Can Cooking Classes Keep Chronic Heart Failure Patients Out Of The Hospital?
Shirline Burbanks is one of the 6.5 million Americans suffering from congestive heart failure (CHF). Recently, she checked herself in to the Tulane Medical Center in New Orleans, complaining of shortness of breath. But unlike most other CHF patients in the U.S., within hours of her admittance, Burbanks was met at her bedside with an offer: to sign up for cooking classes.
The offer came from Colleen McCullough, a research coordinator at the Goldring Center for Culinary Medicine at Tulane. She started working last August to recruit people for the pilot phase of an 18-month study. Its goal is to determine whether the 30-day readmission rate for CHF patients, which is a whopping 22 percent, can be cut by almost half — all by teaching these patients how to make their own meals.
Many of McCullough's potential subjects have been eating loads of saturated fat and sodium their whole lives. Such habits can lead to conditions like high blood pressure and coronary artery disease, which may increase their likelihood of developing CHF, a chronic condition in which the heart can't pump enough blood and oxygen to the body's tissues. High amounts of fat and salt can aggravate CHF, trapping patients in a cycle of ongoing illness.
The condition is "a great one to intervene in," says Kristi Artz, a physician and culinary medicine specialist at healthcare organization Spectrum Health in Grand Rapids, Mich., one of 45 U.S.-based medical training programs that licenses Goldring's curriculum. "Unless these patients change their dietary behavior, over time their [CHF] just worsens. "
Fried, salty, sweet food is "such a cornerstone of New Orleans culture," says McCullough. "When I first start talking to patients" in the hospital — she's interviewed 120 so far and enrolled 60; 30 have taken classes upon being released — "they usually come clean about their diet pretty quickly." Teaching them to change their eating habits may seem like a simple fix, but as the Goldring research team knows, nothing could be further from the truth.
The battle begins before patients hear about the center's kitchen classroom. Many of them live below the poverty line. This sets them up for a multitude of hardships: food insecurity and poor access to nutrition, exacerbated by lousy public transportation. Mobility is often a problem: CHF sufferers can have a hard time walking because of breathing issues or swelling in their feet. In designing the study, Timothy Harlan, Goldring's executive director, wrote taxi vouchers into the grant request, to make it easier for patients to commute to and from Goldring's bright, large kitchen in the bustling Mid-City neighborhood.
With transportation streamlined, other challenges suddenly translate into strong selling points for the classes. "When you're food insecure, the fact that you can get free meals in addition to learning how to make them is pretty attractive," points out Leah Sarris, Goldring's head chef and program director.
The isolation many homebound CHF patients experience is another motivator, says McCullough. "They'll tell me, I have nothing else to do; sign me up for every class this week."
The CHF patients are folded into Goldring's usual 2-hour community classes (the center also runs classes for med students). Once in the kitchen, friendships born of shared medical experience quickly blossom. "They hug when they see each other, and cook in the same groups, and talk and text between classes," McCullough says.
According to Mary Ann McLaughlin, a cardiologist at Mount Sinai Medical Center in New York City, "Any time you have patients with severe chronic conditions, socialization has an important impact. Food bonds people, and they can learn from each other, and share their fears and concerns."
The CHF students have severe restrictions on sodium, and also on fluid intake, because they retain it. Says Sarris, "That basically means we don't teach them how to make soup." What she does teach them is how to make pasta sauces that substitute mushrooms or lentils for red meat. Or New Orleans' favorite red beans and rice, which gets its deep layers of flavor from spices like smoked paprika, rather than pickled pork and sausage.
The classes focus on more than tweaking dishes, though. Sarris explains they often must guide students — many of whom do not know how to cook, and may not read beyond a fourth-grade level — through nutritional basics, using lots of visual aids. They also learn how to shop on a budget, use one bag of rice to make multiple meals, and freeze leftovers. "But more than anything," she says, "we're teaching them kitchen confidence."
The second, more scientifically rigorous leg of the study will likely begin this month, and use randomized controls. They'll enroll 20 CHF patients, half of whom will take classes; the other half will not. Then, says McCullough, "We'll compare readmissions." After the first phase, some folks checked back into the hospital. Those numbers, and the reasons for dropouts, have not yet been assessed, but McCullough says most participants have managed to stay readmission-free.
If that continues for the remainder of the study, the Goldring researchers will consider it a win — both for the health of CHF patients, and the center's fiscal future. Hospitals aren't reimbursed for CHF readmissions that happen within a month. So even a 10 percent drop in rates, explains Harlan, "would fund all of Goldring's programming, full stop."
Other health professionals are also awaiting Goldring's CHF research outcomes. "Up to this point, we've just been focused on disease care," says Spectrum's Artz. "If we could implement [culinary] programs as part of standard medical treatment, we could give out food prescriptions. That's where I hope this leads."
The Goldring pilot has already engendered small successes. "I had one 50-year-old patient who in 20 years had never cooked for her husband before," says Sarris. "We gave her the support to try it, and the effects were pretty profound. Before she took classes, chopping veggies seemed overwhelming to her."
Meanwhile, Burbanks has come close to becoming a vegetarian — even though she hadn't heard the word before she came to class. "She's constantly reworking her gumbo recipe now, and she texts me pictures as if she's asking, "Will you validate this?" says McCullough. "Yeah, I can do that."
Lela Nargi is a Brooklyn-based journalist and cookbook author. Her writing has appeared in publications including Gastronomica, Civil Eats and Roads & Kingdoms.