Speaker 1 00:00:00 And this idea that. Oh. One plant. Good. One meat bad. Too simplistic. Too simplistic a story. We as human beings deserve a much richer tale, you know, in terms of our lives.

Speaker 2 00:00:22 Welcome to Off the Chart: A Business of Medicine podcast, featuring lively and informative conversations with health care experts, opinion leaders and practicing physicians about the challenges facing doctors and medical practices. I'm your host, Austin Littrell. This episode features a conversation between Medical Economics senior editor Richard Payerchin and Dr. Michael Fenster, more commonly known Chef Dr. Mike. They're talking about eating healthy and the role of nutrition and health care.

Speaker 3 00:00:52 I'm Richard Payerchin, reporting for medical economics. With me today is Dr. Michael Fenster of the University of Montana. He's known as Chef Dr. Mike, one of just a few physicians who is an interventional cardiologist and a professional chef. Thank you for joining us today.

Speaker 1 00:01:09 Oh my pleasure, Richard, thank you for for having me.

Speaker 3 00:01:12 To maybe bring the two together. You know, diet, food, nutrition are all huge topics.

Speaker 3 00:01:17 And human health is two for that matter. So it's maybe difficult to summarize, but can you talk a little bit about how the understanding of the relationship between diet and heart health has evolved in recent years?

Speaker 1 00:01:31 Yeah, and it's interesting that I mentioned I just gave a keynote a few weeks ago for the, Health Care Administrators Association, wonderful group of folks. And, and and this is almost along the lines of what we we've touched on. And this is really what I would say is an exciting time, in, in medicine. I actually headed to Harvard shortly, to work with colleagues, and exploring network medicine, and but you know, medicine as a, as a science has certainly come a long way. you know, going back to Hippocrates, Chinese medicine, going back, even further, you know, over 5000 years, Indian medicine, Arabic medicine, and really sort of Western medicine, really evolved from the battlefield. So big changes in the Civil War era, etc.. you know, Clara Barton, etc. ambulance services started in the Civil War and, and that was really based, when we got our concepts of triage and, and what we were focused on were sort of battlefield wounds people weren't worried about, you know, sugars and, and other things.

Speaker 1 00:02:41 They were worried about the fact that, you know, you just got a hole in your leg and that had to be had to be addressed. And, and, and Western medicine, for all the the knocks that it currently gets on things is really excellent at that. You know, at no time in history are we better. I mean, look at what we can do for pro athletes to return them to a pre intervention level of function at a professional athlete level. Forget just being able to walk around so it does a great job with that. But it was never really built to understand complex chronic diseases. And that's where we find ourselves today. Things like heart disease, obesity, diabetes, certain types of cancers, neurodegenerative diseases, they all seem to be rooted in in a, origin of inflammation, a chronic, continuous, low level inflammation, which is sort of, if you think about it, the other extreme from, you know, getting a bullet wound or a shrapnel wound wound on the, on the battlefield and, and our current approach to nutrition or diet and its involvement in these aspects of these types of diseases really goes back about 100 years.

Speaker 1 00:03:57 Arguably, we could say that nutrition is a very young science, and its origin was when Casimir Funk, the Polish scientist, first discovered the first vitamin or vitamin, which he labeled the nutrient a vital amine. From where we get the word vitamin or vitamin. And he discovered a substance in rice bran that could prevent or cure beriberi, which worldwide was a horrible disease in the early 1900s. so common. In fact, it was called the national disease of Japan. And it was incredibly debilitating. And so all of a sudden, we had this huge early success where we could look at a diet and say, oh, it's missing X, and if we give X in a certain amount, the disease goes away. And that's phenomenal, right? That that is tremendous. And in a way I think nutrition is the study of nutrition. The science of nutrition is sort of a victim of its early successes. It was so good and so effective that 50 years later, by the 60s and 70s, particularly in Western countries, we didn't we're not really dealing with these deficiency diseases anymore.

