Last week, we had the great privilege of interviewing Dr. Blake Shusterman, a board-certified nephrologist at Carolina Nephrology in Greenville SC, and host of the online cooking show, The Cooking Doc (www.thecookingdoc.co). He shared what it's like as a medical professional trying to educate his patients while working to make the food system healthier for everyone.
Over the past decade, Dr. Shusterman has witnessed firsthand many of the barriers people face when it comes to eating healthy - from lack of money to grocery store design - and he's made it his mission to tackle those issues head-on.
Can you tell us a little bit about your journey in healthcare and how the food system has shaped the way you practice medicine today?
As a kidney specialist, I care for patients with diabetes, high blood pressure and chronic kidney disease. Dietary management is a key component of both preventing and treating each of these conditions. When I moved to South Carolina nine years ago and started my current job, I was surprised by the lack of nutrition knowledge of my patients and by their inability to understand how the way they were eating was effecting their health.
My patients, especially those in the rural areas, have grown up within a food system that hasn’t prioritized healthy food and healthy living.
In these areas, there are fast food restaurants on every corner, screaming with temptation and convenience. If my patients happen to bypass them, the sit-down restaurants will reel them in and serve them fried food, meat and three vegetables (of which the nutrients have been boiled or fried out of them) or all you can eat buffets.
And if families decide to eat at home, their food choices may be limited – the cheapest choices are often the least healthy—and a culture that has prioritized larger portions of fried food with gravy, mashed potatoes, sweets and macaroni and cheese instead of smaller, fresher meals.
Unfortunately, many of my patients have eaten unhealthy food for so long, they don’t know how to enjoy or how to cook healthier food. As these realizations sunk in, I set out to find a way to change the culture.
What is one thing you would change about the food ecosystem in your community that would make a profound impact on your patients' quality of life?
This is a difficult question to answer because it’s almost impossible to find “one thing” that would make a profound impact on quality of life. As a high impact starting point, however, I would love to see a change in the organization and structure of the grocery stores. It would be amazing to have the grocery store organized into sections that include: Local. Healthy Snacks. Good for High Blood Pressure. Diabetic Friendly. Low Sodium. Whole Grain. High Fiber. These could be the first aisles that you see when you get into a store, as opposed to the high sugar and on-sale processed foods that bombard you when you walk in. The rest of the store can be organized into these sections: High Sugar. Highly Processed. No Nutritional Value. High Saturated Fat. Bad for Your Heart. Salted like the Ocean. Guaranteed to make your Blood Sugar go up.
When did you first realize your patients struggle unnecessarily hard to lead healthy lives?
A few years after I started practicing as a nephrologist, I was caring for a man in his mid 40s with diabetes, high blood pressure and obesity. He worked full time for many years, but because he had struggled with these issues since his twenties, the burden of his health issues became too much for him to handle, and he went on disability.
When I saw him in the office five years later, he was ready to make a change in his health. Once he made that decision, the obstacles for him to get healthy were more than I ever imagined.
The first barrier was money. Because of difficulties with health insurance and poverty, he could not afford all of the medications that I had prescribed him. His difficulties did not stop there. He cared for his severely debilitated mother, who required a lot of attention that took away from his ability to make his own food. His kitchen was tiny and he was unable to afford any of the cooking apparatuses that make cooking easier and more fun: such as sharper knives, a blender, new pots and pans, etc. When we decided to talk about shopping in a healthy manner, he described his inability to afford gas money to get to the grocery store, a lack of family support to help him get there and a monthly government check that ran out by the time he paid for his electricity, rent and his mother’s supplies. There was very little money left for discretionary spending on healthy food. He had to make it through one day at a time, and, because of that, the importance of leading a healthy life became a lower priority. It was just too hard and too expensive.
Doctors have to remember this as we ask people to lead healthier lives. Health, though important, is only one aspect of survival, and people have to make hard choices each day about how to spend their money and make it onto the next day.
What has you most outraged about your local food system?
This blog post I wrote last year exemplifies my frustration with the restaurant options in Greenville, SC. Like many other cities in the US, we have made good food a point of pride in our city and have used it to attract restaurateurs and tourists. Unfortunately, there is very little connection between the restaurants that open and the dire need for people to change their eating habits to focus on healthier eating. Individuals don’t want to order healthier foods and restaurants don’t want to focus on creating healthy meals that taste as good as the unhealthy ones.
How do you choose to impact your local food system? (either in your work through Balanced or other projects you are working on locally)
Through the development of The Cooking Doc, my online cooking show, I have developed a means to communicate to my patients and to other members of my community, highlighting the importance of healthy eating. Over the last year, I have started reaching out to local restaurants and media publications to spread the word. Even if people aren’t cooking my recipes, by educating my patients and others about how to eat in a way that protects their health, I hope to inspire everyone out there to change their eating habits.
If you could design the ideal meal for your patients, what would it be?
The ideal meal for my patients is the healthiest, affordable meal they can prepare and stick with long term. I try not to tell them to follow a specific dogma such as low calorie or low fat or low carb, but more to figure out what they like and tailor a diet to their likes, dislikes and lifestyle. There are a few suggestions that apply to most of my patients. Each meal should have a fresh vegetable and a fresh fruit. This is easier than it seems—sometimes I tell them to add a few berries and a handful of spinach or arugula on the side of a meal. I also try to encourage them to eat slowly and mindfully. And I want them to try new things: new vegetables, whole grains, beans.
The tagline for my cooking show is #ChangeYourBuds which means I want them to change their taste buds to enjoy healthier foods. Many of my patients have developed taste buds that favor unhealthy foods instead of foods that are good for them. Over time, my followers and patients work to #ChangeTheirBuds to like fresh healthier foods, fruits and vegetables, and whole grains.
How can our readers get in touch with you if they would like to know more about your work?
Dr. Shusterman is a board-certified nephrologist at Carolina Nephrology in Greenville SC, and host of the online cooking show, The Cooking Doc (www.thecookingdoc.co). He teaches viewers to make healthy and delicious meals and he is passionate about patient education and the importance of diet in the management of chronic diseases. He currently serves as President of Carolina Nephrology and Director of their Chronic Kidney Disease clinic. During the remainder of his time, he directs three dialysis units and oversees the medical student nephrology rotation at the USC School of Medicine in Greenville. Dr. Shusterman completed his residency and fellowship at the University of Virginia and received his medical degree from The Ohio State University.