Selected Podcast
Food is Medicine
Dr. Daniel Feig leads the Food Is Medicine Program at Children's of Alabama. In this episode, he explains how changing a child's diet and eating habits can help treat some childhood illnesses.
Featured Speaker:
Daniel Feig, MD, PhD, MS
Dr. Dan Feig is a professor of pediatrics and division director of Pediatric Nephrology at University of Alabama, Birmingham (UAB). He was on the pediatric renal faculty at Texas Children’s Hospital and Baylor College of Medicine from 2001until 2011 when he moved to Birmingham to join the faculty at UAB and Children's of Alabama. In 2011 Dr. Feig joined the faculty of the Department of Pediatrics as a full professor and as Division director of Pediatric Nephrology. In addition to his administrative role as division director, he is medical director of the Pediatric Renal Transplant Program and Co-Director of the Renal Fellowship Program. In terms of hospital/departmental service he is a member of the Serious Safety Events (SSE) team, part of the Solutions for Patient Safety (SPS) program, which is developing bundled programs to reduce patient risk, and the Physician Information Technology Advisory Committee. Dr. Feig’s current clinical service commitment accounts for a little more than 50% of his time. He has 12 weeks of inpatient service per year, in part to protect the research efforts of his junior faculty. He has outpatient general renal, pediatric hypertension and renal transplant clinics each week and a monthly outreach clinic in Montgomery. Dr. Feig’s research interest focuses on the physiology of early onset essential hypertension as well as the prevention of hypertensive target organ damage. His studies have shown that uric acid is a mediator of early essential hypertension and uric acid reduction can both treat high blood pressure and prevent its development in certain adolescent populations. He also studies obesity related hypertension in adolescents and is evaluating novel screening and management strategies to mitigate risk of organ damage before weight loss can be successfully achieved. His other recent studies have evaluation the cost effectiveness of hypertension evaluation strategies, management of hypertensive emergencies in infants and the effect of cardiovascular fitness on change in blood pressure. His research has been funded by grants from the NIDDK, NHLBI and NICHD as well as several industry sources. Transcription:
Food is Medicine
Cori Cross, MD: Welcome to Peds Cast, a podcast brought to you by Children's of Alabama at Birmingham. I'm pediatrician, Dr. Cori Cross. Today, we'll be speaking with Dr. Daniel Feig. He's the Director of the Division of Pediatric Nephrology at Children's of Alabama at Birmingham. Dr. Feig will be discussing a very interesting topic, and one I'm really excited to dive into, the Food Is Medicine Program at Children's of Alabama. Dr. Feig, thank you so much for sharing your expertise with us today.
Dr. Daniel Feig: My pleasure.
Cori Cross, MD: So tell us, what does the nephrology department mean when they say food is medicine? What is the aim of this program?
Dr. Daniel Feig: Children with kidney failure have a number of issues that require a very, very restricted diet. So the kidneys are involved in blood pressure regulation, in regulation of electrolytes, including sodium and potassium. They are involved in the management of bone metabolism, so control of calcium and phosphorus. And when the kidneys aren't working very well, then children are in a situation where they have to dramatically restrict their sodium intake, their potassium intake, their phosphorous intake, and frequently have to restrict how much water they take in per day in order to maintain their health. This combination results in essentially everything that tastes good being off the menu. And it's a tough transition for families. And it's a particularly tough transition for kids.
When we wander around the dialysis unit and each of the chairs for hemodialysis have a dedicated television screen, the vast majority of the kids are watching Food Network rather than Cartoon Network or sports or something like that. And they're all looking for ways to find some food that tastes better than what's allowed on their menu. And the ramifications of not sticking to their diet are critically important because it can threaten their potassium or too much sodium can threaten their lives. Too much water or sodium can result in extremely high blood pressure and poor control of phosphorous metabolism can irreversibly damage their bones. So it's critically important to get this under control.
Cori Cross, MD: I can imagine that's really difficult, particularly when you think about how limited kids' palates normally are anyway, and now you're throwing in all of these restrictions. I'm sure there's challenges that the parents and caregivers face when trying to provide these specialized diet and learning to sort of prepare food in a new way.