Speaker 1 00:05:10 People weren't showing up on your doorstep with scurvy and beriberi and pellagra and so on and so forth. And the problem is that deficiency diseases and the way that we solve them with a sort of very simple systems type analysis and approach and linear reductionism, very Newtonian way of thinking. You know, it's it's sort of that clockwork approach where if the spring isn't working and we replace the spring, the clock works. that that worked great for nutrient deficiency diseases. But again, it doesn't work so well for things like heart disease and diabetes and certain types of cancers. And so I really feel like for the last 50 years, we've been trying to put, you know, square pegs and round holes Goals, and I think that is why. And certainly I think many who are watching this within the primary care space and within the space of being a human being who has to eat and wants to know, like what I eat is good for me and and what things might kill me, that that we haven't done a very good job with that.

Speaker 1 00:06:13 It's just been very confusing, full of contradictions back and forth. And I think at the root of that is just a way, oversimplified approach where we try to look at a nutrient and then connect that to some sort of, disease effect, whether it be prevention or causal, and we just divide it up into very singular, good guys and bad guys, antioxidants. Good guys eat more of those cholesterol. Bad guys stay away from that. Where when you look at it, cholesterol is, your body makes cholesterol for a reason. You need it. you know, it's the insulation around the neurons that connect, you know, our, our brain, our brain cells. So to say, oh, well, you know, cholesterol is bad is really out of context. And so I think that that where we are now is a place probably only in the last, maybe ten years or so where we have the tools. And by that I really mean computers and the computing power to start putting those pieces back together.

Speaker 1 00:07:20 And, and I hate to use this word because it sounds so woowoo. And, and people often take it out of context, but it really is about being much more holistic in our approach and understanding how these things work with each other. to give you an example, let's just for argument's sake, say, wow, you know, if you eat red meat, that that is something that could be bad for you, depending on the type of red meat you eat. But if you eat that red meat with, a compound that's found in garlic and olive oil And red wine. all of a sudden, that compound that's associated with bad outcomes in red in red meat is negated. when those things are combined and and work in synergy. And and therein lies, you know, one of our approaches, we talk about nutrients, and yet we eat food. And there is a whole, this is, Julia manicotti out of Harvard. And one of her associates coined this term, which I love in a nature paper, and they call it the dark matter of nutrition.

Speaker 1 00:08:29 And to give you an idea, we talk about nutrients and and nutrition science like we know it. All right. Like, we have the entire, you know, not only the the letters and the words and the language, but all the dialects. you know, if we know these nutrients, we attach some things. And right now, the, the we study about 188, I think is the latest in the USDA database. if we look at the number of compounds in food, they're up over 140,000. So to give you an idea of how much sort of I could think of expressions, but, involving the ocean and, and and so forth. But let's just say we're shooting in really shooting in the dark. And then you think about how, as I just said, they often work in combinations. So it's not one nutrient, one effect. It's this plus this plus this gives you that. And and quickly we can see and really explain why we're so, we do such a poor job when it comes to that.

Speaker 1 00:09:31 But I think this emergence now of this network or, or as I like to, to phrase it, a complex systems type approach, a much more holistic approach of putting things, these things back together, is opening the door not only on understanding, but also giving us the tools to personalize it. So here's something everybody understands. there are people that have a peanut allergy. We probably all been on the plane when they say, oh, don't you know, open your peanuts because somebody has an allergy and they could die if I eat a peanut. That's a form of really good nutrition for my body, right? Lots of my body does lots of good things with a natural roasted peanut. Yet it kills somebody else. So that just tells us that we don't metabolize, we don't react. We don't respond to that information in a uniform way. And to give blanket everyone do this. Everyone eat that approaches. again, really doesn't make sense. But with these tools that I'm talking about, we're now getting into the realm and just scratching the surface of being able to personalize that.

Speaker 4 00:10:45 Say, Keith, this is all well and good, but what if someone is looking for more clinical information? Well.

Speaker 5 00:10:52 Then they want to check out our sister site, Patient Care Online, the leading clinical resource for primary care physicians. Again, that's patient care online. Com.

Speaker 3 00:11:05 That may be a good segue to kind of a question I wanted to ask about in the context of primary care, when the doctors are in the exam room with the patients. What advice would you would you give to them to maybe initiate that type conversation, to maybe even keep the patient from developing those conditions in the first place?

