Melanie Cole, MS (Host): Welcome to Long Live Childhood, a pediatric health and wellness podcast presented by Rady Children's Health. I'm Melanie Cole. And today, we're talking about food, kids and healing. We're learning about culinary medicine and how it can help your child.

Joining me is Dr. Ashish Chogle. He's a board-certified pediatric gastroenterologist, Division Chief of Pediatric Gastroenterology and the Medical Director at Rady Children's Health Orange County; and Kristin Feiler, she's a culinary medicine registered dietician at Rady Children's Health Orange County.

Thank you both for joining us today. And Dr. Chogle, I'd like to start with you. For someone that is a gastroenterologist and treating children, how did you end up building a program centered around cooking and food?

Ashish Chogle, MD: Yes, Melanie. It does sound like an unusual combination, but here is what I have learned, that the best ideas do not come from textbooks—they come from our patients. We learn as clinicians every day from them. And year after year in clinic, I kept hearing the same thing from families that, when a child came in with stomachaches, with constipation, reflux, I have prescribed medications and it does help. But then, the families look at you and ask, "Doctor, is there something else that we can do to help our kids?" And the answer has been, yes, it is sitting there on your kitchen counter the whole time. We have been underutilizing one of the most powerful tools in medicine, which is food.

And food talks to your brain. Food influences your immune system. Food calms down the inflammation or has the potential to rev it up and worsen it. And, you know, to add to that, I like to cook myself, and I'm a big foodie. So, all these worlds came together to give us the culinary medicine program at Rady Children's Health of Orange County. And we decided that we are going to meet the families where healing actually happens. Not in the exam room, not in their kitchen. It is at their table over a meal, and that's where we want to meet the families.

Melanie Cole, MS: I couldn't love that more. And as someone who's been in the field for very, very long time, and who also is an avid gardener, growing vegetables and stuff, and cooking, it's been something I've imparted with my kids and I couldn't agree with you more. I think that what we're doing now is really—there's a shift, a paradigm shift going on, where we're treating the whole person. And we've learned over the years that nutrition is medicine and we're learning more.

I mean, Dr. Chogle, in medical school, you didn't even really get nutrition training back when. But now, we're integrating this more and more into the daily practice of medicine. So, Kristin, I'd like you to explain a little bit about what that term culinary medicine is. Dr. Chogle gave a good explanation, but I'd love for you to expand a little bit on what that even really means.

Kristin Feiler, RDN, LD: Absolutely. So when you come to a visit, the next step is what we do, right? Taking some practical care tips, and then expanding it into the home. And what we're seeing is patients and their families are typically handed a list of foods or things that they cannot eat, and that can be very disheartening.

And as a dietician, with much experience, I've seen this inpatient. And then, when we see patients outpatient, they're lost and they don't know how to take care of themselves at home. Culinary medicine bridges the gap that we're missing in healthcare, which is you might be getting excellent care here at the hospital. But now, that we have to translate this into real life at home and lifelong skills that are missing, we've missed out on truly integrating foods and natural products that we can help enhance our health.

And so, culinary medicine, what it really is and what makes it different is that we teach patients and their family members what they can eat, how to make themselves feel better, how to use this evidence-based nutrition advice, and truly empower them to enjoy food and to build connection at home and everywhere out with their friends and their families and feel safe and comfortable again.

We really use the evidence-based nutrition, such as focusing on fiber for our gut health. We balance meals and focus on blood sugar. We focus on hydration and electrolytes. All of these tips that we might cover in the hospital, we make it realistic, affordable, practical, and fun, and really integrate both patients and their families into their care so patients can build some autonomy at home and have choices.

Melanie Cole, MS: One of the things I love that you said is we teach them what they can eat. So, everything isn't about what you have to eliminate, but what you can include, which I think is more inclusive. It's a little bit more uplifting, sort of more positive reinforcement than negative.

And Dr. Chogle, when we think of culinary medicine and food is medicine, what conditions are we looking at in the pediatric population that this can really help? Because we know Kristin just mentioned constipation. Kids have all kinds of sore tummies. And then, there's, you know, inflammatory bowel diseases. There's all kinds of things going on. So, tell us a little bit about the conditions that you are looking for food to help us with.

Ashish Chogle, MD: So, Melanie, food is useful for pretty much any GI condition. We see all sorts of GI conditions, including stomach aches and constipation, reflux, celiac disease, food allergies, inflammatory bowel disease.