Dr. Daniel Feig: That's exactly what the Food Is Medicine Program is about. It's trying to help families learn to use unfamiliar ingredients that are safe for their children, trying to make meals that are on the diet and agree with the palates of young children. And one of the challenges that we didn't expect to find is that, as we go through the options for the diet, many of the ingredients are more expensive than kind of a more conventional diet would have. And so that an effort to stick with the renal diet is also a huge financial strain on families.
Cori Cross, MD: So I can imagine that preparing dialysis-friendly meals can be more expensive. Are there programs that help to reduce the cost to families?
Dr. Daniel Feig: So there aren't organized programs that reduce the cost. But one of the things that we can do in the Food Is Medicine Program is we actually sit down with families, make a shopping list and provide the ingredients on the shopping list. And so we've been able to generate enough philanthropic funds that we can actually provide weekly care packages for the families in need.
Cori Cross, MD: Wow. That's amazing. And are you doing all this through the Children's Table Charity Event or are there other fundraisers as well?
Dr. Daniel Feig: The main funding for this program comes through the Children's Table fundraising event.
Cori Cross, MD: And is that a yearly event? Tell us something about that.
Dr. Daniel Feig: So it is an event that prior to the pandemic was every year. It has been slightly interrupted by the COVID-19 pandemic, but we are expecting it to be launched in a full-fledged fashion the in spring of 2023. And what we do in that event is we have recruited a number of celebrity chefs from around the Southeast, including James Beard award winners Chris Hastings and Adam Evans, as well as Martha O'Hara from Big Spoon Creamery, and Leonardo Maurelli from The Hotel at Auburn and many others who come to the facility at Meredith Studios, which is where they produce Food and Wine Magazine and Southern Living Magazine and many others, and have a number of test kitchens. And they provide small plates for folks who attend this fundraising event and generate the funds that we use to run the Food Is Medicine Program.
Several of the chefs have also volunteered some of their staff to help teach cooking classes within the dialysis unit. And that was also interrupted by the pandemic, but we expect that to be something that we'll be able to initiate in the next several months.
Cori Cross, MD: That's amazing. So you're really providing this holistic approach to dialysis, because you're not only dialyzing the patients, but you're basically trying to maintain the function of their kidneys to the best of their ability. I was just wondering where and by whom is all of this taught? So if you have a child who's undergoing dialysis, are they meeting with nutritionist regularly? How do you factor all of that in?
Dr. Daniel Feig: We have a couple of enormously talented and knowledgeable nutritionists who are dedicated to working with the renal patients. And they come into the dialysis unit and meet with families on a regular basis. And so that has been what we have been doing for four years. And we were hoping to be able to incorporate some of the the chefs as well in the meal planning and cooking demonstrations.
Cori Cross, MD: So if our listeners wanted to get involved, how would they get tickets or donate to the Children's Table?
Dr. Daniel Feig: Children's of Alabama has a public website and posted on that public website website are notices for the various community events that are upcoming. Hopefully, we will have a date for the 2023 Children's Table Event in the near future. It is not posted yet, but again, we are working on getting that scheduled.
Cori Cross, MD: So listeners, if you're interested, you'd go to childrensal.org, which is the Children's alabama website. And hopefully, lots of people out there will come to it, because it sounds like an amazing event. I wanted to just discuss any changes that you've seen in patients since you've been implementing this Food Is Medicine Program. So I'm assuming you have very grateful parents, because I know I would personally find it really daunting to have to find a whole new way of cooking. But what have you seen in just the change in the patients and their families when they have this type of support?
Dr. Daniel Feig: For all of our kids on dialysis, we measure a number of clinical parameters and laboratory tests on a monthly basis. And among those kind of markers for nutritional and mineral status are included in those monthly measurements. And we've seen over the two years that we've been doing this program a significant average improvement in their bone health and their control of serum potassium. So on the objective laboratory markers, we're seeing an improvement with the education and the food and ingredients provisions.
Cori Cross, MD: That's amazing because I'm assuming that you're not just seeing physical improvements, but that, you know, subjectively, there's a lot of emotional improvements too to have that support as a family and as a child.
Dr. Daniel Feig: Yeah. And we also do quality of life measurements on a quarterly basis basis and have seen some improvement on the quality of life scores for both the kids and their parents. I'd like to think that much of that improvement is associated with this particular program, although we do a lot of other programs within the dialysis unit that are probably contributing as well.