Speaker 1 00:11:25 Yeah. So I think, you know, obviously it depends on the patient and where they are in this progression. So if somebody, you know, very healthy otherwise well asking you, hey, what things can I do. So I don't go down this path. I'm kind of I'm feeling great right now doc. And and you we can recommend, you know, the the exercise, the diet programs, etc. more often.

Speaker 1 00:11:48 You know, than than not if they're in their primary care doctor's office. They're there because they got a problem. So maybe it's overweight, maybe it's it's diabetes, whatever it is. And so again, as I said, you know, we have to stop the bleeding if you will. So I'm not adverse personally to say, hey, I'm going to put you on this. We've got to get, you know, £20 off in the next six, eight, 12 months, whatever it may be. At the same time we initiate that, we really start to we really have to, in parallel, initiate a program to help them change their behaviors. And that's what it's really about, right? It's you know, we look at and we say, oh, you know, my genes say I'm going to get this and that and everybody gets a study. But you know, the genetics are responsible for, you know, 10%, maybe a little more than 10% of disease manifestation. What we're learning is that a lot of this is sort of the epigenetic phenomenon where it's our interaction, with our environment.

Speaker 1 00:12:49 and not always, But a lot of times we have a choice with that. And so it comes down to the choices we make, the behaviors we engage, etc.. And so I think you want to put something into place so that you have a strategy, much like they talk about, you know, with all these endless wars that, that, that keep popping up, it's like, well, you don't just go in and start shooting people. You have to have a strategy. And the first thing you develop is the exit strategy. How do we ramp off what is victory. And so the same thing. So I want to lose some weight. Well how much weight do we need to get off with these medications. And then once we achieve that how do we keep that up with this other strategy. And we need to put that other strategy in place. So you have parallel things going on. And so that's what I would say the conversation is about. It's very easy. and in, you know, in some instances very lucrative to simply write for the drug, sell the drug, dispense the drug and have that lifetime customer, you know, keep coming back every month or every week, you know, for the rest of their lives.

Speaker 1 00:13:59 I think where medicine and looking at what we're supposed to be about, which is helping people achieve, you know, health and wellness in a sustainable way, including an economically sustainable way is okay, we need to do this now. What's our offer? here's a program that's worked really well. I want you to get involved with this. what sort of things can you do? you know, I want to, you know, hear you. I see, you know, your company pays for a gym membership. Are you using it? Start going once a week, you know, etc., those sorts of things. So I think we have to do all those things at once and not just write a write a prescription. And I get it. because when I was doing private practice, I can't tell you, I drove my my nurse about pulled her hair out because people knew. Right? I was a chef. So they come in and they start talking food and she's like, you are now 60 minutes behind all your patients.

Speaker 1 00:14:55 You know, there's a mutiny going on in the waiting room. I need you to wrap this up. I was like, yeah, but they're talking about some really interesting cuisines. You know, they just got back from Thailand. I got to hear about this. So. So I totally get the the time consequence. but I think that's also a great opportunity to use your physician extenders. we work with those in our approach. through bridge Med, we're often, you know, working with a nurse practitioner or, sometimes practices employ their dietitians, etc.. So I think that that's a just a great team approach, and a great utilization of physician extenders where docs can oversee things, kind of captain a ship, but, you know, somebody else is up in the rigging.

Speaker 3 00:15:42 You've written several books about the intersection of medicine, food, diet, nutrition. Can you talk a little bit about your books?

Speaker 1 00:15:49 Yeah. Actually, I will break it here for you, Richard. First time. So I'm I'm wrapping up about halfway done with the new one, which is called dinner with God, Understanding the Language of food.