And one more thing that we have to remember is that the gut does not operate alone. There is something known as the gut-brain axis, which is a direct line of communication between your gut and the brain. So, the battle that these parents and the kids face at the dinner table, it's not just emotionally exhausting, but it makes the medical problem worse. And with culinary medicine, this is what we intend to do to break that cycle of the battle at the dinner table by making things easier, empowering the families, getting the kids at ease with food, and develop that positive relationship with food.

Melanie Cole, MS: It really develops a lifelong positive relationship with food, which I think is just so key. So when we think of your program, Kristin, tell us about the program itself, your team, what families can expect when they come to see you.

Kristin Feiler, RDN, LD: In our program, utilizing the food as medicine, we are teaching parents and their families about how food supports their growth, their development. We individualize the care process. And we'll not only give recipes, but explain the ingredients and their purpose in their health process to focus on overall wellness. And we've brought them back home. We are teaching actual cooking skills. We've noticed that the shift in our world has been convenience. We're busier. We're more stressed. We have a lot of parents who have dual-earning income families, or we're having a lack of access to resources or food, and we're struggling maybe with obtaining food.

And so, food insecurity is such a big issue. What we do is we meet families where they're at by providing appropriate resources according to their needs, whether that be focusing on food banks and recipes that will be healthier that we can access at food banks, whether that be utilizing any program that they're able to get into, whether that be utilizing our recipe bank that we've created for our patients and families that our community members can use, and even our staff here at Rady Children's Health And we are showing them how to cook. So, getting hands on and teaching the cooking skills so they can make these items at home. We show them at different levels from ages two and older even, getting your kid in the kitchen.

As a mom and a dietician, I have my kids in the kitchen with me. We do this with our patients, so showing them even a two-year-old can wash leaves, tear leaves, mix in a bowl/ It might get a little bit messy, but that's part of it. It's a sensory experience where we're showing them that even just touching a new ingredient or new food can have them gain interest and maybe even try a new food. That tends to be the biggest battle. Children might develop fears of foods. They might also have had a bad experience with the food in the past, or might not know or haven't tried a certain food. And so, we're exposing not just kids, but surprisingly parents as well, and really showing them the benefits of what this food can offer and why it makes sense for them to try it out in many different ways.

That food exposure and that hands-on experience, kids get excited to try different foods, even at events like when we bring our program and do cooking demonstrations at Pretend City even. We've had children try foods that they wouldn't even look at—green foods, purple foods, red foods, and get them excited because their friends are eating it. And we're making it fun and exciting and hands-on and maybe even a game, and they get to actually enjoy this with their friends and their family.

Ashish Chogle, MD: And, Melanie, you know, to add to what Kristin has very perfectly put out there is that our long-term vision is that we don't want culinary medicine to be confined within the hospital walls. We want it everywhere, including schools, in grocery stores, community centers, and every family home of every patient.

To that end, we are also working with teen advisory groups like iCAN, which is the International Children's Advisory Network. And here is what I have learned, that if you really want to change how kids eat, you better ask the kids and listen to them because they'll tell you exactly without any filters what works and what doesn't. And we have learned a lot from them. Community is where we can change lives and we really want to be the catalyst for that.

Melanie Cole, MS: I hear you when you say, get the children involved, Kristin, because it's something that I did as a mom. My kids are in 20s now. But as a gardener too, I had them help me in the garden. They didn't love the weeding part. But once we got to harvest the vegetables that we grew, then they were excited to learn to cook it. So, I mean, I think that that all goes together. And as Dr. Chogle mentioned, the grocery store and all of the ways that we can bring the family in.

Now, Kristin, as I understand it, you're taking this beyond the hospital. Can you expand a little on what Dr. Chogle was just talking about out into the community? Tell us about that.

Kristin Feiler, RDN, LD: Absolutely. So, what we've realized is that if it's not realistic, it's not affordable. If it's not attainable, it's not going to work. We are taking real-world problems and our own struggles, what we've been dealing with at home, and focusing on how to show families how to make meals that are cost-effective, time-saving, simple and taste really good, but also trying to find avenues to make this accessible.

