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Culinary Medicine in a Bowl

Striving for Epicurean enlightenment

I am often asked, “What is Culinary Medicine?”

The answer usually involves a brief explanation of the multidisciplinary and evidence-based approaches to food, health, and wellness that form the foundation of the Culinary Medicine approach. This is something that I have covered in this column before (see "Culinary Medicine: A New Frontier for Innovation, Integration, and Implementation" and "Culinary Medicine: Beyond the Evidence" for further detail). This definition and detailed explanation, while technically correct and intellectually satisfying, like most things that feed only our heads, can leave us a little wanting.

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Ingredients for Pappa al Pomodoro
Source: Red Tail Productions, LLC used with permission

Culinary Medicine is really much more about giving people the tools they need to empower themselves and re-forge a deeper, richer, and more nurturing relationship between themselves and the foods they choose to eat. It’s much less about categories, classes, calories, nutrients, and a one-size-fits-all, eat-this-not-that approach. That approach has failed epically over the last half-century. That is why at the heart of Culinary Medicine is an understanding of the food experience.

Words often fail at capturing that precise perspicacity. And make no mistake, Culinary Medicine is an experience; it is to be experienced. It is to be tasted. In the end, it is about us as individuals and our relationship with food, and by dynamic extension, our relationship with each other, our communities, and ultimately the world we live in.

One of the five core principles or attitudes that comprise the foundation of our Culinary Medicine approach is “presence.” Culinary Medicine demands our focus be in the present. It demands that we be here and now, not ruminating about the ups and downs of the past nor lazily fantasizing about the future. And that is where Culinary Medicine has great overlap with the Culinary Arts.

Source: Red Tail Productions, LLC, used with permission
Doing the concasse. With a few simple ingredients, technique matters.
Source: Red Tail Productions, LLC, used with permission

The Culinary Arts, to a certain extent, are about enjoying and celebrating the moment through the vehicle of the meal. There is no care for the past; there is no current concern for the future; there is only the pleasure of the moment to be reveled in. It is a dance; it is a kiss; it is that power that bends space and time to engrave a moment upon our being.

Within the practice of Culinary Medicine, we strive for every meal to be that kind of food experience. We strive with a moment of mindfulness set upon an attitude of gratitude to create a memory as rich, luxurious, and nurturing as the food itself.

All this I found in a bowl of Pappa al Pomodoro. It is a simple Italian tomato soup, a rustic one at that. Like so many great dishes, its origins trace back to a humble peasant food. It is a way to stretch the usefulness of some stale, crusty bread by combining it with a few simple ingredients. In fact, it is basically only five ingredients: fresh tomatoes, onion, garlic, basil, and a stale loaf of bread.

But the modesty of the ingredients is deceptive. Anything but the sincerest of sun-ripened tomatoes brought forth for flavor, not convenience, will not suffice. It is not about adding more, or taking away, or modifying, or endowing it with a shelf life far in excess of any living creature, except Keith Richards.

Source: Red Tail Productions, LLC, used with permission
Everything simmers together; with a few simple ingredients, proper ratios yield perfect balance.
Source: Red Tail Productions, LLC, used with permission

The spartan nature of its constituents means that every ingredient counts. Every ingredient is exposed. There is no food additive or artificial flavoring to cover our sins. You need to execute the preparation and infuse it with the passion of foreplay later realized. Sloppy, lazy, or apathetic technique will be made to lie naked upon the palate, exposed to all.

For in the world of Culinary Medicine, these ingredients and techniques are not for a recipe; they are for a reverie. They transport us. The singular bite is laced with emotion, pleasure, perception, and memory, both coming and going. Approached with respect, this humble soup becomes the enormity of summer, the breeze of Tuscany, and the healing power of the present far in excess of the vitamins, fiber, antioxidants, and everything else that will be processed to sustain the body in the hours to come.

Source: Red Tail Productions, LLC, used with permission
The question becomes, "Is the most convenient food the best food?"
Source: Red Tail Productions, LLC, used with permission

You could, of course, try to assuage such a primal hunger and need with a can convenience: a ready-made canister of ultra-processed tomato soup. It is, in our world of labels and boxes, where we lump together all things “tomato soup.” That too, in another way that words fail us, fits our misdirected and inexact categorization of how what we eat that ultimately becomes who we are. That microwaved can eaten in a cubicle is as far removed from the Pappa al Pomodoro served alfresco with a glass of great Tuscan wine as Keeping Up with the Kardashians is from Macbeth.

You can try to quantify Shakespeare. You could do so by counting pages or words. You could try to grossly oversimplify it by assigning labels like “tragedy” or “comedy.” Ultimately, though, it embodies greatness precisely because it defies mere descriptors. "The Way" that can be articulated is not "The Way." It must be understood; it must be… experienced. Jimi Hendrix never asked if you were good, bad, or indifferent. He simply wanted to know, “Are you experienced?”

Great ingredients form the basis of a great meal, and ultimately that forms the basis of a great food experience. But only when we engage the moment with a powerful passion and proper perspective. It is only then that great words, or great ingredients, become pure poetry.

Red Tail Productions, LLC, used with permission
A bowl of Nature's Wisdom; Pappa ala Pomodoro
Source: Red Tail Productions, LLC, used with permission

So, “What is Culinary Medicine?”

In truth, I can never fully answer that. Because ultimately, Culinary Medicine comes back to the individual, to you. The taste of the soup is at the end of the day defined only by your reality. The Pappa al Pomodoro I experienced is tomato soup, that’s what Pappa al Pomodoro “is.” But what it “means,” what it embodies, is everything Culinary Medicine is about. And I can guarantee you, my friend, none of that will ever be found in an ultra-processed can of convenience.

More from Michael S. Fenster M.D., FACC, FSCA&I, PEMBA
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