Speaker 1 00:16:02 And so it's really, a, a technique and a way of looking at our food experience, in terms of communication and information, that's not really being done. a lot of places, maybe even anywhere else. So it's it's what how we teach, what we teach at the university. And we try to understand it, in terms of information systems and communication. So you can imagine, I'm a wine guy, I love wine. And so you could take a Pinot noir grape, that are two that are genetically identical. Identical plant, one in Willamette Valley in Oregon, plant one in Burgundy, France. and your wines aren't going to taste anything like each other. and we understand that. And we totally get that when it comes to to wine. And it's what the French call the terroir that sort of shaped by the epigenetics and molded, you know, in that area real food has that as well. And so, you know, each bit of real food we eat tells a story. It's telling us a story about how it was raised and if it was processed and what things were added and what things were taken away.

Speaker 1 00:17:17 And our bodies listened to those stories. And we are the some of those stories because we interact with it. I talked about epigenetics and environment. The biggest impact of environment is what you take from the outside and actually put inside your body every day. And so that is why the quality of the food we eat makes such an important impact on not only our physical health, but also how we age and increasingly it's associated with our mental health and mental well-being as well. So that's, you know, where I would kind of close this out is, is the quality of our food. If you can give if I could give one piece of advice, it's, you know, pay attention to the quality of your food. You know, a grass fed steak is not necessarily a worse food than a plant, a piece of plant based meat alternative that's been ultra processed with GMOs and and mechanisms and, and God knows what else, you know, has been added in there. This idea that oh one plant good, one meat bad.

Speaker 1 00:18:30 again too too simplistic. Too simplistic a story. We we as human beings deserve a much richer tale. You know, in terms of our lives.

Speaker 5 00:18:44 Oh, you say you're a practice leader or administrator. We've got just the thing. Our sister site, Physicians Practice. Your one stop shop for all the expert tips and tricks that will get your practice really humming again. That's physicians practice.

Speaker 3 00:19:01 Our discussion is fascinating to me, but this is this is something that I both, as a journalist as well as a consumer, kind of run into a little bit in the sense that there's there's simply so much number one, food information and nutrition information and health information that exists. You know, it's pervasive in our society. There's an equal amount of misinformation pervasive in our society. And then you have all these different variables about location, you know, individual health and and just individual body. there's a financial factor because you could take identical twins. And if one earns $1 million a year and one is living in poverty, they're probably not eating the same stuff, right? Where I'm going with this is.

Speaker 3 00:19:48 And I'll let me throw this out there too, because we're responsible for this. We we report on studies that at times seem to find contradictory findings and results about about sometimes the same food products, the same nutrients, the same vitamins. Yeah. How how are physicians and patients supposed to deal with all that?

Speaker 1 00:20:11 Well, first of all, to, to use the old culinary expression, take it with everything with a grain of salt. you know, and and what always comes to mind is, and I don't know for a fact this is. But it was always attributed to the Buddha. It's like, believe nothing, even if you have heard it for me, unless it agrees with your own common sense and experience. And and I think that's a good rule of thumb, because all these things you said are very true. And and there's an incredible bias, that most people in the medical, health, nutrition and sciences refuse to acknowledge or ignorant. Acknowledging which is really goes back to the reality of the universe.

Speaker 1 00:20:53 So to jump to. Particle physics and quantum mechanics for a moment to make a point. If I were to say, well, I think, you know, light is composed of a wave function. And I set up an experiment called a slit lamp. And I do that experiment, I say, look, light is a wave. And if I change my mind and say, well, I think light is a particle and I change it to measure it as a particle, I say, it's I'm right. Light is a particle, not a wave. And so the answer is yes because it depends on how we measure it. And the answer that we get and how we look for something determines the information that we will receive. And so to extrapolate that there was a fascinating study Be done by not by physicians, but by, epidemiologists, you know, who are looking for ways of analyzing, to analyze big portions of data. And they picked red meat because they knew it would get published, because that's always, forgive the pun.

Speaker 1 00:21:57 Again, a juicy topic. And they said, well, looking at these studies that have been published on governmental data like the Nhanes data, etc., etc. over 30, 40 years, as you said, contradictory data, they said. But, you know, for each of these data sets, there's like 12 different hundred, 1200 different ways to analyze the data. Not all of them totally valid, but it depends how you want to look at it and to an extent, what answer you want to get. So they said, well, we're going to take the data set, but we're going to run because we now have the computing ability run all the data through every possible permutation of how we can look at it, and then see what all the results tell us. Long story short, what it showed is that if you eat red meat, you have an approximately 7% reduction in mortality, according to the vast majority of the studies. The exact opposite of what the conventional wisdom is, which says that if you're going to eat red meat, it's going to shorten your lifespan, you're going to have a heart attack, etc., etc., albeit, again, to even parse that data further.