Cori Cross, MD: In summary, is there anything else you'd like to share with our listeners today?
Dr. Daniel Feig: Just the importance of a holistic approach to management of disease, that includes diet, quality of life, as well as their medications and their high tech procedures is really what is allowing us to be particularly successful in the management of these patients and helping them grow up to be healthy citizens, who go then go into the workforce, go to college and really be happy adults.
Cori Cross, MD: That's the goal. It sounds like you guys are doing a wonderful program, and really supporting the families who are coming to Children's of Alabama. Dr. Feig, thank you so much for joining us today. This has been a very educational discussion. I know I've learned a lot and I really appreciate you taking your time to educate myself and our listeners.
Dr. Daniel Feig: Thank you so much.
Cori Cross, MD: You've been listening to Children's Hospital of Alabama Peds Cast. For more information or to refer your patients to Children's of Alabama, visit childrensal.org. I'm your host, Dr. Cori Cross. Thanks for listening.
Food is Medicine
Cori Cross, MD: Welcome to Peds Cast, a podcast brought to you by Children's of Alabama at Birmingham. I'm pediatrician, Dr. Cori Cross. Today, we'll be speaking with Dr. Daniel Feig. He's the Director of the Division of Pediatric Nephrology at Children's of Alabama at Birmingham. Dr. Feig will be discussing a very interesting topic, and one I'm really excited to dive into, the Food Is Medicine Program at Children's of Alabama. Dr. Feig, thank you so much for sharing your expertise with us today.
Dr. Daniel Feig: My pleasure.
Cori Cross, MD: So tell us, what does the nephrology department mean when they say food is medicine? What is the aim of this program?
Dr. Daniel Feig: Children with kidney failure have a number of issues that require a very, very restricted diet. So the kidneys are involved in blood pressure regulation, in regulation of electrolytes, including sodium and potassium. They are involved in the management of bone metabolism, so control of calcium and phosphorus. And when the kidneys aren't working very well, then children are in a situation where they have to dramatically restrict their sodium intake, their potassium intake, their phosphorous intake, and frequently have to restrict how much water they take in per day in order to maintain their health. This combination results in essentially everything that tastes good being off the menu. And it's a tough transition for families. And it's a particularly tough transition for kids.
When we wander around the dialysis unit and each of the chairs for hemodialysis have a dedicated television screen, the vast majority of the kids are watching Food Network rather than Cartoon Network or sports or something like that. And they're all looking for ways to find some food that tastes better than what's allowed on their menu. And the ramifications of not sticking to their diet are critically important because it can threaten their potassium or too much sodium can threaten their lives. Too much water or sodium can result in extremely high blood pressure and poor control of phosphorous metabolism can irreversibly damage their bones. So it's critically important to get this under control.
Cori Cross, MD: I can imagine that's really difficult, particularly when you think about how limited kids' palates normally are anyway, and now you're throwing in all of these restrictions. I'm sure there's challenges that the parents and caregivers face when trying to provide these specialized diet and learning to sort of prepare food in a new way.
Dr. Daniel Feig: That's exactly what the Food Is Medicine Program is about. It's trying to help families learn to use unfamiliar ingredients that are safe for their children, trying to make meals that are on the diet and agree with the palates of young children. And one of the challenges that we didn't expect to find is that, as we go through the options for the diet, many of the ingredients are more expensive than kind of a more conventional diet would have. And so that an effort to stick with the renal diet is also a huge financial strain on families.
Cori Cross, MD: So I can imagine that preparing dialysis-friendly meals can be more expensive. Are there programs that help to reduce the cost to families?
Dr. Daniel Feig: So there aren't organized programs that reduce the cost. But one of the things that we can do in the Food Is Medicine Program is we actually sit down with families, make a shopping list and provide the ingredients on the shopping list. And so we've been able to generate enough philanthropic funds that we can actually provide weekly care packages for the families in need.
Cori Cross, MD: Wow. That's amazing. And are you doing all this through the Children's Table Charity Event or are there other fundraisers as well?
Dr. Daniel Feig: The main funding for this program comes through the Children's Table fundraising event.
Cori Cross, MD: And is that a yearly event? Tell us something about that.