So, we're going to be focusing on collaborating with schools and teaching cooking classes. Very excited to get hands on with patients and their family members and students in the community, working with Northgate Market. And then, also, some of our community programs like WoW, which is really neat that we're able to formulate a nutrition prescription program to address food insecurity and really harvest some health outcomes that are measurable to help benefit our community members as well.

We also have our own patients at the abdominal pain clinic that we're developing recipes for, and collaborating with our inpatient providers like our inflammatory bowel disease providers and colorectal providers to make sure that we are creating recipes that these patients and family members can follow along with us at home and cook alongside us. Because if we make this bringing them into our kitchen and having them at our table, it's a fun environment. It's a more inviting environment because we actually care once they leave home. We want to prevent and manage the disease. And we want to keep them out of the hospital if possible, and give them those tools to be able to feel healthy and thrive.

Melanie Cole, MS: What an absolutely cool program this is that you have developed. And I want to give you each a chance for a final thought here. And Dr. Chogle, I would like you to speak about what you want families to take away from this and about your program and one simple thing from a gastroenterologist that you would like families to do together. Because as we've all learned, role modeling is important. So, the parents, all doing it together is just so important. What's one thing that they can do today right now to get started with food as medicine?

Ashish Chogle, MD: It's almost every day that I get asked by parents how do we eat? Like, can you tell us what should we eat? What is a healthy diet? Because if you look on the internet, if you look online, there are so many definitions of healthy diets. There are fat diets. There are, you know, anti-inflammatory diets, antihistamine diets, and gluten-free diets and dairy-free diets. It's very simple.

And, you know, this comes from our belief in a concept known as back to the roots. That means across cultures and continents throughout generations. Families have kept their children healthy with real food by giving them seasonal produce, using traditional recipes. Sharing a meal on the table. Our job is to help these families dig it back up and go back to the roots, go back to simpler eating. I think that is my number one recommendation or gift to my patients, just knowing what is the definition of healthy eating. I think that's what they should be knowing, when they come through our culinary medicine program or even otherwise.

Melanie Cole, MS: What a great program. Kristin, I'd love to give you the last word. When I think of helping families, what you're doing to learn to cook and eat healthy. Sometimes it can be a pain, right? It's not easy to eat healthy and do all the cooking. It's so much easier to just use products that are pre-made for you. But there are some that make our jobs just a little bit easier as moms, as clinicians. I'd love for you to give your best advice as a dietician and a specialist in culinary medicine, some of the tricks and tips that you give your patients every day with your best advice on ways to make it just a little bit easier for us.

Kristin Feiler, RDN, LD: Absolutely. There is a time and place for different foods. There's a time and place for balance and moderation and sometimes convenience. But what we're trying to focus on is that we want families to feel empowered. We want them not to feel overwhelmed. We want them to feel capable. We want to provide the tools that they can learn how to make food at home fast, easy, and convenient for your own schedule, because whole foods can be fast, easy, and convenient, and honestly, more cost effective. Teaching them how to prep ahead of time, maybe even freeze meals. Make crock pot meals. Learn how to bake instead of fry. You can switch your cooking method and truly enhance the nutritional value of the items that you're eating. Make them in a healthier way. Even make them taste better.

When you have whole foods available to you, that's truly where you find yourself actively building health and really treating your illness. These tools are the most important. Because if you are focusing on building long-term habits with your children, they're going to take that into the rest of their life, which will affect them physically, emotionally, and truly change their life.

Those small moments of connection at the table and showing them how and involving them in their care, in their food in the kitchen is the most important tip I can give. It will make the world of difference, and that building of confidence for parents and their kids. It's the most wonderful gift of all.

Melanie Cole, MS: It's very rewarding, and that was beautifully put. And I agree with you. Thank you both so much for joining us today, sharing your expertise, and really telling us about the program at Rady Children's Health because what an important great program. It's great work that you're both doing. Thank you so much again for joining us.

And thank you for tuning in to Long Live Childhood, a pediatric health and wellness podcast, brought to you by Rady Children's Health. Together, we can keep kids happy, healthy, and thriving. For more information on culinary medicine, please visit choc.org/gastroenterology, and you can search Integrative Health Culinary Medicine. If you enjoyed today's episode, please consider downloading, subscribing, rating, and reviewing Long Live Childhood on Apple Podcast, iHeartRadio, Spotify, or Pandora. Your support truly means a lot. Thanks so much for joining us today.