When an Apple a Day May Keep the Doctor Away

Sarah Krumholz and Molly Hurd are second-year medical students at the University of Vermont, Larner College of Medicine.

In the following blog post, they write about the culinary medicine initiative they created and offer to first-year medical students.

L-R: Molly Hurd, Sarah Krumholz

“Culinary medicine is understanding the links between food, health, and well-being. In culinary medicine, the social, cultural, and emotional aspects of food are paired with nutritional science to act in tandem with medical interventions in disease prevention.”

What is Culinary Medicine?

Food unites us. It is linked to our emotions and is integral to our experience as human beings. And yet, as much as it joins us, our connection is personal. We can all relate to how a particular food makes us think of home, feel connected to our culture, or ignite a fond memory. Food is also essential to our health. Diet can be positively linked to disease outcomes: increased fiber intake can reduce the risk of coronary heart disease; plant-based diets can decrease the risk of type 2 diabetes. It can also have negative associations, like the relationship between an increased risk of cardiovascular disease and mortality that comes with added sugar intake. 

Culinary medicine is understanding the links between food, health, and well-being. In culinary medicine, the social, cultural, and emotional aspects of food are paired with nutritional science to act in tandem with medical interventions in disease prevention. As co-leaders of the Lifestyle Medicine student interest group, Molly Hurd ’26 and I recognized the importance of this understanding in medical education and the need for a culinary medicine initiative at Larner College of Medicine. With this recognition, Molly and I developed a student-led initiative to offer culinary medicine to first-year medical students, providing monthly culinary medicine programming centered on lifestyle interventions for chronic disease.

The Disconnect Between Dietetics and Medicine

I personally understood the need for this initiative through my clinical experience as a registered dietitian. In my practice, I often observed a disconnect between dietetics and medicine. While working in outpatient clinics, I regularly observed patients referred to our care with a diagnosis of diabetes, cardiovascular issues, and liver disease. On the hospital floor, I talked to patients at the bedside—often after an acute coronary event or a limb amputation resulting from uncontrolled diabetes. I offered handouts and a number to call to make an appointment at offices with long waitlists and limited openings. Currently, Medicare only reimburses medical nutrition therapy with a paired diagnosis such as diabetes, kidney disease, or a recent kidney transplant. Preventive visits are not covered. 

Increasing Physician Nutrition Knowledge

The downstream effects of a poor diet manifest as irreparable damage that could have been prevented with early intervention. Registered dietitians have expertise in the field of nutrition and should be utilized as an important member of the health care team. However physicians, regardless of specialty, are often the first line of nutrition intervention for many patients. Our culinary medicine initiative strives to provide foundational nutritional knowledge and counseling skills to medical students to better prepare them to address prevention and provide early intervention in patient care.

Preventative Nutrition Counseling Can Save Lives, and Reduce Health Care Costs

Downstream nutrition intervention typically impacts not only patient outcomes, but also overall health care spending. In a 2019 cost analysis study estimating the annual economic burden of health care costs related to cardiometabolic disease, an additional cost burden was found for those with suboptimal nutrition, translating to a total additional population cost burden of $50.4 billion annually. With the direct annual cost estimated to be $276.3 billion overall, this finding suggests that improvements in diet can mitigate 18.2% of these costs. 

Considering Social Determinants

This analysis highlights the need for more preventive nutrition counseling within our current health care model. However, dietary improvements are more complex than instructing patients what they should and should not eat. Social determinants of health play a key role in determining the feasibility of lifestyle changes that can improve outcomes, and as such, are an essential consideration when counseling any patient on dietary modification. Several factors, including income, employment, disability, living environment, and structural racism influence food security—defined as when all people, at all times, have physical and economic access to sufficient, safe, and nutritious food that meets their dietary needs and food preferences for an active and healthy life.

Understanding a patient’s resources and living situation can impact the recommendations you make. Making recommendations that are not feasible for a patient can damage their trust in you and, ultimately, the patient physician relationship. Therefore, it is important to know how to adequately counsel patients to make recommendations that align with the barriers they face in making these dietary modifications. In our culinary medicine course, we are integrating counseling skills that consider social determinants of health. 

Getting Better at Speaking with Patients about their Nutrition

Molly and I held the first of five culinary medicine sessions in early September, and it was an inspiring success. It was attended by twenty-eight engaged and passionate first-year medical students excited to expand their knowledge and skills. Each course is structured with a 45-minute didactic session, followed by building community while cooking two recipes together as a group. One of the most striking moments of our first session was when we asked students why they chose to participate. They echoed much of what we felt ourselves. Physicians know that food impacts health and disease progression, but they wanted to know how to have those conversations on a human level with their patients. 

These sessions aim to educate on the science of culinary medicine, but more importantly, help students increase their confidence in engaging with patients in conversations about nutrition. This education, we hope, will extend beyond the classroom as we plan for students to utilize this training to teach others in the community as well. After the course ends, we want to provide opportunities for students to share what they’ve learned by offering culinary medicine courses to the broader community—because just like listening to the heart and lungs, we need to practice getting better at speaking with patients about their nutrition, too. 

This piece was written collaboratively by Sarah Krumholz ’26 and Molly Hurd ‘26.