Dr. Daniel Feig: So it is an event that prior to the pandemic was every year. It has been slightly interrupted by the COVID-19 pandemic, but we are expecting it to be launched in a full-fledged fashion the in spring of 2023. And what we do in that event is we have recruited a number of celebrity chefs from around the Southeast, including James Beard award winners Chris Hastings and Adam Evans, as well as Martha O'Hara from Big Spoon Creamery, and Leonardo Maurelli from The Hotel at Auburn and many others who come to the facility at Meredith Studios, which is where they produce Food and Wine Magazine and Southern Living Magazine and many others, and have a number of test kitchens. And they provide small plates for folks who attend this fundraising event and generate the funds that we use to run the Food Is Medicine Program.
Several of the chefs have also volunteered some of their staff to help teach cooking classes within the dialysis unit. And that was also interrupted by the pandemic, but we expect that to be something that we'll be able to initiate in the next several months.
Cori Cross, MD: That's amazing. So you're really providing this holistic approach to dialysis, because you're not only dialyzing the patients, but you're basically trying to maintain the function of their kidneys to the best of their ability. I was just wondering where and by whom is all of this taught? So if you have a child who's undergoing dialysis, are they meeting with nutritionist regularly? How do you factor all of that in?
Dr. Daniel Feig: We have a couple of enormously talented and knowledgeable nutritionists who are dedicated to working with the renal patients. And they come into the dialysis unit and meet with families on a regular basis. And so that has been what we have been doing for four years. And we were hoping to be able to incorporate some of the the chefs as well in the meal planning and cooking demonstrations.
Cori Cross, MD: So if our listeners wanted to get involved, how would they get tickets or donate to the Children's Table?
Dr. Daniel Feig: Children's of Alabama has a public website and posted on that public website website are notices for the various community events that are upcoming. Hopefully, we will have a date for the 2023 Children's Table Event in the near future. It is not posted yet, but again, we are working on getting that scheduled.
Cori Cross, MD: So listeners, if you're interested, you'd go to childrensal.org, which is the Children's alabama website. And hopefully, lots of people out there will come to it, because it sounds like an amazing event. I wanted to just discuss any changes that you've seen in patients since you've been implementing this Food Is Medicine Program. So I'm assuming you have very grateful parents, because I know I would personally find it really daunting to have to find a whole new way of cooking. But what have you seen in just the change in the patients and their families when they have this type of support?
Dr. Daniel Feig: For all of our kids on dialysis, we measure a number of clinical parameters and laboratory tests on a monthly basis. And among those kind of markers for nutritional and mineral status are included in those monthly measurements. And we've seen over the two years that we've been doing this program a significant average improvement in their bone health and their control of serum potassium. So on the objective laboratory markers, we're seeing an improvement with the education and the food and ingredients provisions.
Cori Cross, MD: That's amazing because I'm assuming that you're not just seeing physical improvements, but that, you know, subjectively, there's a lot of emotional improvements too to have that support as a family and as a child.
Dr. Daniel Feig: Yeah. And we also do quality of life measurements on a quarterly basis basis and have seen some improvement on the quality of life scores for both the kids and their parents. I'd like to think that much of that improvement is associated with this particular program, although we do a lot of other programs within the dialysis unit that are probably contributing as well.
Cori Cross, MD: In summary, is there anything else you'd like to share with our listeners today?
Dr. Daniel Feig: Just the importance of a holistic approach to management of disease, that includes diet, quality of life, as well as their medications and their high tech procedures is really what is allowing us to be particularly successful in the management of these patients and helping them grow up to be healthy citizens, who go then go into the workforce, go to college and really be happy adults.
Cori Cross, MD: That's the goal. It sounds like you guys are doing a wonderful program, and really supporting the families who are coming to Children's of Alabama. Dr. Feig, thank you so much for joining us today. This has been a very educational discussion. I know I've learned a lot and I really appreciate you taking your time to educate myself and our listeners.
Dr. Daniel Feig: Thank you so much.
Cori Cross, MD: You've been listening to Children's Hospital of Alabama Peds Cast. For more information or to refer your patients to Children's of Alabama, visit childrensal.org. I'm your host, Dr. Cori Cross. Thanks for listening.