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After the gourmet meal of nori rolls with wild salmon, mixed-vegetable stir fry and a frozen banana dessert, there wasn't a tummy left unfilled.
If all went as planned, there wasn't a tummy left upset, either.
This dinner was for patients of an Ellicott City doctors' office — prepared and served in the office — and meant for those suffering from irritable bowel syndrome or other gastrointestinal troubles. It was one of a series of cooking classes aimed at improving health through diet and part of an evolution among family doctors to emphasize better preventive care to lower health care costs.
"In primary care, the goal is to get people healthier, and to get there, you need more than pills and potions," said Dr. Warren M. Ross, a physician at Crossroads Medical Associates who launched the cooking project last fall. "You need a transformation in lifestyle. But it's not effective when you just tell someone what to do or tell them to read a book. They need an experience."
Ross formed a subpractice called Integrative Medicine at Crossroads that blends conventional medicine with alternatives and had been thinking for years about how to better engage patients in improving their dietary habits. He recently visited Tulane University School of Medicine's Goldring Center for Culinary Medicine, which educates medical students and doctors in its "training kitchen."
It's unclear how many doctors go on to open training kitchens at their practices, as the movement is just catching on, said Allison Righter, co-chair of the Teaching Kitchens Collaborative, a partnership between Harvard University's T.H. Chan School of Public Health and the Culinary Institute of America.
She said such kitchens are more often opening in larger facilities, such as universities, hospitals and corporate campuses, though there are individual medical practices with demonstration capabilities.
The collaborative's goal is to promote more such teaching kitchens. It's been holding an annual conference since 2006 to train doctors and other health care professionals on the latest nutritional science and cooking methods and send them back to their practices, universities or health systems better prepared to show patients how to cook — or at least better counsel them.
"It's an opportunity for physicians and health care providers who oftentimes are not getting this kind of training in medical school," Righter said. "They learn to start something in their own place."
The collaborative is now reviewing the types of kitchens that have opened — from mobile stations with a single burner and cutting surface to commercial kitchens — and how effective they are at improving the health of their target patients, employees or public visitors.
Some medical schools are also incorporating more about nutrition in the classroom. Dr. Nanette Steinle, an associate professor at the University of Maryland School of Medicine and a registered dietitian, has helped the school incorporate nutrition lessons within several classes for first- and second-year students. Residents who plan to work in family medicine receive more instruction, and many students rotate through the neighboring Baltimore Veterans Affairs Medical Center, where patients with weight problems are offered cooking classes.
The classes began years ago when the National Institutes of Health awarded grants to a small percentage of the nation's medical schools to help develop and integrate nutrition eduction into the curriculum, said Steinle, also interim chief of the endocrine and diabetes section at the Baltimore veterans center.
She said the University of Maryland was fairly eager to add nutrition instruction, but she said the subject has to compete with a lot of other topics, including other behavioral challenges such as smoking cessation and exercise.
"Maryland has a number of opportunities for students in the curriculum to develop skills, though I'm not saying it's a complete package," she said. Nationally, she added, "We still have ways to go in terms of achieving what would be an ideal situation, but there are a lot people and associations involved at many levels to bring this about."
Back at Crossroads, classes are open to patients and the general public for a $60 fee, though Ross has been successful in getting insurance to cover some costs. Already, some committed patients have shown a bit of success, losing weight and reducing medications for blood pressure.
Many classes are general, offering instruction in healthy fats, carbohydrates or proteins; foods for detoxification; and cooking with herbs. Others target people with specific problems, such as diabetes or heart disease.
In the recent class for irritable bowel syndrome, the course focused on certain carbohydrates that people with the condition can have trouble digesting. Too many can trigger abdominal pain, cramping, bloating, gas and other symptoms.
Keri Connell, an herbalist and nutritionist who leads the Crossroads kitchen, creates a menu of foods that are well tolerated by patients but are simple to prepare and, perhaps most important, are tasty. She and her instructional partner Sara Cooper shop, prep and run each cooking demonstration for six to 10 patients like a television cooking show (which she hopes to launch on YouTube at some point).
Patients sit at a bar surrounding the cooking area and enjoy a meal prepared in front of them over about 90 minutes. They are encouraged to ask questions and are provided tips about everything from how to slice the rutabaga, which can stand in for less-nutritious potatoes, to where to buy coconut flour that can be substituted for wheat, which makes some people bloat. Connell made sure to show what a cup of broccoli or red peppers looks like so patients understand the size of a portion.
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Bina Mehta, a 53-year-old from Clarksville, said she's been trying to figure out what is causing her digestive issues and has been working to adjust her diet. She's attended other Crossroads classes, such as one on medicinal mushrooms, though she's wasn't fond of the fungi before Connell showed her how to use it in risotto. She was told mushrooms could help with the pain and swelling from arthritis that had debilitated her before she altered her diet.
"Food is medicine," said Mehta, who has made the mushroom recipe for her family. "This may help me more than the doctor visits."
Connell emphasized that patients still need the care of doctors, particularly if they need to go on diets that involve eliminating certain foods or if they are on medications.
Rita Sherman was looking for a gastrointestinal specialist to help figure out her specific medical needs but came to Crossroads cooking classes for tips and recipes. Chemotherapy a decade ago had side effects that changes to her diet seem to help, she said.
She was particularly interested in learning to make the nori rolls but collected all the recipes, including ones for coconut blueberry muffins, mock potato salad and "nice cream" that involved blending frozen banana, unsweetened coca powder and cinnamon.
"I don't want to order food, I want to make it," said Sherman, a 62-year-old from Laurel. "I need to be able to see it."