Speaker 1 00:23:07 Many of those red meat studies do not differentiate between ultra processed meat, which again, is could be a cheap, you know, commercial hot dog. And we should generally, unless you're very knowledgeable, be avoiding unknown meat in tubular form. And, you know, a grass fed steak from a heritage breed that was open, pastured and, you know, raised right down the road as a chef. Those are two completely different, you know, things. But in terms of science, we lump them together. And and it does go to the weaknesses of our classification system, which again is derived in the history of what comes out of kind of nutrients, and looking at one thing and then and really focusing in on these things of macronutrients and calories, which is a at the base root of, of sort of the tree of information that has sprung forth from nutrition. So one is to take it with a grain of salt and, and does it make common sense to me and then to venture source? Because there are and I've come across it and had many discussions, you know, on stage and panels and things where really, as you said, if you have any particular viewpoint, you can usually find some sort of study somewhere, publish to support it.

Speaker 1 00:24:27 What we've tried to do in our analysis is said, let's not look at one study. Where's the the data? What is the data telling us in terms of the information? What is it saying? Does it make sense and does it jive with all the other bits of data and again, you know, make sense in that story. And, you know, one of the things that came out is, well, gosh, you know, real food that nature has produced is a very different animal, if you will, a very different product than what is ultra processed foods are. so we have to acknowledge that what's been promoted and what the conventional wisdom, I think, is that, oh, well, we used to hunt and gather whatever we could get fresh. Then we learned to dry things in the sun, and then we would salt things, and then we would freeze dry things. And so ultra processed foods are just a natural evolution of society, in terms of processing the food. And so, you know, buying some powdered, you know, stuff to make instant mashed potatoes is, you know, sort of the same as eating a potato if I were to dry it out.

Speaker 1 00:25:35 And the fact is, that is absolutely not true. We were talking a little bit before about the additive, derived from carrageenan and how that really caused people who were susceptible to Crohn's disease, inflammatory bowel disease to have exacerbations and eating the food. Same sort of food could have been potatoes, but without that additive in it, did not experience, you know, manifestation of that disease. And so, it's it's really I think we're sort of at a, turning point, hopefully in, in how we, we view food, and, and start to understand it and, and really begin to understand not only the story it's telling us, but get back to in a way that food again becomes very personalized for us. we give these blanket recommendations. So many carbs, so many calories, you know, this much vitamin A, etc., etc. and we need to, As physicians and health people, I think directed in a in a personal way for diet to be sustainable. And my, my chef hat's coming out now.

Speaker 1 00:26:50 you know, it's got to be delicious. I've got to love to eat what I'm preparing or what I'm sending down to experience every day. And so that means that really it has to be crafted for me, not, you know, for someone else. And a great example involves some, some cultural roots. Right. So we talk about the health of the Mediterranean diet. But if someone is from Asia and has an Asian heritage or, or, you know, grew up culturally in that environment, those ingredients may be very foreign and and not palatable at all. And so, you know, should we tell everyone you know who lives in rural Vietnam that to be healthy, they have to eat a mediterranean diet? That doesn't make any sense to me. and certainly does not necessarily, you know, go along with how the gut microbiome has developed. For them to consume those foods over centuries of millennia. So, Great question. You ask. but I think it really comes down to, you know, the individual.

Speaker 1 00:27:54 And again, hundreds of thousands of years ago, we were hunter gatherers. And so we have to do that again. we have to become hunter gatherers, but we don't do it in terms of actually getting the produce because we have it there. But we have to gather knowledge and then hunt down, the ingredients and, and components of the meal that, you know, adhere to to our knowledge base.

