care that we really have not made public in a really constructive way. Wandy as you know is a surgeon at Harvard who also writes for the New Yorker, writes brilliantly and he writes about food near the end of life and about our goals in medicine. He writes we've been wrong about what our job is in medicine he says. We think it's to ensure health and survival but really it's to enable well-being and well-being is about the reasons that one wishes to be alive. Those reasons matter not just at the end of life or when debility comes but all along the way. Food is the hundred years war in retirement facilities. A woman with severe Parkinson's disease keeps violating your period diet restrictions. A man with Alzheimer's disease hordes snacks in his room violating house rules. A diabetic is found eating clandestine sugar cookies and pudding knocking his blood sugar way off target. Medicine has forgotten how vital such matters are to people. We want autonomy for ourselves and safety for those we love. People want the right to lock their doors, dress how they like, eat what they want. So this is the second part of the talk. When do you prescribe comfort food? I think there are three indications at least. One is to do what Gawande suggests when you want to enable well-being and quality of life. I think a comfort food should a patient want it is a really good thing. You want to trigger feelings of caring and healing certainly if you want to improve anorexia and most of all when health and survival are not the primary goals when they're secondary. Second, when you want to with a patient honor autonomy more than safety when someone really needs that feeling of independence and kind of a demonstration of it I think you want to say what would you like to eat? What's your favorite food? Let me get it for you or let their family get it for them. And then third, when you want to explore fears, goals and trade-offs instead of simply deciding for patients or just giving them information but when you want to have an actual relational discussion I think these three ideas form the basis of my suggested indications for prescribing comfort food and I suggest you use an actual prescription slip. Third, comfort food is culinary medicine. The art of food and cooking blended with the science of medicine is the definition of culinary medicine that has as a mission restaurant quality meals that aim to prevent and treat disease with its vision being that of an accessible effective safe toolkit in a clinician's pocket. And actually culinary medicine is becoming a thing. The first course, cooking nutrition course was taught at State University of New York Upstate in 2004. Harvard has a CME conference that's over subscribed every year since 2007. Tulane has a curriculum that is now licensed to nine different medical schools in culinary medicine. I taught the first clinical student elective with Des Moines University and Santa Barbara Cottage Hospital last year. It's becoming a thing and this is part of culinary medicine. So use your prescription pad, write a prescription for comfort food especially for patients near the end of life and perhaps at other times. Don't worry about healthy or nutrition in comfort food. It's not the primary goal. The primary goal is to enable well-being. And then write prescriptions for condition-specific healthy recipes for patients who are not near the end of life because there are such prescriptions and they're available. I want to give you a taste of a comfort food that is important to me. These are beehives on my property in Santa Barbara. I have a little organic farm and take care of bees and harvested this raw, hand extracted unfiltered honey and with friends centrifuged it down and brought you all samples and a little straw that you can find on the chocolate chip cookie table. The reason this is important other than it's really incredible and you'll like it is because as a clinician who is really interested in food and thinks that it can be a therapeutic tool, it's safety, it's flavor and depth of flavor and the ability to savor this comfort food is something that I treasure and it's a way to avoid going from David in 1504 to David in 2014. Savoring comfort food is the secret to its cure. Thanks very much. We go way back, Dr. Lupuma. I met you when I was a clinical dietitian so if you want to learn how to make Matt's ball soup I'll be happy to do that. Thank you very much. And to anyone else, what I've done over the past 10 years is take physicians one on one and teach them as Dr. Lupuma has presented culinary medicine. And now it's exploded and as he mentioned it's in all of the major medical centers but also around the world. So what I want to turn to is coming from California, raising your honey having all of these wonderful access would you comment on what about having in every community clinic a garden and having our patients invested in really nurturing what it is they're then going to consume and nourish and sustain. I also want to add I spoke with a tool Gawande when he was here and I suggested that we take his lab and meet with patients, families and ask them what those foods are because I think larger than the nutrients that's in food you touched on what the memories were and Dr. John Morley who I'm sure you know at WashU has always for 20 years said at some point we need to give patients over the age of say 75 what foods they really enjoy. We need to count less and care more. So I welcome your conversation on these points. Thank you Maria, thank you especially and for your own work. There is actually great data about community gardens and community health one that's actually emblematic and illustrative of that movement in the Bronx where the sociodemographics are terrible but the kinds of contribution in creating and employing members living around what was a terrible block filled with drug dealers and rusted cars before but now as a community garden that sells its extra produce at the farmers market distributes it to people in need and actually lowers blood pressure for the people who participate in it in a standardized, careful way is in fact a really powerful tool and so Alice Waters started this in the late 80s with the edible schoolyard in Berkeley and so there are many such interventions that we can offer and I think they all ought to be tried and integrated into education once they are helpful and effective. I don't want to stand between us and lunch any longer.