Speaker 3 00:28:21 I'll tell you what to continue in that vein then. And this is something that we've we've already touched on how busy our primary care physician readers and viewers are when they're dealing with their patients. That, of course, includes, you know, work and family life, too, sometimes, unfortunately. And, you know, it's a demanding job, but I was curious. What advice would you give to a doctor of any at any stage in their career? Who wants to learn more about preparing healthier food for themselves and their families?

Speaker 1 00:28:49 well, come see us online at the University of Montana because we teach our culinary medicine program.

Speaker 1 00:28:54 It's, because I have to travel and do so much. So we've we've made it, that works around my schedule, which was brilliant during, you know, I was like way ahead of the other professors during Covid because they didn't know what a zoom was. And we already had our whole course, you know, online. So, it is online. so join us there, become part of, you know, our community. certainly follow us. Me on social media. I'm not Gordon Ramsey, so I don't have a PR team. And depending on my schedule, maybe a day or two. But I do answer all the questions myself individually and happy to, you know, help people. And I've worked with, folks and institutions on instituting culinary medicine programs. Culinary medicine. Principles. How do we incorporate that? done things with, you know, working with physicians and health care institutions and then patients and saying, well, how do we do that? Many people have, challenges, you know, economic challenges.

Speaker 1 00:29:57 Time challenges are often some of the biggest, for us. And and really, you know, those are the sorts of things where as a professional chef, you know, we don't do everything right. We do prep work and we have things ready. And so when that comes in, we can cook it and get it out. And you're not waiting for hours, you know, for a meal. And so we some of those things carry over to, you know, the everyday, you know, home cook and their kitchen. same things with waste. So, you know, I, I'm a big believer in zero waste is what we shoot for. We may never achieve it, but that's the goal. So when I cut vegetables, trim, we call it trim. You know, the tops and bottoms, the carrots, the peelings of onions, the celery leaves you might not use. Right. So, we save those, dry them out, and then when I have a leftover chicken bones, you make homemade stock.

Speaker 1 00:30:56 It's healthier for you. if you were to try to buy that stock in a in a supermarket with a celebrity chef, it's 15 bucks a quart. for a certain celebrity chefs, you know, bone broth, and you can make it for about $0.06 a quart, you know, if that, with. It's just leftovers. and that's how we do it in a restaurant. and it's the secret to delicious risotto is risotto is all about the rice and the stock. That's all it is. So, you know, those those are the things that, that I would certainly recommend. Yeah. Don't don't be shy. Reach out. and for, for docs that are looking for, help with their patients. Visit med brides med. No. E in between bridge and med dot health. And that's our interactive I inclusive app, if you will, for helping patients make these healthier choices and improve behaviors based on the data of culinary medicine.

Speaker 3 00:32:00 Excellent, excellent. I'll tell you what. On that vein, I'll let you get off to the rest of your Friday here and just have a great weekend.

Speaker 3 00:32:06 And I do look forward to talking again.

Speaker 1 00:32:09 I appreciate it. Thanks, Richard. It's been great. And I'll shoot you the recipe over the weekend.

Speaker 3 00:32:13 Very cool. Thank you so much.

Speaker 1 00:32:15 Thanks. Bye bye.

Speaker 2 00:32:30 Again, that was a conversation between Medical Economics senior editor Richard Payerchin and Dr. Michael Fenster, aka Chef Dr. Mike. My name is Austin Littrell and on behalf of the whole medical economics and physicians practice teams, I'd like to thank you for listening to the show. And as you please, subscribe on Apple Podcasts, Spotify, or wherever you get your podcasts so you don't miss the next episode. Also, if you'd like the best stories that Medical Economics and physicians practice publish delivered straight to your email six days of the week, subscribe to our newsletter at Medical Economics and Physicians Practice. Oh, and be sure to check out Medical Economics Pulse, a quick hitting news podcast that offers concise updates on the most important developments affecting your practice, your bottom line, and the broader health care landscape delivered by the editorial team at Medical Economics.

Speaker 2 00:33:11 Off the chart, a business and medicine podcast is executive produced by Chris Mazzolini and Keith Reynolds and produced by Austin Littrell. Medical Economics, Physician's Practice and Patient Care Online are all members of the MJH Life Sciences family. Thank you.